REMARKS AT OPENING SESSION NATIONAL CONSULTATION ON IDD ELIMINATION, ISLAMABAD, PAKISTAN

DAVID P HAXTON

8 February 1994

Mister Chairman: First of all let me share with you my feeling of honor and special privilege at being present and invited to participate in this meeting.

In the time allotted to me this morning, I would like to share a few thoughts with you in the hope that they are pertinent to the discussions today.

We meet today to begin a renewed process to remove once and for all time the stealthy scourge of IDD which insults humanity with its terrible toll on the genetic potential of so many of our contemporaries.

We also meet to take note that the combination of political commitment, popular will and private support in Pakistan which augurs well for the more rapid achievement of the goals we have set for ourselves.

As we approach our tasks in these discussions, perhaps we would like to recall some of the development lessons we have learned over the past few decades in many parts of the world and especially in South Central Asia. We all realize that development has led to sectoral thinking and to sectoral compartments, but, in my opinion, that is more related to how the delivery mechanisms are organized than it is to the problems to be addressed. Of course, some sectoral division is desirable and some is even necessary, but as Professor Myrdal wrote many years ago, "....there are not educational problems; there are no medical problems; there are no economic problems. There are only problems which have these and other aspects." So it is with IDD, in my opinion.

While IDD is..in many countries..still considered to be a "health problem", we have learned that the solution and the road to elimination lies with political decision and commitment; with solid and proper administration and management; with industry both private and public sector; with communications; and with social demand.

In pursuing our goal to provide iodated salt to all of the population by the end of 1995, and to eliminate IDD from the nation and the globe by 2000, we shall need to understand...and to act upon the understanding... that the problem is so pervasive that we need all sectors, all elements of both the private and the public sectors.

We meet in historic times. This is true in general and in specific relation to IDD. In general we can look around us and see that we live in a time of global change that comes to humankind kind perhaps every 1000 years. As accepted norms for statehood alter and accommodate; restrained expressions of nationhood are emerging. The end of the cold war presents us with opportunities not thought possible for half a decade. It also brings with it dangers and challenges. The resources of time, talent and talons devoted to the cold war should now be available for alternate application and dedication.

Too, we note simultaneous progress in other human endeavors. The end of apartheid of race is imminent; that of gender is in sight. The original ideas of the founders of the United Nations might now at last be put into practice. Nations can now for the first time since W.W.II devote more of their national resources to national development and reduce the expenditures on war and violence. All of these changes, as remote at times as they may seem to us, have a direct bearing on our work to eliminate IDD from the earth in this decade.

Please recall that even in the midst of a global political crisis, the leaders of the world found it possible to attend the Global Summit on Children and to endorse the idea of virtual elimination of IDD before 2000. They also found it possible to support and to attend the Montreal Meeting on Hidden Hunger and to reaffirm their collective decision to assure adequate national plans in each country to achieve that goal and in this decade.

The ideas inherent in national development which bear on the quality of life of humans are now public discussion and receive more powerful political expression...and such was not always the case. So changes are taking place and these changes are opportunities for those interested in micronutrient malnutrition and its virtual elimination as a scourge of humankind.

We are, I believe, living through an exciting period of revolution. But it is not a revolution of violence, of guns, of cannon, or guillotines. It is a revolution of ideas, and human concerns and application of knowledge. The remarkable yields of science and technology in communications, in medicine, in engineering, and transport are one expression of that revolution. Another dimension of that revolution is the dramatic elevation of questions of human survival, human development and humane progress on the agenda of the world.

It is an obscenity that the world allow that one more human be born a cretin or mentally retarded when we know with assurance how to prevent it.

The results of our work are nothing less than the assurance of the genetic potential of each human on earth.

A grand alliance has been formed and is expanding. This alliance is comprised of governments with national plans to eliminate IDD; of private industries in the food supplementation business; of communicators with the professional capacity to transfer knowledge; of non governmental organizations like ICCIDD; of UN Agencies like UNICEF and WHO; of centers of excellence like Emory University and PAMM. It is necessary to expand this alliance for elimination and assure through the empowerment of people that all are enlisted in the effort to eliminate IDD.

We deal also today with the question of an idea whose time has come, but about which we have been slow, in deed, to act. It seems incredible that the world has known about the basic cause of the problem of the problem of IDD for 8 decades and has known what to do about it for about that long but as we approach the end of the century, we still have 1 billion people at risk and manifestations of the problem on all continents. It is even more incredulous when we take into account that for most of that time we have know how to prevent IDD; what it costs to do so; and the essential fact that the process actually works.

So what has taken us so long to put an idea whose time came, into action for those that silently await the lifting of the burden of the stealthy scourge of IDD? (We ought to imagine for a moment what it must be like to be, for example, a cretin: never to comprehend music; or to love; or to speculate; or to learn poetry; or to enter the world of books. To those that suggest, we need more date, I suggest we need more action.)

Until recently, we had some obstacles in the path of progress; let me cite a few:

a. Inadequate awareness of the problem. This was due to lack of communications between those that held the knowledge and those that could apply it for public health.

b. Inadequate comprehension of the magnitude and the consequences of the problem. Again, lack of communication between those that knew and those that could act.

c. In adequate political commitment to address the problem. This was evident in governments as well as development agencies. Again due in part to poor communications.

d. Lack of assurance of an adequate supply of raw material to assure permanence.

e. Primitive methods of salt production, packaging, and quality assurance.

f. Inadequate communication between policy makers and profitable productive capacity.

I believe that in good part, these same obstacles have been in the path of progress in reducing a good number of insults that affect women and children, including immunizations, diarrhoea management, family planning, vitamin A deficiency, and iron deficiency.

So, where are we today?

