Evidence of inequality in Thailand’s school system made the headlines in recent weeks after separate reports by the Public Ministry of Health and the World Bank. The report from Thailand’s Public Ministry of Health revealed that the average IQ of Grade 1 students in rural areas had fallen to 89 points, 11 points lower than Grade 1 students in urban schools, who averaged 100 points. The World Bank’s report, ‘Thailand’s Economic Monitor’, revealed that one-third of 15-year-olds in Thailand are ‘functionally illiterate’ and that the disparity between education in rural areas and urban areas should be a national concern requiring urgent action.

While educational inequalities and the failings of the Thai education system deserve to be prioritized in Thailand’s educational reforms, there are underlying factors which exacerbate these inequalities and require urgent attention. Foremost amongst these is the health crisis which currently inhibits thousands of rural students from realising their full potential –malnutrition and nutrient deficiency.

The link between nutrition and school performance has been long acknowledged. UNESCO has been urging developing countries to tackle child malnutrition for decades, stating in a report that “early malnutrition and poor nutritional status among students can, and will have significant adverse effects over school progress”.

Our understanding of nutrition, learning and cognitive development has increased significantly since the 1980s and there is now substantial evidence that insufficient intake of nutrients such as; Vitamin A, Vitamin B, Vitamin E, Iron, Iodine and Omega-3 acids, can be detrimental to children’s intellectual development. Recent research has also pointed to the long term effects of poor nutrition during children’s formative years which can result in lower IQs and permanent learning disabilities.

One health initiative that could substantially improve the lives of Thailand’s disadvantaged students is surprisingly simple – ensuring children consume adequate amounts of properly iodized salt. Iodine deficiency is a global health concern, it causes developmental delays and intellectual disability with acute iodine deficiency resulting in cretinism, a condition still found across Thailand. Figures from the World Health Organization suggest that iodine-deficiency accounts for losses of between 10 and 15 IQ points. The prominent British medical journal, The Lancet, identified iodine deficiency as “the most common cause of preventable mental impairment worldwide” and leading health experts estimate that iodine deficiency results in an unnecessary loss of more than 1 billion IQ points worldwide.

According to the 2012 Multiple Indicator Cluster Survey (MICS), only 71% of Thai households consume adequate levels of iodized salt. This figure drops to 54% in the poorest households. This is also a huge regional disparity with 82% of households in Bangkok and 54% of households in Thailand’s Northeast consuming adequate levels of iodized salt. Unsurprisingly, regions with the lowest IQ averages and weakest educational results are those same areas with the highest levels of iodine deficiency.

At the heart of the iodine deficiency problem lies the production of iodized salt, not Thailand’s levels of salt consumption. As recently as 2011, 90% of Thailand’s salt producers completed the iodization process by hand, a method which has proven to be highly ineffective. When tested by Thai health officials, salt iodized by hand showed inconsistent levels of iodine, with iodine undetected in some samples. The current methods of producing fish sauce, a primary source of salt in Thailand, have also been shown to produce inconsistent levels of iodine.

Since 2011 there have been laws in place which require salt producers to ensure their salt contains iodine levels of 20-40 ppm, the levels recommended by the UNICEF and WHO. However, without cooperation, reliable monitoring procedures and genuine commitment, these laws will fail to improve the lives of children suffering from iodine deficiency.