FACTS againest MYTHS V0L-IV-5-1997
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- FACTS againest MYTHS V0L-IV-5-1997
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VIKAS ADHYAYAN KENDRA
'97 VOL IV #5
INFORMATION BULLETIN
Being True to One’s Own Salt:
The Myths of the Universal Salt Iodisation
M
n 1994, India adopted the policy of Universal
X
Iodisation of Salt (UIS), first launched in 1954
by WHO. Since then the market for iodised salt has
increased, adversely affecting the ready availability of
‘common salt’, an essential item of Indian culinary
tradition since ages. Further, on January 28, 1998
through an Executive Order, the Central
Government’s Food and Agriculture Ministry banned
the storage, sale and use of common salt, making it a
criminal offence punishable by a fine of Rs. 1000/- and/
or imprisonment upto 6 months. The ban has come in
force not through a Central Act but by invoking Clause
IV of Section 7 of the Prevention of Food Adulteration
Act 1954. Such a major decision involving millions of
Indians has thus been taken and imposed upon them
totally by-passing the parliamentary procedure.
The ban has been imposed on the grounds that almost
all states of India are endemic to a range of Iodine
ficiency Disorders (ODD), the most prominent of
se being goitre, the swelling of thyroid gland in the
throat. It is also being argued that iodisation of salt is
the most effective method of conrolling and reversing
IDD as salt is used by all people in their diet in more
or less the same quantity. The move of UIS is backed
by UNICEF, International Council for Control of
Iodine Deficiency Disorders (ICCIDD) and a section
of Indian scientists.
«
Strategy of IDD Control
Although goitre and its treatment is mentioned in
ancient Ayurvedic texts, organised efforts based the
modern approach to goitre control were initiated in
India in 1955 through adoption of National Goitre
Control Programme (NGCP). They concentrated on
endemic pockets in the 2000 km stretch of land from
sub Himalayan range to North-Eastern states. Based
on the evidence from European countries, deficiency
of iodine was presumed to be the sole cause of IDD;
and hence the supply of iodised salt was employed as
the only strategy to counter IDD. In 1983, an
investigative report by Nutritional Foundation of
India (NFI) severely criticised the government for the
failure of NGCP. The Central Government in response
appointed a Task Force under the chairmanship of the
then Salt Commissioner, P. Subramaniam. The Task
Force recommended UIS by 1990 on the following
grounds :i. Difficulty in keeping out non-iodised salt from
endemic areas;
ii. Prevalence of IDD throughout the country;
iii. Lack of ill-effects of iodised salt in normal
individuals.
Interestingly, a new ‘mapping’ of IDD-endemic areas
carried out just before the Task Force Report showed
that IDD has spread to almost all States, including
coastal areas rich in Iodine. Although a number of
nutritionists, endocrinologists, biochemists, physicians
and voluntary agencies challenged the veracity, of the
criteria on which the decision of UIS was taken, the
government ignored all their pleas, and finally initiated
the implementation of UIS throughout India w.e.f. May
28, 1998. The government and the monopoly houses
selling branded iodised salt have initiated high pitched
media campaigns to warn people that cansumption of
‘common’ salt would result in goitre, mental
retardation and hamper intellectual development of
children.
A major fallout of these developments is the massive
erosion of the market of ‘common salt’ rendering lakhs
of people engaged in its manufacture, trading and salt
jobless. The skyrocketting of prices of salt has
immensely benefited large monopoly houses selling
‘branded’ iodised salt. Most affected have been the poor
especially the actual or potential victims of IDD.
Fishworkers who have been using crystalline salt for
preservation of fish find powdered, ‘branded’ salt too
FACTS against MYTHS
#5’97
FOR PRIVATE CIRCULATION ONLY
Page 1
All these developments affecting peoples lives raises a
number of disturbing questions regarding the whole
campaign of the so-called UIS programme. It is
imparative to therefore scrutinise the programme and
demystify its relevance to peoples health. The first step
however in this direction is the outright dismantling
of the various myths being propagated by vested
interests in the promotion of iodised salt. For this let
us acquaint ourselves with the basic facts related to this
issue.
MYTH : Iodine deficiency is prevelant in all parts of
India and hence the entire nation is endemic to IDD.
