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Presentation Bioethics Congress 2010

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Ukraine September 2010

Ukraine September 2010

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  • 1. Realization of a National Strategy for the Prevention and Controlof Iodine Deficiency Disorders
    Frits van der Haar, PhD
    Emory University, School of Public Health
    Atlanta, Georgia, USA
  • 2. Main Themes of Presentation
    Progress in the Prevention of Iodine Deficiency in South-East Europe and the Commonwealth of Independent States during 2000-2009
    Iodine Deficiency in Ukraine
    Relationships of Dietary Iodine Supplies and Salt Iodization Strategies in Industrialized Countries
    Recommended Next Steps
  • 3. Progress in the RegionSE Europe and CIS during the Decade2000 - 2009
  • 4. 4 more countries have attained USI
    2 more are close to the goal
    4 more have coverage of 50-69%
    Thenumber of countries with coverage <50% fell by 8
  • 5. A Decade of Action in National Salt Iodization Strategies in S.E. Europe and CIS
    End-of-Decade situation
    Plentiful iodized salt supplies and optimum iodine nutrition realized in ARM, BEL, BiH, BUL, GEO, KAZ, KOS, MAC and TUR
    Plentiful iodized salt supplies and iodine nutrition almost optimum in AZE, KYR, MOL, MON, ROM and SER
    (15 out of 20 countries = 75% success rate)
    Iodized salt supplies are facing operational challenges, and iodine nutrition improving but not yet adequate in ALB, TAJ and UZB
    No principle decision on salt iodization, dietary iodine supplies are stagnant, and persisting evidence of insufficient iodine nutrition in RUS and UKR
  • 6. Iodine Nutrition Achievements during the Decade 2000-2009
    Urinary Iodine Concentrations in School-age Children
    Balkan Area
    CIS Area
    Urinary Iodine Concentrations in Pregnant Women
    CIS Area
    Balkan Area
    * Women in Ukraine and Kazakhstan were not pregnant
  • 7. What are Reasons for Success?
    Partnership Collaboration: Positive Common Testimony by the Key Stakeholders on:
    The need to ensure plentiful iodized salt supplies for prevention of brain impairment in each new generation of citizens
    The feasibility of national legislation/regulation to achieve optimum iodine nutrition of the population
    Evident Concern to ensure quality iodized salt supplies among the salt industry/trade sector, the food authority/inspection and the consumer rights/interests organizations
    Regular Monitoring by public health institutions, using up-to-date methods and technology, striving for high standards in analysis and reporting, and promoting publicity of the results
    International Collaboration, including an official request for independent acknowledgment of successful national achievement
  • 8. Iodine Deficiency and Salt Iodization in Ukraine and other Industrialized Countries
  • 9. Ukraine: Surveys of Adult Women
    Kravchenko V, 2005-2007
    48 Sites covering Ukraine
    Academy Medical Sciences, 2002
    National Micronutrient Survey
    Recommended range
    (100 - 200µg/L)
    Recommended range
    (100 - 200µg/L)
    Iodine from natural food: 64µg/L
    from iodized household salt: 22µg/L
    Iodine from natural food: 66µg/L
    from iodized household salt: 23.5µg/L
  • 10. 50% Shortfall When Women Enter Pregnancy
    Minimum UI for pregnant adult women
    Minimum UI for non-pregnant adult women
    From iodine
    inhousehold salt
    From iodine
    in common foods
  • 11. Damage Assessment Report 2006: Losses due to Iodine Deficiency
    Intellectual Impairment in Newborns
    33,068 Births Each Year
    Loss of IQ Points 446,418 Annually
    Future Foregone Economic Earnings
    $36,586,000 Each Year
  • 12. What Would a Prevention Strategy Cost? Cumulative Projections over 10 Years
    3-Year Investment 1.375 million US$
    Break-even at 4 Years
    10-Year Benefit : Cost Ratio 44.6
  • 13. Would Iodized Household Salt be Adequate to Prevent Brain Damage?
    Pregnant women
    Normal range
    School children
    Firsova N, Demina T et al, Donetsk Medical University, 2007-2008
  • 14. Most of the Salt Intake is from Consuming Industrially Processed Foods
  • 15. Bread & Cereals are Major Commodities
    in the Total Food Salt Intake
  • 16. Salt Iodization Practices in Western Europe: Example of The Netherlands
    Iodization Standards:
    Bread salt 50-65 mg iodine/kg
    Household salt 15-25 mg/kg
    Both Standards are not Mandatory
    Normal range
    Realization:
    Bread bakeries 93% adoption
    Households 65-70% coverage
    Iodine supplement use 5-21%
  • 17. Salt Iodization Practices in Western Europe: Example of Denmark
    Iodization Standards:
    Bread salt 13 mg iodine/kg
    Household salt 13 mg/kg
    Both standards are mandatory
    Recommended intake
    Average requirement
    Median Increase: 63µg/d
    Realization:
    Rye Bread 1.4 - 38 mg iodine/kg
    Wheat Bread 0 – 46 mg iodine/kg
    Household salt 0.6 - 31 mg/kg
  • 18. Other Examples of Selective Salt Iodization Strategies
    Belarus
    Germany
    Australia & New Zealand
    Norway, Finland
  • 19. Suggestions and Next Steps
  • 20. Major Issues that may be Delaying National Decision-Making
    The Need for a Population Approach
    Nutrition is not Pharmacology
    Insistence on Free Consumer Choice
    The Problem is only “Mild”
    Do we Choose for Prevention or Correction?
  • 21. The 3 Compelling Imperatives
    Economics
    “The State Continues Bleeding Money”
    Human Rights
    “Unborn Babies cannot Choose”
    Ethics
    “The Greatest Benefit for the Greatest Number”
  • 22. Suggested Next Steps
    Consider the DifferentSalt Supply Channels
    Choosea Selective Iodization Strategy that
    Benefits the Largest Possible Population Share
    Focuses on Prevention of Newborn Brain Damage
    Circumvents the Major Political Objections, and
    Is Proven to be Safe, Effective and Low-Cost
    Adopt an Inclusive Collaborative Approach
    Provide Positive Common Testimony