Development & Aid, Europe, Headlines, Health, Poverty & SDGs

HEALTH: Market Interests Fight Iodised Salt

Pavol Stracansky

BELGRADE, Mar 13 2011 (IPS) - Russia and the Ukraine have been warned they are lagging behind the rest of the former Soviet bloc in introducing a simple and inexpensive public health measure that has curbed the incidence of mental disabilities among children across the region.

UNICEF says that the two countries, whose populations are the largest in the Central and Eastern Europe (CEE) and the Commonwealth of Independent States (CIS, a grouping of ex-Soviet states) region, are using spurious arguments rooted in business concerns to resist introducing mandatory laws making all edible salt iodised and helping prevent mental retardation in children.

Anatoly Karpov, a UNICEF Goodwill Ambassador who has worked extensively in former Soviet Union countries to promote salt iodisation, told IPS: “There is no logical explanation for why Russia and the Ukraine are not mandating the use of iodised salt. The authorities do not seem to have a real grasp of how important this is.”

Iodine deficiency has been classed as the most common preventable cause of mental disability in the world. More than 38 million children are born with impaired mental abilities every year because their mothers’ diets do not contain enough iodine, according to UNICEF.

The World Health Organisation (WHO) has backed providing iodine through salt for human and animal consumption as the easiest, most effective and least expensive way for complete prevention. The cost per child of iodising salt – the iodine is sprayed into salt during the refining process – is 0.05 dollar per year, according to the World Bank.

UNICEF and the WHO launched a programme of global salt iodisation more than a decade ago aimed at getting regional governments to make iodisation of edible salt mandatory.

At a forum in Belgrade last week to review a nine-year study of the programme led by the WHO and UNICEF in the CEE and CIS regions, UNICEF representatives reported dramatic success between 2000 and 2009. The study showed that in 2000 only seven of 20 countries in the region had more than 50 percent of households using adequately iodised salt. But that number had risen to 14 by 2009.

They singled out countries such as Belarus and Kazakhstan, among others, as examples of where governments, local business leaders and child healthcare organisations had worked together successfully to help overcome iodine deficiency, including adopting programmes to iodise not just table salt but salt used throughout the entire food production process including animal feed.

They also described how they had seen clear physical evidence of the health effects of salt iodisation.

Vilma Tyler, clinical nutritionist and regional nutrition specialist for CEE and CIS with UNICEF, told IPS: “In Kyrgyzstan, for instance, there are some remote areas where the soil is very depleted of iodine and many people in the past had enlarged thyroids and would walk around with big growths on their necks. It was so common in some places that it had become to be seen as a mark of beauty in some communities.

“However, a significant decline in this has been seen in a short amount of time and that is one example of the success of the programme.”

But the study highlighted the scale of continued problems with iodine deficiency in Russia and the Ukraine, neither of which have mandatory salt iodisation legislation.

The report said that if mandatory iodisation were to be adopted in both countries, it would potentially raise the daily consumption of adequately iodised salt in the region to up to 98 percent on average from the current 51 percent.

Salt iodisation has met with continued resistance in Russia and the Ukraine. Governments have repeatedly failed to back compulsory iodised salt.

Some opponents of the programme have complained of higher production costs for iodised salt, especially in the financial crisis.

The Belgrade conference last week heard how supermarket chains in Russia had, under growing economic pressure, begun buying salt from producers in a tender process with an emphasis on the lowest offered price. This led to the top five retail chains selling only non-iodised salt.

The salt programme’s backers however, reject this argument. Tyler told IPS: “The extra costs (of iodising salt) are minimal compared to the positive health effects that can be gained from it.”

Others suggest a wider set of interests at play in opposition to mandatory salt iodisation, especially in Russia.

One source at the Belgrade conference, who asked not to be named, told IPS: “The people who are against this in Russia and the Ukraine are pharmaceutical companies who want to market more iodine tablets, salt producers, other food industries and the government. They say that iodine is available in other products and therefore there is no need for legislation on mandatory salt iodisation.

“But the issue with those arguments is that, can all these ‘other products’, which include iodised vodka of all things, actually be given to kids and pregnant mothers? And also, producing all these products is still a more expensive and less effective way of getting iodine to the population.”

Karpov also told IPS: “In Russia, there is solid opposition (to iodising salt) and that opposition is in the commercial world where people want to make some business out of this.”

Some opponents of compulsory salt iodisation have cast doubt on its medical benefits. In India, where compulsory salt iodisation was abandoned in the late 1990s but reinstated in 2005, some groups have cited doctors saying that salt iodisation is not a guaranteed cure for iodine deficiency.

They also claim that in some cases too much iodine can actually lead to vitamin deficiencies, indirectly negatively affect the heart and produce a number of other physical and psychological problems.

Doctors and nutritionists supporting the UNICEF salt iodisation programme say that there is no ground for any doubt over its efficacy.

“Any health questions raised about this programme are just an excuse to not use iodised salt,” Tyler said. “The iodine level in salt is so low that there could be no negative health effects at all.

“There is also regular monitoring carried out to make sure that too much iodine goes into the salt and is kept to a safe level which has been determined by the World Health Organisation following numerous studies.”

Data from Russia and the Ukraine on iodine deficiency shows how serious the problem remains there compared to other countries in the region which have adopted mandatory salt iodisation.

The number of newborns not protected from iodine deficiency in Russia is over a million. This is more than twice as much as the country with the next highest figure, the Ukraine, which in turn has almost double the number of most other states in the region, the Belgrade forum was told.

However, there is hope that the situation could change in the near future after a delegation from the Russian Agriculture Ministry attended the Belgrade forum and presented proposals to back legislation on mandatory iodised salt, information campaigns to promote iodised salt consumption among the population, and the introduction of iodised salt into food production chains.

“For the first time we have had representatives sent to this meeting from Russian ministries,” Karpov said. “I believe we will see some movement on this issue in Russia and the Ukraine this year. Every day is important when it comes to preventing iodine deficiency and so the sooner there is movement the better.”