That is why UIS is a must.
FACT : Not so! The claim must be challenged on
conceptual and methodological grounds. The inferences
drawn and extrapolation made from available data
have been proved to be highly exaggerated, misleading
and biased.
A study shows that in the last few years, coinciding
with the new proposed policy of universal iodisation,
the figures for Goitre and cretinism have been grossly
exaggerated. The very definition of an “endemic
district”, as put in practise by the National Goitre
Control Programme is totally faulty in that “A district
is considered endemic when the prevalence rate of
Goitre is 10% or more”. But what about the remaining
population of 90%? And what about the impact of
iodine over-use?
Regarding the IDD affected population consider the
following:
❖ During 1950-70, 40 million were onsidered to
be at risk ofIDD, with 9 million affected in India;
In 1981-82, WHO reported 150 million to be at
risk of IDD, with 54 m. having actual Goitre, 2.2 m.
suffering from cretinism, and 6.6 m. affected by milder
neurological defects attributed to iodine deficiency;
❖ In 1997, even higherfigures of300 million exposed
and 60 m. having Goitre were quoted.
Scientific evidence to support these figures, however,
is non-existant. Further, these figures have not been
arrived at on the basis of detailed studies but highly
questionable mathematical models and callous
administrative methods (like taking 10% of Goitre
prevalence for declaring a district as “endemic”).
Consequently, the maps demonstrating Goitre
endemic areas are patently false. For example, a few
isolated pockets in Maharastra have been surveyed.
This led to the whole state being shaded and shown as
“endemic goitrous”. This undoubtedly is a faulty design
of survey at work. Similarly, the figures for M.P. too
are false. There are other glaring examples,viz.,
i
•
Iodine is a micro-nutrient needed by the body
■for performing various vital functions. The
daily requirement of iodine depends upon age
• and'-is slightly higher in pregnancy/lactation.
(Cf. Table below)
—MB
Hi
expensive and inappropriate for their daily needs. Thus,
UIS would greatly affect the traditional fishing
industry.
Age
Intake (micrograms)
0-6 months
40
6-12 months
50
1-10 years
70-120
11 years-adulthood
120-150
Pregnancy
175
Lactation
.200
Source: ICMR Bull, Vol. 26, No. 6
(A Microgram (mg) is a thousandth part of a milligram-mg)
The requirement of iodine is almost same for
people living in different parts of world. The
total iodine required by an individual in the
lifetime would be accommodated on tip of a pin.
However, like other micronutrients, e.g.
vitamins, iodine needs to be supplied to body
everyday. An intake of excess iodine at one time
is not useful as the body excretes the excess
iodine immediately. High excess (daily 1 mg or
more)-if taken regularly can cause , toxic
reactions. However, intramuscular injections of
iodised oil can serve as a depot which releases
iodine slowly over a period of 2-4 years.
Sources of Iodine
Iodine is mainly deposited in soil and water.
Large amounts of iodine have been leached from
the surface soil by glaciation, snow and rain and.
carried by wind and rivers. Hence, the occean is 1
the biggest reservoir of iodine Each litre of sea
water contains 50-60 mg of iodine. Water from
deep wells and oil well effluents are also rich in
iodine.
Iodine' occurs as iodide ions in nature. In
presence of sunlight, iodide is oxidised to
elemental iodine, which escapes into the
atmosphere. Every year about 4 lakh tons of
iodine is lost from seas to the atmosphere where
its.concentratidn is much lower (about 0.7 mg/
m3). Through rain and snow, it is deposited on
the mountain tops and soil and is ultimately
carried back to the ocean. Hence, salt prepared
from sea water 'naturally’ naturally contains'5.8
mg. of iodine per. gm. of salt (without 'any
fortification).
