|The Prevention and Control of Iodine Deficiency Disorders - Nutrition policy discussion paper No. 3 (UNSSCN, 1988, 130 p.)|
The recent WHO success in eradicating smallpox raises the possibility of similar approaches to other preventable diseases. Such an objective seems appropriate for both iodine deficiency and vitamin A deficiency (WHO, 1984). Certain requirements must be met for an eradication programme to be feasible. These are:
1. The problem is important and of sufficient size;
2. There are effective preventive measures for mass use;
3. Delivery systems are available;
4. Practical measures exist for monitoring and evaluation.
This report sets out to show that these requirements are indeed met where IDD are concerned. The necessary resources must now be found to prepare, implement and evaluate plans for prevention and control.
Increasing momentum has already been generated by some demonstrable success of major national iodization programmes in the large iodine-deficient populations of Indonesia (Dulberg et al., 1983) and China (Ma et al., 1982). Some successes in smaller countries, e.g., Guatemala and Papua New Guinea, were achieved earlier (Thilly and Hetzel, 1980).
These large national programmes have used both iodized salt and injections of iodized oil. The convenience and effectiveness of the latter in correcting severe iodine deficiency as originally shown in Papua New Guinea has made eradication more feasible because of its suitability for many millions of people, particularly in Asia, who are living by subsistence agriculture, and whose diet cannot be adequately supplemented with iodine through their salt supply.
Public health programmes (including IDD control programmes) should concentrate on areas where economic development is likely to be delayed. IDD are likely to regress in association with economic development due to diversification of the food supply, providing an increased intake of iodine, as has occurred in parts of Europe since 1920. In regions in developing countries where significant development is not likely to occur yet for some time, however, the persistence of IDD can be anticipated and justifies a public health intervention.
Much more than technology is involved in a global IDD-control strategy, however. It requires the spreading of information to the many millions living in iodine-deficient regions who are at risk. Only awareness of the problem will encourage political and financial commitment, and this is particularly important in maintaining the required continuity of effort.
A high proportion of the start-up costs of a large-scale control programme may have to be borne by international agencies and bilateral donors. Effective action depends, however, on governments, which will have to shoulder recurrent costs eventually, and their willingness to do so will depend in turn on an informed electorate. In this way the elimination of IDD as a significant public health problem could come about.
The World Health Assembly in May 1986, noted that total prevention and control of IDD by reducing goitre rates below 10 percent in school children is feasible within the next five to ten years (39th World Health Assembly, Resolution 29). It also noted that such control would lead to improved quality of life and productivity, and improved educability of children and adults, for many millions living in the iodine-deficient areas of the world.
A great opportunity exists to remove or control an ancient scourge of mankind. The necessary knowledge and technology are available; what is needed now is their effective application in national public health programmes.