HEALTH-INDIA: Iodisation Campaign Taken With a Pinch of Salt

By Ranjit Devraj Reprint | | Print |

Ranjit Devraj

NEW DELHI, Feb 28 2003 (IPS) - An international campaign to get the Indian government to re-introduce a ban on non-iodised salt is going nowhere, thanks mainly to stiff opposition from groups that say the compulsory iodisation of salt benefits large-scale manufacturers of packaged salt and can actually be harmful for some people. .

India has seen a see-saw battle between the pro and anti-iodisation lobbies since the early 1950s, when scientific studies of goitre in the sub-Himalayan areas of India indicated that the condition marked by unsightly swellings in the neck was the result of thyroid glands overworked for lack of iodine.

A programme of ensuring adequate iodine intake by dosing table salt with potassium iodate seemed to work wonders in controlling goitre in the sub-Himalayan areas. This prompted the government to initiate by 1984 a fierce salt iodisation programme under the aegis of the World Health Organisation (WHO).

But the big day for the pro-iodisation lobby, which included distinguished medical scientists, came in January 1998 when the central government banned the sale of common salt altogether and instead made it compulsory for all groceries to stock only iodised salt.

Two years later, the anti-iodisation lobby struck back, forcing the government to lift the ban and leave it to consumers to decide what they wanted to buy – cheaper common salt produced by an ancient cottage industry or packaged, branded and iodised table salt sold by big manufacturers.

By then, the issue had taken on emotional overtones. A group called the Swadeshi Jagran Manch (Self-reliance Protection Movement) recalled that the right to use common salt, freely available on sea coasts, was a key issue in Mahatma Gandhi’s movement for independence from British colonial rule.

”Iodine supplementation is needed only for people living in high-altitude areas, where the substance is know to leach away from the soil and not for people who live in the coastal states such as Gujarat, Kerala, Orissa, Maharasthra and Goa,” said Bajranglal Gupta, leader of the SJM. The government heeded him.

Reaction to the government’s lifting the ban on non-iodised salt came not only from the Indian medical establishment, but also from such groups as the Geneva-based International Council of Nurses, the Hague-based, International Pharmaceutical Federation, and the World Medical Association headquartered in France.

Today, the issue of whether to re-introduce universal and compulsory salt-iodisation is still being fought out in the Supreme Court and at the statutory National Human Rights Commission (NHRC).

The NHRC observed that in high-literacy states like Kerala, people had information about what was good for their health. But the same did not hold necessarily hold true for states like northern Uttar Pradesh and Bihar, where half the population was illiterate. But the NHRC urged the health ministry to conduct surveys on the availability of iodised salt, the quality of iodisation and prevalence of iodine deficiency disorders and to take measures to ensure that iodised salt was readily available to all sections of the population on an affordable basis.

This has carried the iodisation battle to states like Kerala, where the two lobbies have come up with wildly differing statistics that they have presented in meetings like the Ninth Asian Congress of Nutrition, which concluded on Thursday in New Delhi.

At the congress, a team from the National Iodine Deficiency Disorders Control Programme was on hand to show that although Kerala ”being a coastal state was believed not have an iodine deficiency problem”, the state still had 16.6 percent goitre prevalence and was endemic for iodine deficiency disorders according to WHO criteria.

”Iodised salt constitutes an important source of iodine to the population (of Kerala) and 48.9 percent of households use it, ” declared C S Pandav and M G Karmakar, two of the best known proponents of salt iodisation.

But in Kerala, compulsory iodisation of salt as a strategy to prevent iodine deficiency disorders is being opposed by the formidable Kerala Sastra Sahitya Parishad (KSSP), a voluntary agency which has for long been associated with the ‘Health for All’ ideal.

In a statement, KSSP general secretary N K Sasidharan Pillai noted that although iodine deficiency was an important public health problem in many areas of the country, the state as a whole was not an endemic area. ”Pushing salt iodisation in such non-endemic areas is unethical and colossal waste of energy that could be focused on other important concerns,” Pillai said.

Pillai has challenged the findings of the central study, supported by the United Nations Children’s Fund (UNICEF), and points to a study conducted by the National Health Survey two years ago that showed adequate iodine levels although only 39.3 percent of households in the state used iodised salt.

”We have demanded that this campaign to promote iodised salt stop immediately as it is misleading the public,” Pillai said.

Voluntary groups that have resisted the ban on ordinary salt include the Narmada Action Group, led by internationally-known anti-big dam campaigner Medha Patkar, on the grounds that it has taken away the livelihoods of thousands of poor people who depend on making salt from sea water and selling it.

”Not only did were these poor people deprived of meagre profits from selling salt at about four cents a kg, but they were forced to buy branded salt for their own use at 12 cents a kg which they can ill afford,” Patkar said.

The Narmada Action Group pointed out that iodised salt is not mandatory anywhere and its use was actually discontinued in coastal areas like Tasmania and the Netherlands because of a condition called thyritoxicosis, thought to be caused by excess dietary iodine.

According to the group, it made no sense to treat all of India’s billion plus population with iodised salt when only about 2.5 percent of the population actually suffered from iodine deficiency and an unknown number from an excess of the element.

Among those who oppose universal iodisation of salt is leading city endocrinological consultant RP Singh, who says many of his better-off patients suffer from hyperthyroidism because their diets were already rich in iodine – and had to be advised to stick to non-iodised salt.