Sasha Baron Cohen has received a great deal of attention this year for his movie Borat which portrays a fictional Kazakhstan reporter poking fun at Khazakstanis and unsuspecting Americans. Neither the Kazakhstanis nor unsuspecting (and later embarrassed) U.S. “interviewees” were as amused with Cohen’s antics as were the millions who paid to see the movie. There is some good news for Kazakhstan, however, and it comes in the form of a health campaign to get the population to use iodized salt. The success of this campaign was reported in a New York Times article by Donald G. McNeil, Jr. [“In Raising the World’s I.Q., the Secret’s in the Salt,” 16 December 2006].
“Valentina Sivryukova knew her public service messages were hitting the mark when she heard how one Kazakh schoolboy called another stupid. ‘What are you,’ he sneered, ‘iodine-deficient or something?’ Ms. Sivryukova, president of the national confederation of Kazakh charities, was delighted. It meant that the years spent trying to raise public awareness that iodized salt prevents brain damage in infants were working. If the campaign bore fruit, Kazakhstan’s national I.Q. would be safeguarded. In fact, Kazakhstan has become an example of how even a vast and still-developing nation like this Central Asian country can achieve a remarkable public health success. In 1999, only 29 percent of its households were using iodized salt. Now, 94 percent are. Next year, the United Nations is expected to certify it officially free of iodine deficiency disorders. That turnabout was not easy. The Kazakh campaign had to overcome widespread suspicion of iodization, common in many places, even though putting iodine in salt, public health experts say, may be the simplest and most cost-effective health measure in the world. Each ton of salt needs about two ounces of potassium iodate, which costs about $1.15.”
Such campaigns are taking place around the world. South Africa, for example, has also made significant strides in getting its population to use iodized salt. It deploys inspectors around the country to test salt in local stores to make sure it is iodized. The South African government considers this such an important issue that any store owner caught selling non-iodized salt is jailed.
“Worldwide, about two billion people — a third of the globe — get too little iodine, including hundreds of millions in India and China. Studies show that iodine deficiency is the leading preventable cause of mental retardation. Even moderate deficiency, especially in pregnant women and infants, lowers intelligence by 10 to 15 I.Q. points, shaving incalculable potential off a nation’s development. The most visible and severe effects — disabling goiters, cretinism and dwarfism — affect a tiny minority, usually in mountain villages. But 16 percent of the world’s people have at least mild goiter, a swollen thyroid gland in the neck.”
The effects of iodine deficiency have been known for a long time, but an organized global campaign to eradicate it was only organized sixteen years ago.
“The 1990 World Summit for Children called for the elimination of iodine deficiency by 2000, and the subsequent effort was led by Professor [Jack C. S.] Ling’s organization [the International Council for Control of Iodine Deficiency Disorder] along with Unicef, the World Health Organization, Kiwanis International, the World Bank and the foreign aid agencies of Canada, Australia, the Netherlands, the United States and others. Largely out of the public eye, they made terrific progress: 25 percent of the world’s households consumed iodized salt in 1990. Now, about 66 percent do.”
That is another testament to the fact that when communities of practice arise and use best practices and recognized standards — in other words, the Development-in-a-Box™ approach — remarkable achievements can be accomplished. The goal of the World Summit was to eradicate Iodine Deficiency Disorder by 2005. Although that didn’t happen, the strides that have been made are impressive. Among the reasons the Summit’s goal hasn’t been achieved is ignorance — ignorance on behalf of local salt manufacturers who don’t realize the power of their product as well as ignorance by the public who fear the introduction of iodine into their food.
