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 mental Impairment 10-15% IQ loss Goiter Cretinism

Iodine Deficiency Lowers IQ (10-15%) and Productivity Endocrinology Center, Moscow, 2002 Irreversible!

Iodine Deficiency in Russia: Lost future Productivity ( without action ) US$ 1.4 billion Net value ( )

Iodine Deficiency in Russia: Gains in Productivity (with 50% reduction) US$ 355 million + Net value ( ) 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) Endocrinology Center, Moscow, 2002

Iodine Deficiency - The Solution Universal Salt Iodization Essential!

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

Household levels of iodized salt consumption (as of 2001) (countries for which data are available) Source: UNICEF MICS/DHS surveys

Production of Iodized Salt (unofficial data)

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? 12 Copenhagen - Mild Aalborg - Moderate : <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 iodization Salt Iodization of table salt (% market share)

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