Page 2
V The most quoted study involves comparison ofonly
26 goitrous subjects in the Himalayas with controls in
England! The levels ofboth T} as well as TSH in subjects
were found to be higher than controls. Although this data
suggests near normalfunctioning of.thyroid, the inferences
drawn from it were totally misleading;
Although only 1% children in goitre-prone areas
sufferfrom cretinism, it was reported that 15% ofchildren
suffer from varying degress of mental retardation using
misleading terms like 'subclinical cretinism". One such
study involved comparison of 26 children of goitrous
mothers with 20 controls, using a highly subjective and
racist tool ofIntelligence Quotient (IQ) and Development
Quotient (DQ). Although the result revealed mean DQ
of98.4 and 94.4 for control and other group respectively
the minor difference between both sets ofDQ was blown
out ofproportion Jby faulty use ofstatistics;
Aravindan puts estimate of people affected as follows :
total goitre cases -10 m, visible goitre - Im, and those
producing clinical problems 0.15 m. Some sources cite
|^ven lower numbers.
MYTH : Iodine deficiency is the single major cause of
goitre and other problems related.to thyroid
disfunctioning.
However, regions exposed co prolonged
leaching remain deficient in iodine as the return
of iodine to soil through natural cycle is
incomplete. Hence, in India the Himalayan
slopes, the Gangetic plain and the North Eastern
States show persistent iodine deficiency. All
crops grown in this soil and hence the human
and animal population which grows on it
become iodine-deficient. Iodine content of
plants in iodine-deficient soil is much lower
(upto 10 mg/kg) than in other regions (lmg/
kg) both on dry weight basis. Similarly iodine
levels in water in iodine deficient area was found
to be below 2 mg/litre as compared to that of 9
mg/litre in, for instance, Delhi which is not
iodine deficient.
Iodine Content of Foods
For those residing in non-iodine defincient areas,
normal diat (vegetarian or non-vegetarian) can
supply sufficient iodine. The average iodine
content of foods is shown in the following Table:
. Average Iodine Content of Foods (in micrograin)
FACT : This myth is based on the knee-jerk reference
to experiments conducted in the West. For instance,
experiments conducted in Debbyshire and
Switizerland are often quoted. However, these studies
carried out in temperate countries may not apply to
countries like India with tropical climate.
Although the relationship between iodine-deficiency
and problems related to thyroid disfunctions e.g. goitre
has been well-established, several other goitrogens have
been identified in recent years. They, include
thiocyanates, Propyl Thiouracil and Methyl Mercapto
Imidazole. They occur in as diverse and common
sources as plant foods e.g. certain tubers, insecticides,
.pesticides and potable water contaminaed with sewage,
"environmental pollutants and medicines like
tetracyclines and sulphonamides too affect thyroid
functioning.
Thyroid-related problems are also on the rise in most
industrialised nations and also in urban India, specially
among women. The advocates of UIS programme claim
that all states and union territories in India to be goitreprone but they have not traced the goitrogenic agents
responsible for it. A 1986 ICMR Survey of 10 States
show that the diet of average Indians including lower
income families contains iodine equal to 2-3 times the
Recommended Daily Allowance (RDA) of 150
microgram (daily intake of even 50 microgram can
prevent goitre). Residents in coastal areas definitely
consume iodine in quantities greater than RDA. Hence,
either excess of iodine supplied through iodised salt or
some other goitrogen may be responsible for the
FACTS against MYTHS
Food
Fresh basis
■
Dry basis
Mean
Range
Mean
Range .
Fish (freshwater)
30
17-40
116
68-194’ |
Fish (marine)
832
163-3180
3715
Shellfish
798
308-1300
386
Meat
50
27-97
-
471-4591 |
1292-4987|
Milk
47
35-56
-
-
Eggs
93
.4 — 1‘
-
ft
Cereal Grains
47
22-72
65
34-92
Fruits
18
10-29
154
62-277
Legumes
30
23-36
234
223-245
Vegetables
20
12-201
385 ;
Quotedin Hetzel 1989
?
204-1636
\
It should, however be noted that large amount
h of iodine evaporates during cooking. A study.:.
