by Jack C. Ling and Cynthia Reader-Wilstein

(Also available in PDF format in English, Spanish and French)

This communication guide is dedicated to the memory of Cynthia Reader Wilstein who died on September 11, 1998 after battling breast cancer and crippling rheumatoid arthritis. She was 49 years old.

Ms. Wilstein began her career developing audio-visual programs for children. She later wrote and produced children’s shows for Connecticut Public Television in Hartford and the Appalachia Educational Laboratory. Ms. Wilstein worked as a communication officer for UNICEF in Nepal and at United Nations headquarters in the 1970s.

Though unable to use her hands to write during the latter stages of her 18-year battle with arthritis, Wilstein worked or wrote for the World Health Organization, the Beyond War Foundation, and the Hewlett-Packard Foundation, using voice recognition-equipped computers. This communication guide was her last professional work.

She is survived by her husband, Associated Press national sports writer Steve Wilstein, and their 18-year-old daughter Tara.

 Note from the Authors

This booklet is intended for program officers and others responsible for the management and communication of programs to eliminate Iodine Deficiency Disorders. The authors hope that those concerned with policy, management and communication will feel free to translate, edit and adapt whatever material they find appropriate for in-country use and/or for specific groups such as salt producers, health officials, and teachers.

Aside from the examples cited here, we realize there are many other valuable illustrations of social mobilization for IDD, and we invite readers to share their positive and negative experiences with others in this field through our website. 

Table of Contents

Chapter 1: A Society-Based Development Strategy
Chapter 2: Building Partnerships
Chapter 3: Building Political Commitment
Chapter 4: Working with the Salt Industry
Chapter 5: Working with the Health Sector
Chapter 6: Working with Schools
Chapter 7: Sustaining the Progress
Chapter 8: Social Mobilization Steps

Foreword

There are three types of countries today with respect to IDD, and each requires a different set of messages for consumers.

Some countries, including some fairly large ones, are not iodizing salt at all or in negligible amounts. In those countries the priority is to get people to understand that they should no longer tolerate the fact that their government or their industry can’t put a little bit of iodine in salt. People need to be made aware that iodine deficiency is bad, it causes brain damage, it’s not the same as goiter, and that if government got their act together they’d put iodine in salt.

The second set of countries is well on the road to iodizing salt and needs just a little bit more of the same medicine. Government sectors should work together with industry to reach people not using iodized salt. They should consider how to approach people through somebody they trust, in language they understand, and with media that are familiar and believable, finding out what will motivate them to change their habits. But whatever strategy is chosen, people need some basic information about IDD so they will demand iodized salt and keep using it.

The third, growing set of countries is already largely consuming iodized salt, so that basic information is no longer relevant. In these countries, people need to be reminded, encouraged to observe, or given reports of the fact that indicators of iodine status have improved, that children’s intellectual development probably has improved as a result of this, and that they should therefore be sure they continue to take iodized salt and that the ancillary structures are in place to ensure that they get good quality iodized salt.

In the last two groups of countries you have many other messages. People should start to pay attention to the quality of salt they buy. They better try to make sure they buy a decent brand of iodized salt made by some reputable company that has a good chance of putting iodine into it. If they’re buying refined salt because they think it’s better quality, people should be sure they’re buying refined, iodized salt. They ought to look for the logo or the brand name or some proof that the salt’s iodized. And they ought to be able to ask their political leaders and their health officials to make sure that a brand of salt claiming to be iodized is in fact iodized, and if it isn’t to make sure that health inspectors or the authorities do what’s necessary to correct that.

Government regulations and advertising can only do so much. In the end, it is up to the people themselves to put health advice into practice. Consumers therefore need access to information that will motivate and empower them to choose iodized salt and demand good quality in the salt they buy.

David Alnwick                                                  Venkatesh Mannar
Chief, Nutrition Section, UNICEF                    Executive Director, Micronutrient Initiative 

Preface

After a long, slow struggle toward ending the devastating mental and physical effects of iodine deficiency, the pace of progress has quickened and the goal of virtually eliminating IDD is in sight. Salt iodization is on target in most affected countries, and the global effort to conquer this problem is reaching its final, defining phase.

The history of this effort is a lesson in what can be accomplished when scientists, development experts, and political leaders work together to focus attention and spur action on a specific health measure. We have learned a great deal about communication and mobilization. We have also begun to apply this knowledge to the creation of partnerships with industry and other stakeholders who can help wipe out IDD entirely and forever by the year 2000.

