Iodine Global Network (IGN)

A Q&A with "The Iodine Man of India", Dr. Chandrakant Pandav, on why his passion lies in universal salt iodization, the impact of his work and how we continue to move toward a world free of iodine deficiency

December, 2019
IGN: Dr. Pandav, why do you feel so passionately about Universal Salt Iodization?

CP: Iodine deficiency disorders (IDD) constitute the single largest cause of preventable brain damage worldwide. The majority of consequences of IDD are invisible and irreversible but, at the same time, are completely preventable. In India, the entire population is prone to IDD due to deficiency of iodine in the soil of the subcontinent and consequently the food derived from deficient soil.

When it comes to the Global health there is no ‘them’, there is only ‘us’. There is a proverb that ‘diseases start in the kitchen’; if they can start in the kitchen why can’t we end them there? This is the thought which motivated me to work toward universal salt iodization. 

In order for any nutrition-specific intervention to be successfully implemented, it should be affordable and available across all areas of society irrespective of any economic barriers. Salt is an integral part of everyone’s life. The recommended daily intake (RDI) of salt is just 10g - 15g per day, so it doesn’t matter whether the person is rich/poor, urban/rural, man/woman. People from all across the world consume it irrespective of the nation, race, culture, language and tradition. Taking these factors into consideration, salt is an excellent option for iodization to address iodine deficiency disorders.
A healthy mind breeds a healthy body, and if health is wealth, then a heathy mind and a healthy body are the absolute of a nation's wealth, and I wanted to be a part of making my country prosperous. Throughout my journey of four decades I have been working and still working on a simple principle that ‘no person should ever suffer from a preventable disease’. 
IGN: Can you describe the differences you see in communities that previously had a large population of people suffering from Iodine deficiency to how their communities are functioning now that they've been the benefactors of USI?

CP: Iodine deficiency and its manifestations have been known to mankind from ancient times. IDD was first documented in India in the Himalayan region by McCarrison in 1908. Further studies documenting goitre in India were done by several other researchers including Stott et al (1931), and Ramalingaswami (1953). India was one of the first countries in the world to start a public health programme to address iodine deficiency disorders based on salt iodization. Fortification of salt with iodine is the widely accepted preventive strategy to fight against IDD.

The Government of India has relaunched National Iodine Deficiency Disorders Control Programme (NIDDCP) in 1992 with a goal to reduce the prevalence of IDD to non-endemic level. In November 2005, the central government issued notification banning the sale of non-iodized salt for direct human consumption in the entire country. This process of transition needs to be augmented towards successful elimination of IDD with sustained consumption of adequately iodized salt, intensified awareness activities and an appropriate monitoring system.

Long ago during the initial days of my career, I happened to visit the Padrauna district in North-Eastern part of Uttar Pradesh, as well as many other interior regions of India. To my surprise I observed not only people but also animals and birds with huge a lump or swelling around their neck, the classic sign of goitre. The general ratio between the upper limb and lower limb is around 1:1.4 for normal human being I have seen people with 1:1 as upper limb to lower limb ratio. People could hardly show any expression on their face.

USI has had, and continues to have, a remarkable impact on Iodine Deficiency Disorders. Currently the prevalence of goitre is almost negligible in such a diversified and populous country of more than 1.3 billion, which is saving millions of IQ points annually.
IGN: Is there one thing about your work that has stuck with you, one person or community whose story you want people to know?

CP: There are two kinds of people in this world; they are mentors and tormentors. I am fortunate enough to have many great mentors in my life. Since learning is a lifelong process, I have learned many things at various points of my life.

I have learned the importance of values from my parents, service and sacrifice from my school, and Science-Statesmanship-Society from All India Institute of Medical Sciences (AIIMS, New Delhi). Through my experience, I have learned that an investment in knowledge and education pays the best interest.

Sometimes good things fall apart so better things can fall together. Maybe that is the reason even after being a Merit Scholar in Class 11 instead of choosing Civil services I accidentally opted Medicine. Education has been the biggest turning point in my life. Later in 1971 I joined the All India institute of Medical Sciences (AIIMS, New Delhi).

To light a candle, you need a burning candle, in a similar manner, an illumined soul alone can enlighten another soul. Those words, from my Mentor Prof. V. Ramalingaswami (director of All India Institute of Medical Sciences, New Delhi then and later on Director General of Indian Council of Medical Research and President of the Indian National Science Academy) have helped guide me to the path in Community Medicine even though I was initially interested in Neurosurgery.

My association with Prof. V. Ramalingaswami was the biggest turning point of my life. Life is unpredictable and you never know what is coming next. We should always be ready to change. The greatest lesson I have learned from life is to ‘learn everything you can, anytime you can, from anyone you can; there will always come a time when you will be grateful that you did’.
IGN: What is your biggest accomplishment working toward the elimination of IDD?

CP: Bringing together the Panchsheel partnership which includes:
i)Government Agencies National/State
iii)Private Sector
iv)International, Bilateral, National Agencies
v)Civil Societies
“A ship is steered by feedback from the outside, not by how the rudder, engines, or crew are behaving”. In the similar manner, working towards the elimination of IDD has never been an internal execution of strategies alone but many challenges across the path while dealing with key stakeholders like policy makers, salt regulators, Government, salt industry, IDD experts, NGOs, Agriculturalists, health care providers, educators, communicators, etc.
IGN: What would your message be to potential donors on how their donation (big or small) can impact lives around the globe?

CP: Giving is not just about making a donation; it is about making a difference. No act of kindness, no matter how small is ever wasted. Sometimes the small actions you do bring a huge difference. The measure of life, after all, is not its duration but its donation. Donation is not always about donating funds but it is also donating time, it is also donating expertise. When you ask a question to yourselves that how much it costs to change a life? The answer might be as simple as all the little things we can do.

Together we can make a difference. If you want to see the change in this world there is only one option left to you; as said by Mahatma Gandhi ‘be the Change you wish to see in this world’. If you think that you do not make a difference in this world then just remember that one rain drop raises the ocean. The world is not left to us by our parents; it is lent to us by our children. So it is our responsibility to turn this world into a better place to live. Remember that the happiest people are not those getting more, but those giving more.
Help us take a stand against brain damage caused by iodine deficiency!