!; shows such losses to. be 20% through frying; 23% ....
j through, grilling, and 58% through boiling. •
; Howeverr, figures may vary depending upon f
’- duration of cooking, temperature, additon of ‘ °
other ingredients etc. Similarly, data on the ' V
j • iodine content offoodstufffrom differentregions |
? of the country is lacking. As per the’ 1986-87
1
t? Report of the National Institute of Nutrition
:
h (NIN), Hyderabad, the daily avarage diet of
t . people from 15 States, including . Gujarat,
RRRHHh_Ri_ R_ HR—RRR—I———1RRB
#5*97
Page 3
occurence of IDD in this region. National Institute for
Nutrition (NIN) has identified some goitrogens in
plant foods. It is claimed that there are other sources
for the origin of Goitre viz., cauliflower, cabbage,
turnip, and mustard contain Piourea which adds to the
growth of Goitre. Plants of Basica family, groundnut
and soyabeans have also been implicated in Goitre. The
current trend of fast-food consumption also leads to
the increase in incidences of Goitre because of
preservatives added in such food.
The hardness of water could be yet another reason for
Goitre. As early as in 1954, experiments carried out
on rats showed that despite regular intake of iodine,
Goitre can emerge if the food contains more than two
percent of calcium carbonate. It will be relevant to state
that the main constituent causing heaviness of water is
calcium.
MYTH : Excess iodine causes no health hazards. And
intake of even 400 micrograms is both safe salubrious.
'FACT: The risk-benefit ratio in areas where cretinism
is an acute problem may be favourable to use iodized
salt even by paying a price of such hazardous effects.
But it is patently illogical to subject our entire
population to such risks where the use of iodized salt
is unwarranted.
Milder forms of endemic goitre were observed as a
restdt ofprophylaxis with iodised salt in US, Iran and
Iraq. Iodine-induced hyperthyroidism has been reported
in US, Tasmania (Australia), Europe and South America.
This problem is common in people above 40 years ofage.
Hence, it has been suggested that this age-group should not
be included in iodine - supplementation programmes;
❖
'Sunday Observer’ ofSeptenber 15, 1996 carried a
report ofKumkum Somani ofMumbai who is fighting a
battle against Hashimoto’s disease (caused by the use of
iodised salt) and against the government which did not
issue any warnings about the possibility of occurance of
such adverse reactions;
Academy ofNutrition Improvement, Nagpur has
published several case studies ofpeople whose health was
affected by the use of iodised salt viz;
S. D. Pathak, Raipur Dist. M. P, used iodised saltfor
10-15 years. For 4 years, he suffered from recurrent fever
every 8th day, pain in feet, sleeplessness and shivering of
hands etc. No treatment helped but the symptoms receded
and health improved after discontinuation ofiodised salt;
Haribhau Wate, Hinganghat, Dist. Wardha, suffered
from black rashes on hands andfeet and internal disorders
after the use of iodised salt on medical advice;
V The promotion ofiodized salt as a ‘restorative tonic’
or health food’ might also result in increased intake of
salt; which might precipitate problems like hypertension;
FACTS against MYTHS
Maharastra, M.P.,Karnataka, Kerala, Orissa,
U.P., Tamil Nadu and West Bengal contained
more than adequate quantities of iodine. It needs
to be emphasised that
i
1) 150 microgram is the quantity of iodine to be
supplied to body. Actual iodine content offoods
i
should be greater than 150 microgram to account
for loss in cooking, exposure to atmosphere etc.
Moreover, our diet may contain goitrogens
. (agents causing goitre), which increase our
. requirement of iodine;
f
2) Our bodies have a capacity to store iodine
and to excrete its excess. So, the figure of 150
. microgram should not be taken on its face value.
I IDD appear only when the diet is consistently
deficient in iodine for a prolonged period. Mean
daily intake of 50 micrograms or less can ;
precipitate goitre; its severity depends upon the
degree of iodine deficit.
I
Functions and Metabolism of Iodine
i ’ Iodine, in form of iodide, supplied through food
and water is rapidly absorbed in blood through
j the gut. Evefday about 60 microgram of iodine
is trapped by thyroid gland, which is the largest
depot of iodine in the body. The entire human
body contains 15-20 mg of iodine, 70-80% of
which is stored in the thyroid. Excess, iodine is
excreted through urine.
Thyroid secretes thyroxi, a harmone essential for
'. growth and development. It plays an important
f' role in production of energy, regulation of Basal
Metabolic Rate (BMR), growth and maturation
of tissues, activities of brain etc.
