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Presentation Bioethics Congress 2010

Presentation Bioethics Congress 2010



Ukraine September 2010

Ukraine September 2010



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    Presentation Bioethics Congress 2010 Presentation Bioethics Congress 2010 Presentation Transcript

    • 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
    • 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
    • Progress in the RegionSE Europe and CIS during the Decade2000 - 2009
    • 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
    • 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
    • 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
    • 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
    • Iodine Deficiency and Salt Iodization in Ukraine and other Industrialized Countries
    • 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
    • 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
    • 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
      $36,586,000 Each Year
    • What Would a Prevention Strategy Cost? Cumulative Projections over 10 Years
      3-Year Investment 1.375 million US$
      Break-even at 4 Years
      10-Year Benefit : Cost Ratio 44.6
    • 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
    • Most of the Salt Intake is from Consuming Industrially Processed Foods
    • Bread & Cereals are Major Commodities
      in the Total Food Salt Intake
    • 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
      Bread bakeries 93% adoption
      Households 65-70% coverage
      Iodine supplement use 5-21%
    • 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
      Rye Bread 1.4 - 38 mg iodine/kg
      Wheat Bread 0 – 46 mg iodine/kg
      Household salt 0.6 - 31 mg/kg
    • Other Examples of Selective Salt Iodization Strategies
      Australia & New Zealand
      Norway, Finland
    • Suggestions and Next Steps
    • 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?
    • The 3 Compelling Imperatives
      “The State Continues Bleeding Money”
      Human Rights
      “Unborn Babies cannot Choose”
      “The Greatest Benefit for the Greatest Number”
    • 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