A salt producer in Tamil Nadu, India harvests iodized salt from a drying pond. GAIN works closely with local salt producers to upgrade their processing and iodizing equipment. Photo credit: GAIN
By Jonathan Gorstein and Greg S. Garrett
The Life You Can Save and GiveWell recently highlighted the critical importance of iodine nutrition by recommending not one but two non-profit organizations working on iodine interventions: the Global Alliance for Improved Nutrition (GAIN) and the Iodine Global Network (IGN). So why is iodine nutrition important, and why right now?
The evidence is clear. Iodine deficiency is a global public health problem and the world’s most common cause of preventable brain damage in newborns and infants. Goiter (an enlarged thyroid gland in the neck) is just the visible tip of the iceberg. The "hidden" effects are much more life-limiting and severe. During pregnancy, iodine deficiency can cause stillbirth, spontaneous abortion, and congenital brain abnormalities that may lead to irreversible and severe mental impairment.
The impact of iodine deficiency lasts a lifetime. It limits a child’s ability to learn, earn a living, and live a healthy life. These debilitating consequences are often felt by the whole community: a chronic problem can decrease the average IQ by as much as 13 points.
Iodizing salt, raising the world’s IQ
But there is good news. More and more people are getting sufficient iodine, in both industrialized and developing countries. This is most commonly achieved through universal salt iodization (USI), one of the most cost-effective interventions to improve nutrition. The annual cost of initiating, scaling up, and sustaining a national program to fortify salt with iodine is around $0.05-0.075 per person covered. In practice, this means that a donation of as little as $100 per year could protect as many as 2,000 people from the consequences of deficiency. Last year, salt iodization got the WHO stamp of approval. A systematic review confirmed that iodized salt has a large effect on reducing the risk of goiter, cretinism (the most severe form of mental retardation), and impaired cognitive function.
In the U.S., the practice of fortifying salt with iodine began in 1924. The result has been a drop in the number of cases of preventable mental handicaps. Salt was chosen as a vehicle for iodine for a number of reasons. It is consumed in relatively uniform amounts by all segments of the population, even the rural poor. And, contrary to some popular beliefs, adding iodine does not change the taste or smell of salt. Nor does it lead to more salt being eaten. In fact, iodine levels in salt can be safely adjusted up to match declines in salt intake.
Recently the news got even better. Through USI and other iodine interventions, there are now only 25 countries identified as having insufficient iodine intakes. This is down from 54 in 2003. We are now in an unprecedented position: on the verge of being able to eliminate iodine deficiency at a population level, in a sustainable way.
It’s a compelling message, and it’s no surprise that visionaries like GiveWell and The Life You Can Save have recognized its potential. But by recommending both GAIN and the IGN as outstanding investment opportunities, they have also recognized that there is only one way we plan to reach this goal: together.
Our strength is our diversity
Created in 2002 at a Special Session of the U.N. General Assembly on Children, GAIN is the only international organization focused entirely on ending malnutrition. In countries with the highest burden of iodine deficiency, GAIN provides resources and the technical know-how to help build up sustainable national supply systems, and create monitoring and evaluation (M&E) capacity to track progress long after external grants have run their course. GAIN’s USI-related programs are currently active in 16 countries, protecting a hefty half a billion people vulnerable to iodine deficiency, including 19 million newborns every year.
The Iodine Global Network (until recently known as ICCIDD) was established in 1986. From the start it has served as the global scientific authority and advisor on iodine nutrition. In collaboration with other partners, the IGN helped to advocate for the importance of iodine nutrition by documenting the extent of deficiency and its impact on individual countries. Eventually, this helped to catalyze national coalitions to lead USI programs and galvanize global political action for the sustained elimination of iodine deficiency. Through a network of regional coordinators, the IGN is engaged in programs in over 150 countries.
More than a sum of our parts
As part of its global mandate, the IGN has been working to align the interests and harmonize the activities of all stakeholders in iodine programs, including GAIN’s national-level inputs in supply and M&E. As part of this unique partnership, we’ve achieved efficiency and complementarity that transcends our individual strengths and contributions. We’re committed to working together going forward, to ensure that global best practice, science, and expertise—and national capacity and systems—are brought together and strengthened.
Increasingly, our resources will support global and national efforts to sustain optimal iodine nutrition as more and more countries are achieving their first USI successes. The IGN’s convening role, and GAIN’s role in broader nutrition programs (especially as co-chair of the Scaling Up Nutrition Business Network), will be particularly important as we move to integrate iodine into the global nutrition agenda and support the harmonization of strategies for reducing salt consumption and improving salt iodization.
According to WHO, eliminating iodine deficiency would rank alongside some of the world’s biggest public health achievements like eradicating smallpox.
With a simple, safe, and inexpensive intervention (and the many opportunities at our fingertips) there’s no reason why we can’t eliminate iodine deficiency disorders by 2020. Together, with your help, and in our lifetimes, we can achieve the elimination of population-level iodine deficiency and save hundreds of millions of lives.
Jonathan Gorstein is executive director of the Iodine Global Network and clinical associate professor in the departments of global health and nutrition at the University of Washington. Greg S. Garrett is director of food fortification at Global Alliance for Improved Nutrition and serves on the board of directors of the Iodine Global Network.