Presentation Bioethics Congress 2010


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Ukraine September 2010

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Presentation Bioethics Congress 2010

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