Tuesday, March 08, 2005

Please pass the salt

Please pass the salt

Posted 05:41am (Mla time) Mar 08, 2005
By Juan Mercado
Inquirer News Service

Editor's Note: Published on page A12 of the March 8, 2005 issue of the Philippine Daily Inquirer

SAY "iodine deficiency disorder" or blurt out "IDD," and P1 gets you P10 that few will grasp what you're driving at.

IDD means, nutritionists tell us, lack of iodine in the body. In the late 1980s and early 1990s, 9 out of every 10 women in Mountain Province were necklaced with goiters from IDD. Over half the Cordilleras' population was similarly afflicted.

Among kids, IDD inflicts a toll in mental retardation, deaf-mutism and stunting. In the early 1990s, almost 7 percent of Filipino schoolchildren had goiter, higher than the 5 percent cut-off point. That's when a disease is tacked up on the list of public health problems. Was a generation of cretins unavoidable? some asked then.

"Iron deficiency anemia affects as many as 600 million women and children in South East Asia," the Asian Development Bank notes. Its effects "include increased maternal and infant mortality, limited learning capability, reduced immunity against diseases and reduced ability to work and function."

Over the last decade, the Philippines attacked the problem with a combination of law, vitamin supplements and innovations. As part of his first 100 days in office, President Fidel V. Ramos, ordered that all Cordillera Autonomous Region residents be provided with iodized oil capsules. Pregnant women got priority billing the following year.

But spiraling costs and snarled logistics compelled the Philippines to look at international experience. Worrying IDD levels in Sarawak, for example, led the government to import iodized salt in 1982. New laws jacked up iodized salt supplies in affected communities from 28 percent to 65 percent in seven years. Thailand fortified seasoning in instant noodles with vitamin A, iodine and iron since 1996. At present, 80 percent of Thai instant noodles are covered.

This trend heeds the US experience "as the first country that successfully used salt iodization, in the early 1920s, as a strategy" against IDD. Mandatory fortification of staples like flour, oil, sugar and salt saw rates of micronutrient deficiencies fall in Europe.

As a first step here, salt iodization plants were set up in the CAR. In tandem with the country's biggest salt producer, Pacific Farms, the Department of Health initiated a nationwide campaign for iodized salt use.

But it was rough sailing. A Nutrition Center salt farm survey stumbled across wide data and regulation gaps. Salt farms were often lumped with brackish water fish farms. Producers chafed at rules for quality control, warehouse and fortification plants. Neither were they organized to facilitate consultations.

In free markets, like the Philippines, consumers are king. Many think iodized salt is refined (“pino”), which is costlier. In fact, iodized salt can be fine, rough, solar or crystal -- provided it's laced with iodine.

"When Congress passes a law, it's a joke," the comedian Will Rogers once snorted. "And when it cracks a joke, it's a law." But to Congress' credit, it institutionalized salt iodization in 1995 by enacting the "Asin Law." RA 8976 mandates iodization of all salt for human and animal consumption.

Tasked to implement the law, the Bureau of Food and Drugs was swamped. It had to ensure mandatory iodization on a yearly staggered basis among big, medium, small and subsistence salt producers. That was more than it could handle.

"The road to hell is paved with good intentions." Despite the "Asin Law," consumption of iodized salt has remained piddling, rising to 25 percent in 2001 from 15 percent in 1995, barely enough to dent the health threat. Reasons: high price and lack of iodized salt.

Other countries, like Malaysia and Thailand, meanwhile, overtook the Philippines in iodized salt consumption, by ensuring supplies and mandating its use. China chose a different vehicle to reduce IDD: a large-scale program, with manufacturers, to make iron-enriched soy sauce on meal tables. "A pilot study ... showed that anemic school children given fortified soy sauce had significantly better iron profiles than those who did not," an ADB paper notes.

Here, the tide turned in October 2002 with the health department's "Patak sa Asin" campaign where salt in markets and sari-sari stores were tested using low-cost test kits (a drop of solution makes iodized salt turn blue). Backed by local governments and schools, the "Patak sa Warehouse" campaign followed.

Tracking revealed the upward surge. A Unicef survey showed that 31 percent of households used iodized salt three years back. The 2003 National Nutrition survey found use of iodized salt had risen to 56 percent. Now it's 77 percent, says the latest Helen Keller International survey

Using urine tests, the National Nutrition Survey found that "from 1998 to 2003, median level urinary iodine among schoolchildren increased from 71 microgram per liter to 201 microgram per liter."

What does that mean, in layman's lingo? Below 100, IDD would pose a major public health problem. But at 201, "it is now documented that the Philippines has solved its iodine deficiency problem, although pockets of deficiencies still exist."

Thus, the country beat a major threat but few noticed. That's understandable. The victors are invisible. A goiter bulge intrudes. But normal necks go unremarked. There's no accounting table for tallying the number of kids saved from cretinism.

But there'll be little loafing on this laurel. Tomorrow's battles will be with vitamin A gaps, which cause blindness, and illnesses from iron anemia. But passing the salt signals that failure is not necessary.


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