We certainly are not starting at base zero. Much has happened and much progress has been recorded. As science worked diligently to expand our knowledge base and to reveal the consequences of a range of disorders resulting from the absence in diets of a minuscule amount of iodine daily, a good number of nations introduced effective interventions principally based on the production, marketing and consumption of iodated salt. During the 1960's, a good number of governments began programmes, and while some of those progressed, most suffered from lack of political commitment to the permanence of the programme; or from managerial problems; or from lack of collaboration between the public and the private sectors, and the lack of communications with the buying public in order to sustain demand for iodated salt in the market at acceptable prices.

International development agencies expressed concern and offered help. But most assistance was time bound and certainly not on a scale commensurate with the magnitude of the problem. Nor were the UN agencies and the bilateral aid agencies imaginative in seeking allies in the private sector to undertake tasks more suited to industry than to government.

Since the late mid 1980's, however, there has been a growing recognition of what we talk about today and progress is evident everywhere. As impressive as the formal gains are, however, the Global Summit on Children in 1990 once and for all gave global political endorsement to the effort to virtually eliminate IDD, Vitamin A deficiency, and iron deficiency in this decade.

Put another way, the scientists of the world, the planners of the world, the economists of the world to the world political leaders the these goals COULD be achieved.. Moreover, it was seen to be good politics to do so. The political leaders accepted this advice and said that the goals SHOULD be achieved. So it comes to us: Our task seems to be that of determining how to implement plans which will see that the work GETS done.

One element of our work is to outline ways in which the private productive sector can play a role in public health. The corollary to that is to suggest what minimal elements of national policy are suggested in order to facilitate that alliance, accelerate its inception, and guide its implementation.

To ally private sector development in the food industry . . especially in the fortification of foods and in the production of supplements . . with the public needs for the foods and the supplements will help to assure that we become able to insert our needs in to appropriate financial channels, both public and private; in to communications channels, both public and private; into universities and other centers of learning and training; and into other sectors of private industry and of government. This unique combination of interests can help to demonstrate how a public health problem can be addressed in the private sector.

We shall need to talk of some specifics.. and we shall do that. Permit me, at this juncture, however, to remind us of some of the assets which can be combined to make our tasks somewhat easier than might have been in earlier years.

The surge in the communications capacity of virtually all nations over the last ten years has made it possible, for the first time, to put that knowledge and these techniques at the disposal of the great majority of the world's peoples. Sixty percent of the adults in developing countries can now read and write. Eighty percent of all children now enroll in school. But, we need also to remember that radio reaches into a majority of all homes and television into a majority of all communities.

In addition, we need to recall that "development has happened". We now have more than 2 million doctors; 6 million nurses, tens of millions of health workers now at work. In

addition of have tens of thousands of non governmental organizations... not including private industries .. which when added together make for a massive network of support for solid communications and effective social marketing for improved nutritional efforts.

We have still another set of circumstances which we should consider in our acceptance of the task to virtually eliminate micronutrient malnutrition from the globe in our time. I refer to the dramatic change in global geo-politics. This not only will readjust the focus of government to government development cooperation, but will open opportunities more widely and more rapidly to apply the ingenuity of private enterprise to new countries, new challenges, and new markets.

This will not be without its problems. As the major protagonists of the "cold war" both enter periods of readjustment to the new environment, and reduce investment in military hardware and unproductive investment, there will be strains in all elements of society. But, we need to be assured that in the readjustment period which is inevitable, we do not allow the progress of the past few years on the improvement in the condition of children and women to be the first to suffer as national policies are readjusted. With a mutual focal on the elimination of micronutrient malnutrition, both industry and government have an opportunity to show that social development of this kind is not only " doable" but is a good investment in the country, and good politics as well.

Both industrialized and developing countries stand at a clearly marked cross road to health and nutrition. IF the choice is the road to primary health care through reliance on medical technology, then the path will be steep and difficult, and will require expenditure of more resources for less forward movement than most countries can afford, and will allow fewer and fewer people to benefit If, on the other hand, the road of primary reliance on empowering people with knowledge to take on responsibilities of their own, and more control over their own health and nutrition, with easier access to knowledge, then the way will broaden and allow a large portion of the human family to move forward towards "health for all"

But such empowerment has many hindrances, of course, like: grinding poverty; lack of education; muddied propaganda; limited access to basic services like clean drinking water, safe sanitation and adequate housing. So the mere empowerment of people cannot be a substitute for government action to accelerate that process by investment in the basic community services and by initiating imaginative ways in which to mobilize the entire national community into acceptable health and nutrition goals.

The power of persuasion of the commercial marketing forces can be applied, it seems to me, in helping to change dietary habits. While this implies the need to have a product available once the idea has been considered, that is after all the essence of marketing, I suppose. When these are natural foods, like fruits and vegetables, private sector activity is already involved in growing, harvesting, packaging, processing and marketing them in most places.

Since W.W.II, most governments and most development agencies, in good part because of the "cold war", development policy makers and agencies put great emphasis on the role of governments in a range of economic, social and development activities. We are seeing shifts in that approach all around the globe. For the most part the shifts seem to be: (a) attempts to "privatize" holdings and infrastructure of the productive elements in society like manufacturing, mining, transport, and real estate. A shift from centrally planned activities to market driven priorities; (b) attempts to shift responsibility and management of basic services in education, health, agriculture, from government support completely to a shared support of public and private resources; and (c) a growing awareness that public health and improved basic services are good investments for a healthy productive population and such is good for business.

In this global set of changes, it is not too ambitious to think of a mutually beneficial endeavor in each country to eliminate the insults of micronutrient malnutrition. What is required is to overcome the existing mutual suspicion and mistrust between government and private industry. While not an easy task, there are ways and means of beginning.. or of accelerating. One way is to make suggestions on policy and procedure.. and that is in part why we are here.