Ukraine September 2010

1. 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

2. 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

3. Progress in the RegionSE Europe and CIS during the Decade2000 - 2009

4. 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

5. 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

6. 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

7. 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

8. Iodine Deficiency and Salt Iodization in Ukraine and other Industrialized Countries

9. 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

10. 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

11. 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

12. 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

13. 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

14. Most of the Salt Intake is from Consuming Industrially Processed Foods

15. Bread & Cereals are Major Commodities in the Total Food Salt Intake

16. 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 Realization: Bread bakeries 93% adoption Households 65-70% coverage Iodine supplement use 5-21%

17. 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 Realization: Rye Bread 1.4 - 38 mg iodine/kg Wheat Bread 0 – 46 mg iodine/kg Household salt 0.6 - 31 mg/kg

18. Other Examples of Selective Salt Iodization Strategies Belarus Germany Australia & New Zealand Norway, Finland

19. Suggestions and Next Steps

20. 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?

21. The 3 Compelling Imperatives Economics “The State Continues Bleeding Money” Human Rights “Unborn Babies cannot Choose” Ethics “The Greatest Benefit for the Greatest Number”

22. 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