The functioning of Thyroid is regulated by
v intake (and hence blood level) of iodine and
Thyroid Stimulating Harmone (TSH) secreted
by the pitutary gland as shown below :-
Trioditlryronine Cf)
Iodide I
+ Tyrosine -9
\ (in Blood)
(in Thyroid) - Tetratodothyronine (T)
+
or
Thyroxine ’
(in.thyroid)~9(in Blood) ■
' d'T/T,
I in Blood
-9>-PTSH
in Blood
-^Stimulation -^T'T/T4
of thyroid Back to normal
In Holland, a daily prophylactic dose of only 100
micrograms resulted in increased incidences of
thyrotoxicosis, within 6 months of onset of iodine
prophylaxis program. The effect persistedfor as long as 10
years. Hence, the risk ofsupplying about 150 micrograms
of iodine through salt to a population consuming
#5’97
Page 4
adequate/more than adequate quantitism through diet,
should not be underestimated.
MYTH : Iodate is a stable and safe source of iodine
for human consumption in tropical countries.
FACT : Iodate is more stable than iodide in tropical
climate but its safety is dubious. It is not used for human
consumption in any other parts of the world,
particularly in countries of the North as it is a poison.
The Ministry of Enviroment, Government of India
had also opposed the move of ‘UIS’ as potassium iodate
is shown to be toxic.
Studies in Australia to evaluate the impact of
fortification of bread with iodate had shown high
incidence of ‘thyrotoxicosis’. While some experts
maintain that iodate breaks down and gets assimilated
rapidly into the body, its safety remains suspect for
lack of data on long-term use and because it is an
oxidising agent. Normal food contains only reducing
agents.
^MYTH : Iodised salt being low-cost is affordabale to
Wvew the poor in maximum need ofiodine and its cost
is not much higher than common salt.
FACT : The claim is based on the logic that as the
govermemt is subsidising the cost of potassium iodate
to all manufacturers of iodised salt and helping smallscale manufacturers to set up iodisation plants, the price
of iodised salt would not be much higher than that of
ordinary salt.
Ground realities however present an altogether
different perspective. Prior to compulsory iodisation
of salt, common salt was available to consumers at 50
paise/kg.
The cost of powdering salt, mixing it with iodate and
packaging it cannot exceed 30-40 paise per kg. Hence,
the steep rise in price of salt in recent years can only be
attributed to the unscrupulous profiteering by private
monopoly houses. The following table is self
Year
Brand
1989
(uniodised)
Tata
Sambhar
1995
1998
Type of
Manufacturer
Retail
Price
RsJKg
Small Scale
Large Scale
0.50
1.50 to 2.00
4.50
4.50
35.00
Tata
Captain Cook
Catch
Tata
Captain Cook
Kisan
MNC/Large Scale
Source: From Ref 6 and Market Survey
FACTS against MYTHS
6.00
6.00
6.00
j
Thus, iodine occus in bound form, as T and T
in thyroid, part of which is also secreted in
blood. Iodine deficit stimulates TSH secretion
which stimulates thyroid to produce more T;
and Tt and bring their levels back to normal.
Thus, hypothyroidism (decreased functioning
of thyroid) is caused by low iodine intake and is
charaterised by lower levels of T and T4 and
higher levels of TSH. It is manifested through
goitre and other IDD.
Hyperthyroidism (enhanced functions of
thyroid) is caused by excess of iodine (or by
adequate iodine supplementation to elderly
people with a long history of iodine deficiency).
It is characterised by increased T3 and T4 levels
and lowered values of TSH. It is manifested
through thyrotoxicosis.
IDD
The entire spectrum of IDD for all age groups
is shown in the Table below. Of these, goitre, is
well-known. But the less known IDD like
cretinism are more damaging. It needs to be
noted that pregnant dnd lactating women are the
most susceptible to iodine deficiency. The mothers
iodine deficiency is passed on to the offsprings
which, in turn, affects its mental and physical
development. The IDD can be reduced or
reversed by adequate supply of iodine, specially
in chiIdren. ’.
e state of Dev.
