August 2021

Is it time to walk away from salt iodization?

The fight to protect children’s brains by adding iodine to household salt has been a global public health success story. This success has led many to believe that the job of iodizing salt has been dealt with, that no more investment is needed, and that we can move on to other issues.

But is the task of iodizing salt forever complete? And is the iodine status of global populations sustainably protected? That’s not the picture we see at IGN.

Here are the things that worry us

We don’t know the true situation. Many of the data we use to assess the situation are old, and in many countries, there are large population segments with either inadequate status or about which we have no information, so inequities exist even when average national coverage is high.

In many countries, household salt is no longer the predominant source of salt intake. People cook less at home and consume more processed foods, which may not be produced using iodized salt. Without new data, we don’t know how this is affecting population iodine status.

Countries are slipping back. National programs that were initially successful now struggle with sustainability and continuation. The gatekeepers – decision makers, program managers and the private sector – have become complacent.

Understanding of the importance of iodine nutrition among senior decision-makers and the public has diminished or disappeared, leading to a situation for example, in Europe, where estimates suggest that up to 50% of newborns are exposed to iodine deficiency.

Here’s what we can do to make salt iodization sustainable

We need to update our thinking. Programs were initially set up with a specific focus on eliminating iodine deficiency. While successful, this strategy didn’t sufficiently consider the need to be sustainable within national contexts and competing priorities. To be sustainable, programs must be embedded within broader national policies and budgeted for, implemented and managed as part of wider programs (e.g. nutrition, food fortification).

We must find new solutions to major problems, including challenges in gathering and interpreting data, improving national ownership, and understanding the importance of the use of iodized salt in processed foods to help stabilize national efforts and improve iodine status.

And here’s what else salt iodization has to offer

There’s one more very big reason why it’s not time to walk away from salt iodization. Iodine deficiency was essentially the world’s first global large-scale fortification effort and can lay the groundwork for other large-scale food fortification programs. Through the innovative use of new and existing data, we can learn much from the salt iodization story about the factors determining the success of such efforts, strengthening the foundations of all food fortification programs.