STATEMENT DELIVERED TO NATIONAL ADVOCACY SESSION, ULAN BATOR, MONGOLIA, 1995, A MEETING CHAIRED BY THE PRESIDENT OF THE REPUBLIC.
David P Haxton
Ulaan Baator, Mongolia
November 1, 1995
Iodine deficiency is the world's greatest single cause of preventable brain damage and mental retardation. It manifests itself usually as goiter and inflicts on humankind a range of physical and mental handicaps. Collectively these are "iodine deficiency disorders" (IDD). Environmental deficiency of iodine in the soil is the primary cause of IDD. When iodine is absent from the soil, the animals and plants dependent on that soil will also be iodine deficient.
The Executive Director of UNICEF in 1978 said, "It ought to be a crime to allow one more child to be born mentally retarded when we know exactly how to prevent it" (). The Global Summit on Children listed IDD as a malnutrition problem the world should eliminate in this decade. The Government of Mongolia has accepted the challenge to eliminate IDD from the country and to complete the achievement by 2000.
Besides goiter and cretinism, both of which are present in Mongolia, (), IDD in pregnant women may cause irreversible brain damage in the developing fetus. Infants and young children exposed to IDD may also suffer from brain damage, psychomotor retardation and intellectual impairment. A baby born to a moderately deficient mother may lose as many as 13 IQ points at birth. At the current level of goiter in Mongolia, there is a potential loss of over 500,000 IQ points annually unless priority measures are undertaken.()
From experience in industrialized countries it has been found that the most efficient and effective method of providing the minute daily requirements of iodine to each human in the country is through the appropriate iodation of ordinary common table salt. This method not only assures adequate amounts in the daily diet in a safe and scientifically approved form, it does so at costs that the entire population can afford. In Switzerland, the Government announced that salt iodation was "the most cost effective public health programme in the century". The costs in Switzerland were less than the equivalent of US twenty cents per capita over a decade!
With the announcement of the new national plan to eliminate IDD in his decade, the Government of Mongolia joins more than 100 nations in the world that support the global goal to eliminate IDD in this century. This requires the establishment of an effective salt iodation plan. Mongolia has started such a plan in 1995 and the entire quantity of salt required in the country will be appropriately iodated by July 1996. In addition, the Ministry of Health and the Governors of each Aimag will undertake training programmes to assure that all personnel involved in quality assurance activities will be provided with the most modern skills available. Laboratories well be improved. In addition, periodic testing of salt will assure the public of a good quality product at a fair price.
During the next five years, there will be periodic examinations of urine and blood to assure that people are consuming the iodated salt and receiving the benefits from the iodine. School children will be taught to test iodine content in household salt and will learn about the dangers of iodine deficiency.
Recognition that IDD elimination is not just a "health" problem but requires a broader intervention by a range of institutions is a key factor in the success achieved to date in most countries. This approach offers many valuable lessons for development in the remainder of this decade. One of them is that political commitment is required to assure appropriate financial, technical and other support and to assure priority attention to the problem. Another lesson is to understand that the value of the investment in human capital is more important than the mere costs of operation of an iodation programme. To allow each human to reach its genetic potential is a good political goal and worthy of priority investment. Achieving an acceptable method of measuring progress and communicating those results effectively to the population should be a priority in future programming. It is necessary to make the argument that investment in human capital is equal to that of physical plant investments. This implies the need to modernize evaluation methods with an understanding that everything that matters may not be counted; but everything we do count may not matter!()
The absence of good communications strategies in previous decades was a principle cause of the failure of national programmes to address iodine deficiency. Those that knew about IDD did not effectively communicate with those that could do something about IDD. Those groups did not adequately mobilize society to undertake action to eliminate IDD before continued damage was done.
The lessons learned demonstrate that the convergence of good science, good politics, and good policies can be made to work for the national good. The marriage of these forces gains political support and creates public enthusiasm for implementation through use of modern communications now so widely available.
History teaches us that when we relax our vigilance on the dangers of iodine deficiency, the age old scourge stealthily begins again to undermine our mental growth, our physical growth and our national development. The achievement of universal iodation of salt is, therefore, the first target to be reached. To sustain that achievement, quality assurance systems must be in place and the people fully informed of the value of small amounts of iodine in the diet. Public demand for a good quality product at a fair price is a keystone of success to eliminate IDD.
In summary, the elimination of IDD is "an idea whose time has come". We can eliminate it if we want to. We know what to do. We know how to do it. We know that it works without danger to anyone. We know what it costs. The people are waiting to be relieved of the burden of IDD. They have a right to adequate nutrition.