Address by Dr. M. Zakit Husain, Director, Programme Management, WHO/SEARO

at the

Partnership to End Hidden Hunger - meeting to Sustaining Elimination of Iodine Deficiency Disorders

9-12 April 1995, Dhaka, Bangladesh

Your Excellency, distinguished representatives from the International Council for the Control of Iodine Deficiency Disorders, Colleagues from other UN and Donor Agencies, and Ladies and Gentlemen.

It gives me great pleasure to address the inaugural session of this very important Regional Meeting on "Partnership to End Hidden Hunger Meeting on Sustaining Elimination of Iodine Deficiency Disorders" which, I note, coincides with the Tenth Anniversary Celebration of the International Council for the Control of Iodine Deficiency Disorders. Iodine is a micronutrient that is needed only in microgram quantities. It is a hunger that can easily be satiated through a small input, and yet, it is very often not the case, judging from the fact that almost 1.6 billion people are at risk of iodine deficiency globally, with 655 million showing clinical signs of deficiency. The remedy is simple - as little as 5 US cents per person per year. Invested in a programme of Iodization of salt, this small amount would ensure the elimination of iodine deficiency for many. The cause of the malady, the remedy and the technological solutions have been known for years. And yet, even today, iodine deficiency continues to be the most important cause of preventable brain damage.

Ten out of eleven Member Countries of the South - East Region experience the problem of iodine deficiency. The Government of Bangladesh took the decision for the universal iodization of salt fully four years before the "Declaration of the Universal Access to Iodized Salt by 1995" was adopted at the Second SAARC Conference in Colombo in September 1992. It is indeed gratifying to note that Bangladesh will shortly meet this target and is posed to reap the rewards of the successful implementation of universal iodization of salt. The last survey in the country, conducted in 1993, showed a prevalence of 5 cretins per 1,000 population; 47% had goiters, and the entire population was at risk. Under these conditions, the cost of each disability adjusted for life year saved (i.e. DALY) would be even less than the US amount computed in the World Bank Report of 1993.

The World Health Assembly, while reviewing the progress achieved in preventing and controlling iodine deficiency disorders, decided in 1990, that WHO should aim for the elimination of iodine deficiency disorders as a major public health problem in all countries by the year 2000. The Assembly also urged Member Counties to continue to give a high priority to the prevention and control of iodine deficiency disorders through support of appropriate nutrition programmes as part of primary health care, with a view to achieving the global objective.

In this connection, one may recall the Summit for Children, held in New York in 1990, in which 159 countries participated. As a result of effective advocacy by WHO and UNICEF, the Summit adopted elimination of iodine deficiency as one of its twenty seven goals. This goal was reaffirmed at the Ending Hidden Hunger Conference in Montreal in 1991, and at the International Conference on Nutrition, held in Rome in 1992.

The World Declaration and Plan of Action for Nutrition, adopted at the International Conference on Nutrition, stressed the determination of Member States to work together to end the human tragedy of all forms of malnutrition. It urged them to make all efforts to eliminate iodine and vitamin A deficiencies before the end of the decade. The World Health Assembly endorsed the World Declaration and the Plan of Action for Nutrition in their entirety in 1993. As a follow-up, WHO has already developed its approaches and strategies for the implementation of national plans of action in nutrition. One of the priority areas on which WHO's technical collaborative support to countries is being focused relates to overcoming micronutrient malnutrition. Special attention is being given to strengthen the capacity of global, regional and national programmes in this area. Support is being provided to extend the global micronutrient deficiency information system and effective networking is being implemented with a view to promote continuous dissemination of information on prevalence trends, development of control programs, and monitoring of progress towards the goals set for overcoming iodine, vitamin A and iron deficiencies by the year 2000. Knowledge of the testing of practical approaches for eliminating iodine deficiency disorders and vitamin A deficiency, and reducing iron-deficiency anemia in women is reaching a variety of people.

It is gratifying to note that countries with iodine deficiency disorder problems have shown a firm commitment and determination to reach the target of 95% iodization of salt by the middle of this decade. This target has already been met by as many as 58 of the 110 countries with IDD problems, while 32 are likely to achieve the target this year. Only four have been unable to do so.

The transition from a policy of selective iodization of salt in iodine-deficient areas to one of universal iodization of salt for both iodine-deficient and iodine-sufficient areas was not without hurdles. Apprehensions regarding the possible adverse reactions in populations living in non-deficient populations had to be allayed though iodized salt is considerably less than the supplemental daily dose of 1 mg of iodine, which did not produce any adverse reactions when tested in non-deficiency populations.

Achieving universal iodization of salt, which no doubt is a major event, only means a battle half won. What is needed to achieve the goal of elimination of iodine deficiency is to encourage the consumer to use the iodized salt made so readily available instead of common salt. In addition, it is imperative that the sustainability of the programme should be ensured. Iodine deficiency disorders, unlike communicable-diseases, will not disappear from the globe once they have been eliminated through the use of iodize salt. Salt iodization must continue even after the programme has succeeded in eliminating IDD, for if it is discontinued, or if the efficiency of implementation is reduced, IDD will recur. Political sustainability of the iodization programme should be assured as it is among the most cost-effective of all health programmes. Technical sustainability is also feasible because of the simplicity, low-cost and ease of monitoring through the use of outcome indicators, such as assessment of goiters and urine tests for iodine excretion, and also through a process indicator, via success of iodization.

The World Health Organization is committed to achieving the target of elimination of iodine deficiency disorders by the end of this decade as a part of it's strategy for Health for All by the Year 2000. The elimination of micronutrient deficiency from vitamin A and iodine has been set as one of the major goals of the Organization during its Ninth General programme of Work, covering the period 1996-2000. WHO is fully confident, that with the partnership of Member Governments, UNICEF, ICCIDD, World Bank, UNDP, IDRC, CIDA, and the Micronutrient Initiative, the realization of the goal of elimination of iodine deficiency disorders by the year 2000 will be a reality.

This regional meeting is unique in that it adopts a new methodology known as "Future Search". The organizers have indicated that the guiding principle of this method is to let all who have a role to play to come together, to let people identify their own tasks, and to let the focus be on the future. One of the five tasks assigned to the participants is to develop one or more future scenarios for the elimination of iodine deficiency disorders 5 to 20 years into the future, taking due note of the picture today. I do hope that you will suggest an action plan that will enable the Member Countries and other national and international agencies to achieve our common target and guide us into the next century toward better health for all.

Before I conclude, I would like to express, on behalf of my Regional Director and on my own behalf, our deep appreciation to our partners in action - the Member Countries, the bilateral and international agencies, the ICCIDD, UNICEF, World Bank, UNDP, and others - who have contributed substantially to the progress achieved so far in the movement towards the elimination of iodine deficiency disorders. I have no doubt that with such excellent cooperation existing among the partners, a world free from iodine deficiency disorders can become a reality in the not-so-distant future.