Sustainable Elimination of Iodine Deficiency:

Perspective for Central & Eastern Europe and Central

Asia

ARNOLD TIMMER, UNICEF REGIONAL OFFICE

20 November 2003

Iodine Deficiency: The Problem

At risk of At risk of mentalmentalImpairmentImpairment10-15% IQ loss10-15% IQ loss

GoiterGoiter

Cretinism Cretinism

Iodine Deficiency Lowers IQ (10-15%) and Productivity

End

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Irreversi

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Irreversi

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le!le!

41 million newborns still unprotected: 113.000 per day!

Sub-Saharan Africa

CEE/CIS

Latin America/CaribbeanMiddle East/

North Africa

South Asia

East Asia/Pacific

17 million

8 million

7 million

4 million

3 million2 million

Iodine Deficiency in Russia: Lost future Productivity (without action)

US$ 1.4 billion

Net value (2002-2006)

Iodine Deficiency in Russia: Gains in Productivity (with 50% reduction)

US$ 355 million +

Net value (2002-2006)

200,000 newborns protected !!

United Nations Special Session for

Children:

eliminate iodine deficiency by 2005

also signed by Belarus Government

United Nations General Assembly Special Session on Children (2002)

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Iodine Deficiency - The Solution

Universal Salt Iodization

Essentia

l!

Essentia

l!

In 31 countries, > 90% households consume iodized

salt

UNICEF 2000

In 36 countries, 50-89% households consume iodized

salt

UNICEF 2000

In 38 countries, <50% households consume iodized

salt

UNICEF 2000

Production of Iodized Salt (unofficial data)

0

10

20

30

40

50

60

70

80

90

100U

krai

neR

ussia

Uzb

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anBela

rus

Mol

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Kaz

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tan

Arm

enia

Geo

rgia

Tajik

istan

Turkm

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an

IS production in 1999or 2000, % of total

IS production in 2001or 2002, % of total

Beijing Conference:October 2003

• International meeting for the sustained elimination of IDD

• 27 key countries: successful and those that require more action

• Last push to reach the goal in time by 2005

A few lessons learned

• Iodine intake through natural food

• Mandatory USI legislation: yes or no

Denmark: Investigation of Iodine Intake

How much iodine in a recommended diet?

1 2

Copenhagen- Mild -

75 114

Aalborg- Moderate -

48 70

1: <100 g of fish per week and <½ glass of milk per day

2: 200 g of fish per week and ½ litre of milk per day

Denmark: Investigation of Iodine Intake

Iodine Intake through natural food

• Very difficult to ensure adequate intake

• Not affordable and not accessible to entire population

Mandatory USI legislation: yes or no

• Switzerland: no USI legislation: achieved USI after 60 years through public awareness campaigns!– All food grade salt– All table/retail salt

• Denmark

Salt Iodization in Denmark

•1920: Voluntary iodization of table salt

•1982: Salt iodization prohibited

•06/1998: Voluntary iodization of all salt

Median: 50 μg/day

Voluntary iodizationSalt Iodization of table salt (% market share)

0%

10%20%

30%40%

50%60%

70%80%90%

100%

Aug-98 Oct-98 Dec-98 Feb-99

withoutwith

Salt Iodization in Denmark

•1920: Voluntary iodization of table salt

•1982: Salt iodization prohibited

•06/1998: Voluntary iodization of all salt

•07/2000: Mandatory iodization of all table

(retail) salt and bread

Mandatory USI legislation: yes or no? Belarus:

• Iodization of food grade salt: mandatory• Iodization of table/retail salt: voluntary • Belarus: proportion of salt iodized

– 2002: 52%– 2003 (first 9 months): 54%

• Communication is important but in isolation of mandatory legislation, USI is far away!

• Focus on USI legislation and its obstacles!

Considerations for Belarus

• 100,000 new borns each year

• Population size likely to decrease

• Investment in USI = investment in IQ of new born = investment in education and future of the nation