1. USAID Universal Salt Iodization in the Russian Federation Kerry Pelzman ANE/E&E PHN SOTA Meeting Washington, DC October 9, 2002

2. USAID Iodine Deficiency Disorders IDD remains the most common cause of preventable mental retardation -- even mild IDD  IQ by 10-15% IDD also results in  fetal death, stillbirth, LBW, birth defects, neonatal & infant mortality > 2 billion people at risk worldwide

3. USAID Universal Salt Iodization UNGASS for Children: Global Elimination of IDD by 2005 through USI (> 90% coverage) Salt consumption universal & uniform Iodization cost: 3-5 cents/person/yr Commercial fortification: costs borne largely by industry & consumers > 2/3 of household salt in developing countries now iodized

4. USAID Global USI

5. Infants Born Annually Unprotected from IDD

6. USAID Health in the Russian Federation Population 147 million IMR 18 (1999) U5MR 22 (1999) U5 Underweight 3% U5 Stunting 13% EPI >90% MMR 50 Low political priority for health programs generally & lack of reforms in health sector

7. USAID USI/IDD in the Russian Federation Iodine deficiency widespread, but most severe in Siberia & Far East IDD virtually eliminated in USSR 1950- 1980 (salt iodization & targeted supplementation), but efforts abandoned w/ dissolution in 1991 1997 National IDD Program initiated Health Commission of Gore- Chernomyrdin Committee (State, HHS, USAID)

8. USAID USI/IDD in the Russian Federation Regional harmonization of standards 6 major domestic salt producers + 20-30% of consumption imported from 2 major producers in Ukraine & Belarus Domestic production of iodized salt has increased >10X over past 5 yr, but still < 30% of total consumption Decrees, but no national law or comprehensive strategy for USI

9. USAID Global –UNICEF/Kiwanis –USG: USAID, HHS, CDC –Gates, World Bank, CIDA –Network for Sustained Elimination of Iodine Deficiency –ICCIDD, WHO National –Government –Salt Producers –NGOs, Med/Nutrition/Education Community Partnership

10. USAID USI Program Elements Advocacy: Political & Industry Commitment National Legislation & Regulatory Framework Production Capacity & Quality Control Marketing & Consumer Demand Creation Monitoring: Impact & Sustainability

11. USAID Salt Iodization Can Lead the Way Almost no prevalence data for other MN deficiencies Monotonous diets with lack of animal- source foods, fruits & vegetables Salt iodization first national fortification program in Russian Federation Wheat flour fortification potential