Health planners and international agencies are increasingly recognizing that the elimination of iodine deficiency is an attainable goal with important benefits for many people. Efforts to build IDD awareness are long-standing. In May 2005, the World Health Assembly enacted resolution WHA58.24, "Sustaining the elimination of iodine deficiency disorders" calling for renewed efforts and three-year national progress reports to the World Health Organization.
In December 2007, the UNGASS II examined progress and recommitted partners to overcoming barriers to iodizing salt for the 30% of the world's population who still lack access to iodized salt.
The planning of a global strategy for the prevention and control of IDD has been taken up by the United Nations Administrative Committee on Coordination - Subcommittee on Nutrition (ACC/SCN). In October 1985 the ACC/SCN requested the World Health Organization (WHO) to prepare an international support programme for IDD control. The 39th World Health Assembly (Geneva, 1986) in its resolution urged all member nations to give high priority to the prevention and control of IDD within the ensuing five to ten years and requested the Director General of WHO to give all possible support to the member states in this regard. The International Council for the Control of Iodine Deficiency Disorders (ICCIDD) was formed in 1986 to function as an expert consultative group on the assessment and control of IDD, operating with WHO and UNICEF at the global, regional and national levels. ICCIDD has also formed regional working groups in Africa, South East Asia and the Middle East for developing regional strategies for IDD control.
The World Summit for Children held in New York in September 1990, called for the virtual elimination of iodine deficiency disorders by the year 2000. The International Conference on Nutrition, December 1992 called on governments in collaboration with international agencies, NGOs, the private sector/industry, other expert groups and the community to "....ensure and legislate for the fortification of foods or water with the necessary micronutrients...where iodine deficiency is a significant public health problem, the iodization of salt for both human and livestock consumption is required, recognizing that this is the most effective long range measure for correcting iodine deficiency."
The main strategy to achieve the goal will be the universal fortification of all 'food-grade' salt consumed by all people in countries at risk by the end of 1995. All salt for animal use should also be fortified, since such salt is often consumed by people, and improving the iodine status of animals will improve animal reproduction, milk and meat yield and increase the iodine content of food.
Country strategies
As of 1994 it was estimated that there were more than 90 developing countries with iodine deficiency as a public health problem. These countries can be classified into three groups depending on their main source of salt and the ease with which salt can be fortified:
A. Countries where there is virtually no domestic salt production and almost all salt used is imported. In these countries the ideal strategy will be for salt to be properly iodized in the country of origin. Compared to cost of packaging and transportation, the additional cost of iodization should be low. These costs might be absorbed by consumers or through more efficient and competitive purchasing. Thirty five countries, many of them small and landlocked are in this category.
B. Twenty six countries where most salt is processed and packed in a small number of large modern refineries or where extensive salt iodization is already under way. In these countries, iodization is likely to be simple, straight forward and acceptable and will involve only marginal cost increases. The main needs will be for advocacy and monitoring and loans for purchase of equipment. Some of these countries are exporters, and ensuring that all salt is iodized will help reduce IDD in importing countries.
C. Thirty countries where most salt is produced by large numbers (several hundreds or even thousands) of traditional salt producers who produce variable quality salt on a cottage scale. Universal salt iodization will be the most expensive and difficult to achieve in these countries. Small producers will need to be supported and encouraged to distribute their salt through group operated refineries that can be well managed and monitored.
For further information, please see The Network for the Sustained Elimination of Iodine Deficiency.
