Q: What is the impact of iodine deficiency disorders?
Dalmiya: The most devastating consequences of iodine deficiency are for the unborn child because the foetus needs the micronutrient for brain development. In the most severe cases, the result can be stillbirth or miscarriage. The series of conditions resulting from iodine deficiency – cretinism, goitre, deaf-mutism and dwarfism – are known collectively as iodine deficiency disorders (IDD). But these are really the tip of the iceberg: many children may appear normal, but have lost 10 to 15 intelligence quotient (IQ) points. The result: entire populations growing up with mild IDD – children who will never reach their full potential.
Q: What progress has been made in the effort to eliminate IDD?
Dalmiya: Today, 70 per cent of households in the developing world are consuming adequately-iodized salt. UNICEF measured that about 20 developing countries had reached the goal of 90 per cent of salt being iodized. China was among them, along with a number of very poor countries such as Eritrea. There were another 36 that had quite considerable progress with 50 to 89 per cent of salt iodized. India, Bangladesh, and Pakistan fell into this category.
Q: What steps is UNICEF taking towards the goal of sustainable elimination of IDD by 2005?
Dalmiya: The 30 per cent of households not consuming iodized salt represent 41 million newborns that are not protected. One reason for the dramatic success during the 1990s was extensive advocacy at the national level. However, to meet the goal of eliminating iodine deficiency by 2005 set at the of UN General Assembly Special Session on Children in May 2002, there has to be a recommitment to iodization by both governments and the private sector. What UNICEF is trying to do is create, or reinvigorate, efforts at the national level to involve salt producers in the process from the beginning, not just have the government telling them what to do.
Q: What are some of the reasons consumers resist iodized products?
Dalmiya: Some producers price salt very high, particularly small-scale producers. The technology is very simple but there is a cost for the pre-mix. When iodization laws are not in place and there is both iodized and uniodized salt in the market, people buy the cheaper. In some countries, such as Nepal, people may prefer large crystal salt, which is hard to iodize. People can also be suspicious of fortified products. Old habits die hard. Unless we clearly communicate the message of the benefits of iodized salt, it will be hard to get consumers to change. Civil society and consumer groups also need to take a more active role in demanding that iodized salt be available in the market.
Q: What are some success stories? Problem areas?
Dalmiya: China has done a phenomenal job, mostly because of political commitment. The Chinese government realized that a population not reaching its full potential would make it difficult to compete in the global market. In five years China went from 39 per cent to 95 per cent of salt being iodized. One of the areas that has flared up recently is Eastern Europe, where less than one-third of salt is adequately iodized. The breakup of the Soviet Union scattered the salt industry. UNICEF is trying to focus on large, salt-producing countries such as Russia, the Ukraine and Turkey to get them to iodize, particularly the Ukraine because it exports salt to many countries in the region.