J Disorder
Foetus
Abortions
Stillbirths
Congenital anomalies, Increased
perinatal mortality
Increased Infant mortality
Neurological cretinism (mental
deficiency, deaf mutism, spastic
diplegia, squint)
Myxoedematous cretinism (dwarfism,
mental deficiency)
Psychomotor defects
Neonate
Neonatal goitre
Neonatal hypothyroidism
Child &
adolescent
Goitre
Juvenile Hypothyroidism
Impaired mental function
Retarded physical development
Adult
Goitre with its complications
Hypothyroidism
Impaired mental function
Iodine-induced hyperthyroidism
All Ages
Increased susceptibility to nuclear
radiation
ww.
Page 5
As per 1989 estimates, consumers had to pay Rs. 500
crores for iodisation. The present figure is around Rs.
2500 crores. Salt being an essential commodity, is
required by all, almost to the same extent. Hence, such
a drastic rise in its price hits the poor the hardest. People
in remote hilly areas need iodized salt the most. The
earlier efforts to eradicate IDD endemic in hilly areas
were defeated, precisely because the poor could not
afford the higher price (which is much less than today’s
prices) of salt and hence they preferred to buy cheapn
non-iodised salt. Even today, Adivasis buy salt on
barter system. It is mostly a one-time purchase of large
quantity. With severe cash constraints, purchase of
expensive iodized salt is beyond their means. Often salt
containing little or no amount of iodine is peddled in
these areas as iodized salt. The expensive iodized salt
has captured the market of big cities, where most people
do not need it. But iodised salt required by the needy
would either not reach them, or it reaches them late
when most iodine has been lost to atmosphere.
MYTH : Large number of small-scale salt
manufacturers are the real obstacles to the success of
the salt iodisation programme.
FACT: In 1987, about 8000 small scale manufacturers
produced about 60% of edible salt, from sea water. For
iodisation, it is necessary to produce the crystalline salt,
mix it with potassium iodate and pack it in sufficiently
strong polyethene bags to prevent iodine-loss.
Although lowcost technology for iodisation at small
scale is available, small manufacturers cannot afford to
use it without consistent government support. These
small scale manufacturers cannot survive against the
high-pitched ad campaigns of large scale manufacturers.
Hence, their share in the market is continuously
declining, resulting in loss of employment to lakhs of
people (workers in salt farms as well as sellers).
The real hindrance in success of iodised salt programme
is lack of focus on genuinely affected areas, the
unregulated private sector, the absence of health
education and the centralised, trickle-down approach
of the programme.
MYTH : Iodised Salt sold by large-scale
manufacturers is far superior in quality, (prepared
more hygienecally, with correct iodine content) than
common salt sold by small scale manufacturers.
FACT : A study of 10 brands of iodised salt carried
out by CERC, Ahmedabad in 1995 revealed that 2 had
too less, 1 had borderline and 6 had excess of iodine as
compared “to the legally stipulated limit (30 ppm at
manufaturers end). One product showed 6% less weight
of product as compared to the labeled claim (Even the
labeled claim of 900 gm. is misleading as most people
would buy it as a standard lkg. pack). 6 products
contained a few impurities, 1 was lumpy, 3 had both
black particles and lumps, 1 had white particles and 2
had dirt particles.
FACTS against MYTHS
'
Other Dimensions
|
Even according to these proponents of UIS, 'one
ofthe reasonsfor appearance ofgoitre in new areas
may. be excessiveflooding and changing course of
rivers brought about by extensive deforestation. It
is now also known that large dams cause floods',
deforestation and change in course of rivers.
Goitrogens: Several chemicals, found in food,
pesticides, and insecticides have been shown to cause goitre. In their presence, body requires
more iodine to prevent goitre.
I
Poverty and Resultant Mal-nourishment is an .
important causative factor for IDD. A 1989Report about NGCP in Maharastra clearly . |
stated that goitre was'the result of malnutrition
. and hunger. The poor residing in non-endemic
areas may be affected by IDD if they cannot
afford to buy food in iodine. In the endemic
areas, the worst affected are Hie poor.
A salt substitute ‘B.P. Salt’, priced at Rs. 64.65/kg.
claimed to be the ‘right choice for the right Blood
Pressure’ and carried a picture of heart and of ECG on
its label; thereby indicating its utility in heart
problems. It claimed to have made use of Tata salt, in
which 50% sodium chloride was replaced by potassium
iodide. Actual analysis revealed 80% potassium and
20% sodium. Such large doses of potassium may cause
gastro-intestinal irritation, purging, weakness and
circulatory disorders. It is specially hazardous for those
suffering from certain heart and kidney diseases. The
product carried no warning on its label that it was not
to be used freely or on a routine basis.
