Say Yes, Autumn 2002: Add a Little Salt

A teaspoonful of the trace element iodine is all that anyone needs in a lifetime. However, a deficiency at critical stages of development remains the world’s single most important and preventable cause of mental retardation. Iodine deficiency will cause learning difficulties in a child -- even a marginal deficiency will reduce mental development by as much as 10%. -- and continue into adulthood where it will affect the ability to work effectively.

Because the body is unable to store iodine, tiny amounts are required on a regular basis through the consumption of animal products, fruit and vegetables. Since the element is found in soil, Iodine Deficiency Disorders (IDD) will occur if a diet is based on the produce of regions where the element is scarce.

The solution to the problem of IDD is both simple and inexpensive: food fortification through iodised salt. Since salt is universally consumed on a regular basis, iodised salt has proven to be a highly successful and sustainable intervention. The specially treated salt is no different to regular salt in terms of taste and appearance and the technology required to treat salt with iodine is simple and cheap to run. It is the only long term, sustainable solution which will guarantee an entire population the requisite quantities of iodine in their diet to keep them healthy.

Compulsory Iodisation of Salt

The IDD and Salt Iodisation Programme was launched by the Ministry of Health (MOH) in 1994 in cooperation with UNICEF Turkey. The objectives of the Programme are to:

• eliminate IDD amongst children and reduce them by a third amongst adults by the year 2005;
• cooperate with salt producers to ensure that all salt produced and consumed in the country is iodised;
• inform and train the public;
• preserve the content of iodised salt in production and consumption;
• develop an active monitoring system for the programme.

Compulsory iodisation of salt has been required by law since 1998 in Turkey. However, although the quantity of iodised salt on the market is known, there have been insufficient statistics about its usage to date since it is still not uniformly available throughout the country and of course usage varies according to individual tastes.

Who is using Iodised Salt?

Together with UNICEF, the MOH Mother and Child Health and the Family Planning General Directorate, The Middle East Technical University, Ankara (METU) conducted the ‘National Household Iodised Salt Consumption Survey’. The objective of the survey was to measure usage throughout various strata of society, using a nationally representative sample group.

Because properly iodised salt is not always labelled as such and regular salt has on occasion been wrongly labelled as being iodised, checks using test kits were used to verify samples used by surveyed households. Initial results yielded encouraging signs that the Salt Iodisation Programme has been effective.

Of those households which took part in the METU Survey, 64% use iodised salt. In urban areas, usage is 70% whereas it is roughly half of that in rural areas. Overall, usage varied between as much as 34 years and a very few months.

On a regional basis, the timescale of the scheme appears to be a factor: in Marmara, where usage is highest at 77%, the scheme has been operating for the longest period, whereas usage is less than half of that again in the southeastern provinces of Anatolia where the scheme has been operating for a comparatively short time.

Distribution is another factor: 96% of households in Kırklareli in the north west used iodised salt, for instance, whereas only 6% of the sample group from Adıyaman in the southeast did -- a marked difference.

Education plays a part: when asked the reasons why they use iodised salt, 30% said it was generally healthier, 25% specifically mentioned prevention of goitre and 14% could not say. Of those who do not use iodised salt, 36% did not know what it is for, 24% found it expensive and 18% said that it is useless. More than half of the non-user households were unaware or did not know enough about the benefits.

Patterns of Consumption

A clear picture of eating habits and methods of food preparation is crucial to understanding how people may be encouraged to use iodised salt. Salt is introduced at the earliest links of the food chain and traditional as well as modern methods of animal husbandry determine not only the type of salt consumed but also the quantity.

The varied characteristics of cuisine from one region to another in a country as large as Turkey are also worth noting. While it is relatively easy to ascertain the nature and quantities of salt used by manufacturers, foodstuffs such as pickles, tomato paste and breads which are commonly prepared at home are less easy to analyse. It is fairly certain, however, that the majority of households use non-iodised food industry salt in the preparation of such foodstuffs.

Analysis of individual preferences and knowledge of the benefits helps to fill the picture of those who still need further encouragement to use iodised salt. Over 40% of those aged between 20 and 64 years use it. The figure is relatively higher for the sub-group between 40 and 64 years, possibly because they are more sensitive to health issues. Over 65s tend to be most resistant to using iodised salt.

There is a strong linear relationship between education and iodised salt usage: the higher the level of education, the more likely an individual will be to use iodised salt. Working people are more likely to use iodised salt than the unemployed, which follows, since employment tends to be related to levels of education. This is an important issue since most of the respondents were women, the majority of whom were not employed.

Spreading the Word

Issues of production and distribution are foremost in the initiative to ensure that iodised salt is universally available. After that, educational programmes geared to make people aware of the detrimental nature of iodine deficiency and the advantages of iodised salt are paramount.

It is clear from the fieldwork that if the importance of iodised salt is explained properly, there is immediate acceptance. Understanding the need to use iodised salt will induce the customer to demand it and hence manufacturers will have to supply it.

Programmes to be launched in Primary schools will reinforce efforts to increase popular awareness. It is hoped that cooperation with the Social Solidarity and Assistance Fund (SYDTF) which provides food to school-age children will prove beneficial. Children can be persuaded to take samples of iodised salt home, helping the parents and children who are the most vulnerable group to become aware of the hazards of IDD.

Read more about the effects of iodine deficiency disorders. There are more details about UNICEF Turkey’s programme to eliminate IDD in our Programmes for 2001 - 2005. Read the UNICEF Evaluation Report on Support to the Control of Iodine Deficiency Disorders in Central and Eastern Europe.

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