IDD and child development
When a foetus does not receive enough iodine, the developing brain cannot establish as dense a network of interconnections among the main brain cells and intellectual capacity is compromised for life. In extreme cases children can suffer severe mental retardation, but even where iodine deficiency is less severe all children suffer a reduction of 10-15 percent in learning ability at school.
The problem can be virtually invisible with entire school classes suffering lower educational achievement and considerably fewer students progressing to higher education. Iodine Deficiency Disorders (IDD) are rightly recognised as the world’s leading preventable mental and development disabilities.
IDD and national development
The cumulative loss of brainpower is not only a tragedy for these children and their communities, but also affects national economic and social development. Micronutrient deficiencies, including deficiencies in vitamin A, iron and iodine, can lead to a reduction in national economic growth of as much as 5 percent.
The human body requires less than a teaspoon of iodine throughout the lifetime. To combat iodine deficiency, minute amounts of iodine must be added to the diet. This is most efficiently done – and at very low or moderate cost – by iodizing all salt consumed by humans and animals.
Achievements and challenges
At the time of the World Summit for Children in 1990, only about one in five of households in the world used iodized salt. By the end of 2000, this figure had risen to around 70%, with the number of countries reporting 90% iodized salt consumption increasing from 21 to 27 over the last two years. This global progress towards Universal Salt Iodization (USI) meant that in 2001, 91 million new-borns were protected against significant losses in learning ability.
In May 2002, leaders from government, the private sector, and civil society had met in New York at a special session of the United Nations General Assembly (UNGASS) to celebrate the exemplary progress made towards the World Summit for Children goal of eliminating iodine deficiency disorders (IDD).
The Global Network for Sustained Elimination of Iodine Deficiency is a unique coalition of public, private and UN agencies, launched at that time to support national efforts to sustain progress achieved or accelerate efforts towards that achievement.
From the experiences in those countries where universal salt iodization was achieved, it is evident that the success was due to coordinated actions by all sectors of society – public, private, civic and scientific - working together to give children a smart start in life.
Nevertheless, still over 30% of the salt that people eat is not yet iodized, and in 48 countries, less than 50% of the population consume iodized salt.
In addition, in a significant number of countries -including many industrialized nations- iodine deficiency is known to be a problem but information on salt iodization is not routinely collected or tracked.
That is was why the UNGASS recommended a re-vitalization of efforts to complete the unfinished agenda of the World Summit for Children. In the plan of action entitled “A world Fit for Children”, a prominent goal was set to achieve sustained elimination of IDD by 2005. We now have just over two years left.
An alarming new trend
Despite the impressive progress made in USI, the last few years have also confirmed the worst fears – a global, backsliding trend in salt iodization. Globally, the proportion of households consuming adequately iodized salt decreased from 69 per cent 65 per cent.
UNICEF estimates that in 2002, only 86 million new-borns were protected from brain-damage related to iodine deficiency compared to 91 million in 2001. And the number of children born ‘unprotected’ from iodine deficiency significantly increased to 46 million meaning that there are many more millions of children at risk of brain damage for want of a few grains of iodized salt costing only a few pennies a year. This has ominous consequences in terms of their future – their ability to learn in school and function as productive citizens in society.
National ownership and political commitment as keys to success
This alarming trend can and must be halted. Countries which successfully eliminated iodine deficiency decades ago share certain key characteristics. With national ownership acquired and consumption of iodized salt the universal habit, persistent national oversight led to IDD virtually disappearing. The lesson of “national ownership” is that all the key players—the government, the salt industry, scientific groups, and civil society – need to work together to accept the agreed-upon strategy, pass laws and regulations, and ensure that all salt remains iodized.
Another key to success has been periodic strengthening of political commitment (“re-advocacy”) through national programme reviews by the leadership designed to ensure that conditions are still being met to sustain national elimination efforts and also to re-advocate for continued vigilance.
Only by ensuring that these systems and ‘best practices’ are ongoing in all countries around the world, can we be assured that iodine deficiency does not re-surface and all children everywhere have the best chance of enjoying the best start in life.