1. Improving Public Health by Optimizing Iodine and Sodium Intakes

2. Background
WHO Expert Consultation “Salt as a Vehicle for Fortification” 2007
Policies for salt iodization and reduction of salt to <5 g/day are compatible, cost effective and of great public health benefit. At the country level, close collaboration between salt iodization and salt reduction programs as a coalition is urgently required so that their aims are congruent.

3. Background: Jan.3&4 meeting:
Confirmed:
Recommendations of WHO consultancy “Salt as vehicle for fortification “2007 and
PAHO Expert Group Policy Statement are relevant and that it is necessary to put them in practice .
Agreed on:
common goal to secure “optimum salt and iodine intake in the Americas”.

4. Background: Jan.3&4 meeting
The same small group of stakeholders will serve to prepare the next extended stakeholders meeting, planned after Iodine Network Task Force meting in DC.
This group will draft objectives, expected results and background document for the stakeholders meeting
PAHO will convey the stakeholders meeting in DC to facilitate a next level of collaboration and initiate its introduction in some counties in the Region.

5. Draft position document
proposal

6. Iodine network 2009 resolution
BE IT FURTHER RESOLVED THAT the World Health Organization is urged to share with the Network Board any data, when and if it becomes available, about the achievement of salt reduction in various countries and its projected trends of salt consumption to inform Board discussion and national salt iodization programs to enable ongoing efforts to calibrate iodine fortification levels to ensure appropriate population iodine intakes.

7. 2009 Policy Statement for the Americas
Salt intake should be reduced without compromising micronutrient fortification efforts. National governments are to review national salt fortification policies and recommendations to be in concordance with the recommended salt intake [national targets or in their absence, the internationally recommended target of less than 5 g/day/person by 2020].

8. Optimal intakes of iodine and sodium
Goal:
Iodine fortification and salt reduction programs to converge reaching the common goal of:
Optimal intakes of iodine and sodium
in the population

9. Framework for collaboration:
baseline surveillance of iodine and sodium intakes and of sources of iodized and total salt in the diet, referring but not limited to
co-surveillance using the 24 hour urine excretion method to benefit both programs
systematic literature reviews and additional research if needed to determine the validity of spot urine methods for assessing iodine and salt consumption
carrying out food intake surveys to identify the sources of salt in the diet – both the discretionary use at the table and in cooking in households and what is in processed foods – and the proportion of salt that is iodized
investigating whether and which iodine analysis laboratories can also analyze sodium (and potassium, creatinine) and where possible the marginal additional costs to do so
identifying/mobilizing funds for combined surveillance
assessing knowledge, attitudes and behaviors towards salt consumption

10. Framework for collaboration
Advocacy to governments for joint development/adjustment of iodine fortification and salt reduction policies and programs
synchronized national efforts to monitor iodine intake in order to adjust standards for salt iodization
cross country harmonization of approvals processes for new food products with low salt content and an adequate amount of iodine
cross country harmonization of salt iodization standards and criteria to judge epidemiological performance of the programs

11. Framework for collaboration
Sharing forums for engagement with food industry
Common and coordinated messaging to policy and decision makers and to the public
Monitoring and evaluation of joint iodine and salt programs

12. Next steps:
Convene a working group of stakeholder institutions involved in iodine fortification – ICC-IDD, MI, UNICEF, WFP, CDC-surveillance, nutrition and NCDs, PAHO micronutrient program – and salt reduction – the PAHO/WHO salt experts group, World Hypertension League, Latin American Society of Nephrology and Hypertension  (SLANH), WHO CC on nutrition in Warwick, UK to facilitate/secure a next level of collaboration for Central and South America and the Caribbean.
Approach countries with active salt reduction and iodine fortification programs in the region to pilot the coordination/collaboration and harmonization of programs (choose from Mexico, Brazil, Chile, Argentina, Costa Rica, Canada, US)