Scientists were the first to sound the wake up call. For 40 years, from the 1930s to the 1970s, iodine deficiency was generally, and mistakenly, associated with goiter, viewed as a cosmetic problem among people in the hills and highlands. Cretinism, the most severe consequence of iodine deficiency, was largely confined to mountainous areas and not considered a major public health issue in any nation. During this time, the soil in many parts of the world kept losing iodine because of flooding and overuse of the land, depleting the iodine content in food and spreading the effects of IDD across the plains and coastal areas. Endocrinologists, led by Dr. John Stanbury of the United States and Dr. Basil Hetzel of Australia, among others, have succeeded in establishing IDD as the most preventable cause of brain damage. They have shown that visible goiter represents only "the tip of the iceberg" in terms of the harm IDD causes. Even low levels of iodine deficiency can inhibit brain growth so that a child may lose 10-15 IQ points. Tens of millions of infants and children are affected in over 100 countries.

Recognizing the broad economic and social impact of IDD, medical scientists joined with development specialists to found the International Council for Control of Iodine Deficiency Disorders (ICCIDD) in 1985. They pointed to the need for a world wide campaign using iodized salt as the simplest and least expensive means to rid the world of this widespread malady. This campaign was taken up by UNICEF and WHO. At the World Summit for Children in 1990 world leaders accepted the goal of eliminating IDD as a cause of brain damage and pledged to conquer IDD, setting the specific goals for its virtual elimination by the year 2000.

Progress has been made, but much more needs to be done. Clearly, the scientific and technical aspects of the campaign are critical. It is essential to monitor health progress through surveillance, screening and laboratory work and to assure the quality of the iodized salt product through manufacture, transportation, and storage. But it is equally important to assure the quality of the entire process, particularly the communication and training required to convey to everyone the importance of ingesting minute amounts of iodine on a regular basis. Any relaxation of iodine use would allow IDD to return. Achieving the year 2000 goal calls for a lifelong habit of consuming iodized salt for this generation and for all generations to come.

Sustaining political support for IDD work at various levels of society remains a key factor in reaching the goal. The world is not short of crises; every country faces its urgent issues, and each community struggles to cope with its own problems. Resources for social programs are almost always scarce, and IDD work must vie for priority, often on economic grounds. The fight for attention at the policy and behavioral levels is getting more and more competitive. New communication technologies are adding channels of information, disseminating messages to already overloaded target audiences.

This guide draws upon the collective observations from ICCIDD consultancies in many countries, focusing on non-scientific aspects of the global IDD effort. It describes the process of forming alliances with various elements of society that have a role in fighting IDD. It also recommends the Social Mobilization approach to managing the communication aspects of programs that aim to establish and sustain the use of iodized salt.

The authors have used materials from many sources, including WHO, UNICEF, World Bank, FAO, the Nutrition Unit of UNICEF headquarters in New York, UNICEF offices in Islamabad and Quito, the Program Against Micronutrient Malnutrition (PAMM) of the Rollins School of Public Health at Emory University in Atlanta, the International Life Sciences Institute (ILSI), Population Services International (PSI) and Manoff International in Washington, and the Micronutrient Initiative (MI) in Ottawa. Dr. Claudia Fishman Parvanta of PAMM and Cecilia Cabanero-Verzosa of the World Bank contributed to the sections on message design and alliance-building methods in the last chapter.

Many individuals have contributed to the preparation of this guide. To David Haxton, one of the key development specialists who have championed tirelessly the cause of IDD elimination and contributed to the establishment of ICCIDD, the authors owe a special thanks. Dave was kind enough to read through the manuscript and offer many useful comments. To David Alnwick, Chief of the Nutrition Section of UNICEF, the most active organization in the global IDD effort, who provided the foreword, gratitude is hereby expressed. Appreciation of support also should go to Dr. Eduardo Pretell in Lima, Ms. Raana Syed in Islamabad, Dr. Mauro Rivadeneira in Quito for their cooperation in furnishing reports and checking material. Any mistakes or shortcomings in the guide, however, are the sole responsibility of the authors.

Jack C.S. Ling - Chair, Communication/Education Committee, ICCIDD Board
Cynthia Reader-Wilstein - Communications Consultant