Health experts and advocates have urged a sustained battle against iodine deficiency to avoid a sliding back from achievements made so far through Universal Salt Iodization (USI).
The call was part of the consensus reached at a high level meeting on Iodine Deficiency Disorders (IDD) prevention and control strategies in China hosted by UNICEF China in partnership with GAIN, the International Council for the Control of Iodine Deficiency Disorders (ICCIDD) Global Network and the National Family Planning and Health Commission. It brought together academics, health experts and health professionals to reinforce the commitment to support Universal Salt Iodization, which has played such a critical role in reducing the number of children and pregnant women affected with iodine deficiency.
Addressing the opening of the meeting, Gillian Mellsop, UNICEF China Representative, stressed the importance of preventing iodine deficiency, noting it is fundamental to the physical and cognitive development of children. “Without the right micronutrients in their diet or that of their mothers, children do not get the same chance to grow up strong, healthy, and intelligent,” she said.
IDD, which can result in endemic goitre and impair growth and development, used to be a serious public health threat in China four decades ago. Yu Jingjin, director of the Bureau of Disease under the National Health and Family Planning Commission, said a 1970s survey showed 35 million had goitre and another 250,000 had impaired growth and development, which contained socio-economic development.
Jonathan Gorstein, global project coordinator for the Bill & Melinda Gates Foundation USI Partnership Project, recalled that back then there were villages in parts of western China where 30 percent of the population saw impaired growth and development, and were referred to as “the village of idiots.” Men from those villages couldn't get married because they weren't smart.
The Chinese government's introduction of mandatory USI in 1994, aimed to realize its political commitment of eliminating IDD by 2000, has made enormous achievements and became a model for many countries in the world. National coverage with adequately iodised salt has been sustained above 90 percent since 2005, and the iodine status of the Chinese population is almost optimal.
However, the remarkable success in controlling iodine deficiency has led to reduced vigilance toward IDD and concerns have been mounting over the possibility of excessive iodine intakes amid an increase in thyroid disease. Yu said the public doubts have become a new challenge for the USI program.
In fact, the consensus document adopted after the seminar indicated that no consistent evidence can link salt iodization with the rapid increase of thyroid cancer in China and other parts of the world, which experts believe is caused by multiple factors.
“Given the fact that most areas of China have environmental iodine deficiency, IDD will quickly re-emerge if efforts are not made to adhere to the universal salt iodization policy,” the consensus paper warned.
Michael Zimmermann, executive director of ICCIDD, said there is often a misperception among governments that once they control iodine deficiency then it's behind them, but actually it requires sustained efforts.
According to Gorstein, cases in the UK, the US and Australia, where there are increasing rates of iodine deficiency particularly among women during pregnancy, have raised some alarm, as those countries no longer make it mandatory that all salt be iodized and salt used in the processed food industry is not adequately iodized. “Let's make sure that we keep our guard up particularly in those countries we have been successful,” said Gorstein.
“We need to create the environment that includes the political commitment, legislation, regulatory, monitory systems. Those are the government's responsibility,” said Karen Codling, UNICEF consultant and regional coordinator for Southeast Asia of the ICCIDD Global Network. “And then the food industry needs to respond to those requirements to produce good quality iodized salt.”
As the Chinese government recently announced reform in the salt industry, experts at the seminar called on efforts to adhere to the salt iodization policy after the salt industry is restructured. “The achievements of the IDD program must not be reversed by the privatization of the salt industry. It is recognized that strengthened regulatory control systems for salt production and distribution will be needed in the context of a privatized salt industry,” said the consensus document.
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