Case Studies: Jonathan Gorstein - Abstract

Sam Clark    |    Jonathan Gorstein - Abstract    |    Jonathan Gorstein - Outline    |    Anne Marie Kimbal    |    Ann Kurth
Martina Morris    |    Beth Rivin    |    Bettina Shell-Duncan    |    Clarence Spigner    |    Joe Zunt    |    Combined

The elimination of iodine deficiency through universal salt iodization

Abstract

Iodine deficiency is the world’s most preventable cause of mental retardation, and places unnecessary constraints on the pace of social and economic development in a way that no nation can afford.It is therefore imperative that countries implement programs which assure the sustainable elimination of iodine deficiency disorders (IDD).Many countries throughout the world, both industrialized and developing, have adopted the international strategy of universal salt iodization (USI), i.e. the iodization of all the salt for human and animal consumption, including the salt used in food processing, as the main strategy for the prevention of iodine deficiency. The tools, equipment and procedures for salt iodization have become widely available and have made it possible for countries to implement large-scale programmes

The ultimate goal of USI programmes is to ensure that all salt reaching households and consumers is adequately iodized so as to satisfy the physiological requirements of iodine.However, while the concept of universal salt iodization seems quite simple, the practical realities of implementing such programs are challenging as these require a strong collaboration between Governments and salt producers. This public-private partnership has been essential in forging successful programs but there are delicate considerations when there are competing interests and potential implications of the private sector participating in a social program. In addition, there are issues with small-scale farmers, many of whom are subsistence producers who are very poor and cannot comply with mandatory salt iodization requirements. While their participation is vital, so as to avoid any non-iodized salt leaking to markets, coming up with feasible mechanisms to ensure that their salt is iodized has required innovative small business models, such as community co-operatives, to be developed in many settings . Finally, the selection of table salt as a fortification vehicle is based on the assumption that all populations consume salt in relatively consistent quantities regardless of socio-economic status. However, as hypertension and other chronic diseases emerge, the consumption of salt has declined, while in other settings, table salt is not as readily consumed as other salty condiments such as fish sauce or soy sauce, thereby calling into question the appropriateness of salt as a food vehicle.

This case study will consider the many dimensions of designing and implementing a salt iodization program to address iodine deficiency and will consider the real practical issues of such a program.

Nutrition, Public Health, Private-public partnerships

Learning objectives for this capstone topic could include:

• Understand the importance and epidemiology of iodine deficiency
• Identify the key factors that led to successful implementation of USI
• Identify the obstacles and potential solutions in salt iodization programs with respect to use of salt as a sole vehicle and dealing with small-scale salt farmers
• Consider the importance of public-private partnerships in addressing public health issues