Most ‘refined’, branded products are either by-products
of chemical industries or are derived from sea salt by
removing all minerals (except sodium chloride) from
it. For a very large majority of Indians, iodine supplied
by ‘common’ salt would be sufficient, without ex|
fortification with iodide/iodate. The micronutrients
are a bonus. While iodine added externally to salt
would be lost on storage (in about 9 months), and
exposure to atmosphere, iodine naturally occuring in
it is retained.
MYTH: The government has a well equipped, efficient
and modern machinery required to safeguard and
control the quality ofiodised salt.
FACT: Ground realities indicate an altogether
different picture. For instance,
❖
The task ofdetailed mapping ofareas ofhigh IDD
occurance, based on reliable scientific criteria, has not even
begun;
❖ The question ofidentifyng goitrogens responsiblefor
goitre in iodine-rich areas has also not been addressed. As
#5’97
Page 6
j
the problem ofIDD is not placed in proper perspective, its
‘ solution is bound to remain elusive;
V
The commitment ofproviding and sensitizing the
infrastructure laid down in the Act and Rules has not
been fulfilled. For the Ministry of Health and Family
Welfare, its role is over the moment legal measures were
announced. As the result oftesting ofmarketed brands of
salt by CERCand other agencies indicate there areglaring
lacunae in the implementation-iodine content is not
monitored, non-iodised salt is freely available in hilly
regions most prone to IDD; labelling requirements are
flouted; exaggarated and unsubstantiated claims are being
made in the mass media and on labels. There is no price
control.
It has failed in its commitment— through exemplary
action — against erring manufacturers. The only area
where it has shown unnecessary alacrity is in closing
down the business of small scale producers and sellers
of common salt. Field level reports even from muchacclaimed ‘success’ areas (e.g. M.P.) reveal several
^vGlures of the government programme. As is common
in any government programme, data would be ‘cooked’
or ' doctored1 and a facade of successful implementation
of Act would coninue for some time. A government
which cannot even stop the production and marketing
of drugs banned (adulterated/substandard/unsafe) by
it cannot be expected to monitor the quality of such a
widely used commodity like salt. The ultimate
effectiveness of government machinary would be
judged by the actual impact of government programme
on the prevalence of IDD.
MYTH : Compulsory Universal iodisation of salt is
the only effective way to ensure success ofIDD control
programme.
FACT : It has been established and accepted that
noniodised salt was used by people in highly endemic
areas resulting in failure of IDD control programme.
Jt would have been a better strategy to concentrate on
V^/iis highly endemic, hilly, inaccessible areas and to use
a multi-pronged approach in such areas e.g. by making
iodised salt available at subsidised price through ration
shops, to improve vigilance and prevent entry of non
iodised iodine through barter or sale, educating people,
coordinating the transportation network to ensure
availability of iodised salt etc. Instead, UIS has created
mere problems.
Iodized oil injection provides iodine sufficient for 2-4
years. Its use could be tried out in selected areas, using
the government’s public health machinary or NGOs.
However, proper precautions must be observed to rule
out the propagation of AIDs through inadequate
sterilisation of syringes and other related
complications.
'f.' '
It has been shown that even a small step like building a
road has significanly reduced the prevalence of IDD in
' certain areas.
FACTS against MYTHS
Study of food consumed by goitre-prone population
for presence of goitrogens, improving availability of
iodine-rich food and monitoring the level of iodine at
the ultimate use level are approaches which can help
curb IDDs, if not totally eradicate them.
MYTH: 'Free flow' ability is the most important
characteristic ofsalt.
FACT: This is an ad-induced, elitist, corporate claim!
A study made by Consumer Education and Research
Centre (CERC), Ahmedabd in 1989 revealed that Tata
Iodised salt contained Potassium Ferrocyanide
(prohibited by law) as anti-cooking agent. The natural
salt obtained from sea contains, apart from sodium
chloride, sizeable amount of magnesium, calcium,
potassium and other micronutrients which are benefical
to human health. They need to be removed for making
salt ‘free flowing’.
