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Preface
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After a long, slow struggle toward ending the devastating mental and physical effects of iodine deficiency, the pace of progress has quickened and the goal of virtually eliminating IDD is in sight. Salt iodization is on target in most affected countries, and the global effort to conquer this problem is reaching its final, defining phase.
The history of this effort is a lesson in what can be accomplished when scientists, development experts, and political leaders work together to focus attention and spur action on a specific health measure. We have learned a great deal about communication and mobilization. We have also begun to apply this knowledge to the creation of partnerships with industry and other stakeholders who can help wipe out IDD entirely and forever by the year 2000.
Scientists were the first to sound the wake up call. For 40 years, from the 1930s to the 1970s, iodine deficiency was generally, and mistakenly, associated with goiter, viewed as a cosmetic problem among people in the hills and highlands. Cretinism, the most severe consequence of iodine deficiency, was largely confined to mountainous areas and not considered a major public health issue in any nation. During this time, the soil in many parts of the world kept losing iodine because of flooding and overuse of the land, depleting the iodine content in food and spreading the effects of IDD across the plains and coastal areas. Endocrinologists, led by Dr. John Stanbury of the United States and Dr. Basil Hetzel of Australia, among others, have succeeded in establishing IDD as the most preventable cause of brain damage. They have shown that visible goiter represents only "the tip of the iceberg" in terms of the harm IDD causes. Even low levels of iodine deficiency can inhibit brain growth so that a child may lose 10-15 IQ points. Tens of millions of infants and children are affected in over 100 countries.
Recognizing the broad economic and social impact of IDD, medical scientists joined with development specialists to found the International Council for Control of Iodine Deficiency Disorders (ICCIDD) in 1985. They pointed to the need for a world wide campaign using iodized salt as the simplest and least expensive means to rid the world of this widespread malady. This campaign was taken up by UNICEF and WHO. At the World Summit for Children in 1990 world leaders accepted the goal of eliminating IDD as a cause of brain damage and pledged to conquer IDD, setting the specific goals for its virtual elimination by the year 2000.
Progress has been made, but much more needs to be done. Clearly, the scientific and technical aspects of the campaign are critical. It is essential to monitor health progress through surveillance, screening and laboratory work and to assure the quality of the iodized salt product through manufacture, transportation, and storage. But it is equally important to assure the quality of the entire process, particularly the communication and training required to convey to everyone the importance of ingesting minute amounts of iodine on a regular basis. Any relaxation of iodine use would allow IDD to return. Achieving the year 2000 goal calls for a lifelong habit of consuming iodized salt for this generation and for all generations to come.
Sustaining political support for IDD work at various levels of society remains a key factor in reaching the goal. The world is not short of crises; every country faces its urgent issues, and each community struggles to cope with its own problems. Resources for social programs are almost always scarce, and IDD work must vie for priority, often on economic grounds. The fight for attention at the policy and behavioral levels is getting more and more competitive. New communication technologies are adding channels of information, disseminating messages to already overloaded target audiences.
This guide draws upon the collective observations from ICCIDD consultancies in many countries, focusing on non-scientific aspects of the global IDD effort. It describes the process of forming alliances with various elements of society that have a role in fighting IDD. It also recommends the Social Mobilization approach to managing the communication aspects of programs that aim to establish and sustain the use of iodized salt.
The authors have used materials from many sources, including WHO, UNICEF, World Bank, FAO, the Nutrition Unit of UNICEF headquarters in New York, UNICEF offices in Islamabad and Quito, the Program Against Micronutrient Malnutrition (PAMM) of the Rollins School of Public Health at Emory University in Atlanta, the International Life Sciences Institute (ILSI), Population Services International (PSI) and Manoff International in Washington, and the Micronutrient Initiative (MI) in Ottawa. Dr. Claudia Fishman Parvanta of PAMM and Cecilia Cabanero-Verzosa of the World Bank contributed to the sections on message design and alliance-building methods in the last chapter.
Many individuals have contributed to the preparation of this guide. To David Haxton, one of the key development specialists who have championed tirelessly the cause of IDD elimination and contributed to the establishment of ICCIDD, the authors owe a special thanks. Dave was kind enough to read through the manuscript and offer many useful comments. To David Alnwick, Chief of the Nutrition Section of UNICEF, the most active organization in the global IDD effort, who provided the foreword, gratitude is hereby expressed. Appreciation of support also should go to Dr. Eduardo Pretell in Lima, Ms. Raana Syed in Islamabad, Dr. Mauro Rivadeneira in Quito for their cooperation in furnishing reports and checking material. Any mistakes or shortcomings in the guide, however, are the sole responsibility of the authors.
Jack C.S. Ling - Chair, Communication/Education Committee, ICCIDD Board
Cynthia Reader-Wilstein - Communications Consultant
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