“In many places, like Japan, people get iodine from seafood, seaweed, vegetables grown in iodine-rich soil or animals that eat grass grown in that soil. But even wealthy nations, including the United States and in Europe, still need to supplement that by iodizing salt. The cheap part, experts say, is spraying on the iodine. The expense is always for the inevitable public relations battle. In some nations, iodization becomes tarred as a government plot to poison an essential of life — salt experts compare it to the furious opposition by 1950s conservatives to fluoridation of American water. In others, civil libertarians demand a right to choose plain salt, with the result that the iodized kind rarely reaches the poor. Small salt makers who fear extra expense often lobby against it. So do makers of iodine pills who fear losing their market. Rumors inevitably swirl: iodine has been blamed for AIDS, diabetes, seizures, impotence and peevishness. Iodized salt, according to different national rumor mills, will make pickled vegetables explode, ruin caviar or soften hard cheese. Breaking down that resistance takes both money and leadership.”
It took a long time for the campaign in Kazakhstan to take hold and it took a lot of people working together to make it a success.
“In the 1990s, when the campaign for iodization began, the world’s greatest concentration of iodine-deficient countries was in the landlocked former Soviet republics of Central Asia. All of them — Kazakhstan, Turkmenistan, Tajikistan, Uzbekistan, Kyrghzstan — saw their economies break down with the collapse of the Soviet Union. Across the region, only 28 percent of all households used iodized salt. … In 1996, Unicef, which focuses on the health of children, opened its first office in Kazakhstan and arranged for a survey of 5,000 households. It found that 10 percent of the children were stunted, opening the way for international aid. (Stunting can have many causes, but iodine deficiency is a prime culprit.) In neighboring Turkmenistan, President Saparmurat Niyazov — a despot who requires all clocks to bear his likeness and renamed the days of the week after his family — solved the problem by simply declaring plain salt illegal in 1996 and ordering shops to give each citizen 11 pounds of iodized salt a year at state expense. In Kazakhstan, the democratic credentials of President Nursultan A. Nazarbayev, who has ruled since 1991, have come under criticism, but he does not rule by decree. … Importantly, however, the president was supportive. But even so, as soon as Parliament began debating mandatory iodization in 2002, strong lobbies formed against the measure. The country’s biggest salt company was initially reluctant to cooperate, fearing higher costs, a Unicef report said. Cardiologists argued against iodization, fearing it would encourage people to use more salt, which can raise blood pressure. More insidious, Dr. Sharmanov said, were private companies that sold iodine pills. “They promoted their products in the mass media, saying iodized salt was dangerous,” he said, shaking his head. So Dr. Sharmanov, the national Health Ministry, Ms. Sivryukova and others devised a marketing campaign — much of it paid for by American taxpayers, through money given to Unicef by the United States Agency for International Development. Comic strips starring a hooded crusader, Iodine Man, rescuing a slow-witted student from an enraged teacher were handed out across the country. A logo was designed for food packages certified to contain iodized salt: a red dot and a curved line in a circle, meant to represent a face with a smile so big that the eyes are squeezed shut. Also, Ms. Sivryukova’s network of local charity women stepped in. As in all ex-Soviet states, government advice is regarded with suspicion, while civic organizations have credibility. Her volunteers approached schools, asking teachers to create dictation exercises about iodized salt and to have students bring salt from home to test it for iodine in science class. Ms. Sivryukova described one child’s tears when he realized he was the only one in his class with noniodized salt. … By late 2003, the Parliament finally made iodization mandatory.”
That’s one story Borat is unlikely to cover.
“Kazakhstan was lucky. It had just the right mix of political and economic conditions for success: political support, 98 percent literacy, an economy helped along by rising prices for its oil and gas. Most important, perhaps, one company, Aral Tuz, makes 80 percent of the edible salt. That combination is missing in many nations where iodine deficiency remains a health crisis. In nearby Pakistan, for instance, where 70 percent of households have no iodized salt, there are more than 600 small salt producers.”
The right approach, dedicated people, and dynamic leadership are keys to helping bring billions out of poverty and distress. This holiday season is a good time to reflect on how blessed we are in the developed world and to once again resolve to shoulder our moral obligation to make life better for others. There are so many challenges in the world right now that “donor fatigue” is a real and serious problem. Success stories, like spreading the word about iodized salt, are necessary to remind us that progress can be made.