Drop In India IQ Leads To Ban On Non-Iodized Salt

by Ranjit Devraj

(IPS) NEW DELHI -- India has decided to reinstate a ban on the sale of non-iodized salt after the rate of iodine deficiency diseases (IDD), including lowered IQs among children, appeared to have increased since the restriction was lifted six years ago.

"We are giving two months time to salt manufacturers to revert to manufacturing only iodized salt," Health and Family Welfare Minister Anbumani Ramadoss announced at a meeting on IDD in the national capital on Wednesday.

Leading experts on IDD said Ramadoss' decision represented the biggest single reversal of public health policy introduced by the business-friendly, right wing, Bharatiya Janata Party (BJP) government, which was voted out of power in May 2004 mainly because of the public perception that it cared only for the interests of industry and the elite.

"We know that the BJP government had come under pressure from trader lobbies to lift the ban and they went ahead with it although it was clear that the move would undo the gains of an internationally acclaimed public health program to wipe out IDD through simple but effective intervention, N Kochupillai, a leading endocrinologist, told IPS in an interview.

Iodine is necessary for the production of thyroxine -- a key growth hormone from the foetal stage to adolescence and one necessary for keeping the body active throughout life. Thyroxine deficiency at the foetal and neo-natal stage can thwart mental growth, resulting in lowered intelligence quotient (IQ) ratios and, in extreme cases, cretinism or the 'village idiot' syndrome.

India was a pioneer in the global effort to provide universal salt iodization, beginning with research conducted during the 1950s that established that the high prevalence of cretinism in the sub-Himalayan tracts of India, Nepal and Bangladesh was related to low levels of iodine in the soil.

It was soon realized that all it would take was a pinch of iodine in dietary salt to prevent millions of South Asians from serious mental and physical disability. But there was opposition from the large cottage salt industry, which was historically supported by Mahatma Gandhi in his fight against British colonial taxes.

In more recent times, cottage salt retains commercial advantage for sheer cheapness, selling at a third of the 20 cents it costs to buy a kilogram of branded salt. But, according to Kochupillai, it is the 40 percent of Indians living below the poverty line and already nutritionally deficient, who are likely to buy the cheaper, non-iodized salt and suffer the consequences.

Kochupillai and his colleagues at the endocrinology department of the All-India Institute of Medical Sciences (AIIMS), notably CS Pandav and MG Karmakar bitterly opposed the lifting of the ban, but were overruled by the political exigencies of the day.

Six years down the line it is becoming apparent that the warnings of the experts at AIIMS, India's leading medical research and teaching facility, were well-founded, with unpublished data drawn showing falling IQ ratios among school children from homes that used ordinary salt.

"We are soon going to publish the results of scientific studies that irrefutably link lowered IQ among children to the use of non-iodized salt," Kochupillai said.

Available studies presented at a workshop conducted by the National Iodine Deficiency Disorders Control Program (NIDCP) in February showed that the availability of iodized salt for families had dropped from 49 percent in 1999 to 37 percent in 2003 as a result of the ban being lifted.

This led regional advisor to the World Health Organization (WHO) on nutrition, Rukhsana Haider, to comment at the workshop -- jointly organized with the United Nations Children's Fund -- that India had gone from being a leader in the fight against IDD via iodization of salt to one that was lagging far behind countries that had joined the effort much later.

Papers circulated at the workshop provided valuable insights into India's salt trade, in which the western state of Gujarat -- where the BJP is most powerful -- has a near stranglehold accounting for 70 percent of overall salt production of around five million tons.

A study carried out by the Government Medical College (GMC) in Gujarat's Baroda city found that while the state was the country's leading producer of salt, its people were among the lowest consumers of iodized salt.

According to the GMC study, less than 13.5 percent of people living in Vadodara district were consuming iodized salt and there was a correspondingly high level of IDD in the area, with at least seven percent of the population affected to some degree.

Globally the thrust towards universal iodization of salt picked up after 1990, when 70 heads of state gathered at the World Summit for Children in New York and pledged to eliminate Iodine Deficiency Disorders (IDD) by 2000.

Salt iodization was identified as the main intervention, and by 1998 more than 170 countries had committed themselves to universal iodization of salt. Many governments have provided resources for IDD elimination in their national financial budgets.

According to UNICEF reports, a significant proportion of the populations in more than 87 countries -- at least 68 percent of the world's people -- already have access to iodized salt. Forty-five countries have achieved more than 75 percent coverage.

Success with salt iodization has given governments new confidence to tackle other more complex micro nutrient problems using salt, as well as other food carriers, to deliver essential minerals to their populations.

India's Secretary for Women and Child Development Reva Nayyar said the government is now considering fortifying table salt with iron to counter high levels of iron deficiency and consequent anaemia in women and children.

Ramadoss' initiative is only the latest episode in a seesaw battle between the pro and anti-iodization lobbies since the early 1950s. The fortunes of the pro-iodization lobby have been aligned with the Congress Party or left-wing groups while right-wing groups are clearly identified with the anti-iodization side.

It was a Congress-backed, left-wing coalition called the United Front that first introduced a ban on non-iodized salt in January 1998, making it compulsory for all groceries to stock only iodized salt.

Two years later, the anti-iodization lobby, using its clout with the BJP -- which had replaced the United Front -- forced a lifting of the ban, saying it should be left to consumers to decide what they wanted to buy: cheaper common salt produced by the traditional cottage industry, or packaged, branded and iodized table salt sold by big manufacturers.

And now the communist-backed, Congress-led United Progressive Alliance government has reinstated the ban on non-iodized salt.