For the poor especially those living in inaccessible (and
goitre endemic) areas, price remains the single most
important criteria for buying salt. The fishworkers
who need large quantities of crystalline salt for
preserving fish find the ‘refined’ powdered salt too
expensive and inefficient for their operations. And
some voices from the kitchen complain that the salt
sold under expensive brands is not salty enough. They
require much larger (or variable) quantities of it to get
the required taste.
Conclusions
Rather than being a solution, the UIS scheme has caused
more problems. Hence, iodisation of salt be restricted
and rigorously implemented in the earlier known
endemic regions in North and East India. Mapping of
India for IDD, based on sound scientific principles
should be carried out. Research on other goitrogenic
agents, causes of iodine depletion, amount of iodine in
foodstuffs and diets in different regions should be
carried out.
In the long term, the destruction of the ecosystem
through unsrupulous use of pesticides/insecticides,
building of large dams and deforestation must be
stopped. Suitable measures should be adopted for flood
cantrol and improving quality of soil.
People should be involved in all decisions related to
their health and wellbeing. It must be remembered that
complex public health issues rooted in socio-economic
reality have no simplistic, technical solutions. IDD can
be removed only by eradicating poverty and
malnourishment.
In 1930, the British government had imposed a tax on
production of salt, resulting in hike in its price.
However, the fistful of salt became a symbol of people's
resolve for independence when Gandhiji launched the
salt Satyagraha at Dandi. The nation-wide mass-action
forced the British to repeal its order. For several
#5*97 1
Page?
References
decades the price of salt has remained very low in
accordance with Gandhiji’s directives to independent
India’s ministry.
1.
In 1998, however, salt has again become a symbol of
struggle between the common people and the combined
might of government and monopoly houses, especially
the MNCs. It is salt today, it could be drinking water
tomorrow. If science remains subserviant to commerce,
we might be compelled to drink ‘bottled’, purified
water on the grounds that ‘ordinary’ water is hazardous
to our health! What is at stake is our right to harness
and use our natural resources. It is time to launch the
Second Salt Satyagraha without waiting for the arrival
of any Mahatma. Should we not be loyal to our own
salt?
Save Our Sovereignty
Save Our Salt
2.
3.
4.
5.
6.
7.
8.
9.
Aravindan, K.P. ‘Science’ In Service of Monopolies
Universal Salt Iodisation Policy’, Economic and
Political Weekly’, No. 27, July 8, 1989.
Jaya Rao, Kalnala, S.: “' Ta-ta’ to Common Salt or
Vice-Versa?”, Health Action, July 1990.
Kochupillai, N.P., ‘That’s Why Feudalism Exists?,
Economic Times, March 21,1992.
Anonymous : ‘Know Your Salt*, Consumer
Confrontation, Nov. Dec. 1995.
Hetzel, Basil, S : ‘The Story of Iodine Deficiency’,
Oxford University Press, Oxford, 1989.
‘Control of Iodine Deficiency Through Safe use of
Iodized Salt’, ICMR Bulletin, No. 6, June 1996.
Rao, P. Srinivas, ‘Iodine Deficiency Disorders’,
Nutrition, No. 3, July 1995.
‘Trace Elements in Human Nutrition and Health’.
Pandav, C. S. and Anand, K : ‘Towards the
Elimination of Iodine Deficiency Disorders in India’,
Indian Journal of Pediatrics 1995.
KNOWLEDGEMENT : We are very grateful u
ivindra.R. P. for preparing this issue.
APPEAL
For information/support to campaign, against UIS,
contact the following
* National Alliance of Peoples Movements (NAPM) •...
* Serva Seva Sangh, Sevagram, Wardha,-442 101.
Ph. : 07152-84061
/
‘
‘
For reporting adverse/toxic effects of iodised saltj
contact:
* Dr. Kothari, President, Academy of Nutrition Dev.
Sitabardi, Wardha Road, Nagpur 440 012
* Ravindra R.P., 10 SNDT Staff Quarters, Juhu Road,
Santacruz West, Mumbai - Ph. : 022-6184461
For Copies of this publication please contact:
Vikas Adhyayan Kendra
<
Facts Against Myths is a monthly bulletin offactual
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