HEALTH-INDIA: Worry Over Lifting of Non-Iodised Salt Ban

By Ranjit Devraj Reprint | | Print |

Ranjit Devraj

NEW DELHI, Jun 16 2000 (IPS) - All it takes to prevent millions of Indians from growing into cretins is a pinch of iodine in their salt, say top medical scientists.

But the government has other ideas. Prime Minister Atal Bihari Vajpayee’s government, apparently bowing to pressure from salt retailers, is to lift later this month, a ban on the sale of non-iodised salt in the country.

Alarmed public health experts say this will undo the gains of a successful, internationally acclaimed public health programme to tackle iodine deficiency disorders (IDD).

According to experts like N. Kochupillai, head of endocrinology and metabolism at the prestigious All-India Institute of Medical Sciences (AIIMS) here, at least 200 million Indians are already prone to IDD.

Despite universalisation of salt iodisation since 1984 that was made compulsory in 1998, 70 million Indians suffer from the unsightly swelling of the neck caused by overworked thyroid glands.

“Tragically, this proposition to lift the ban, conceived by the government is unthinkable and anti-public health…iodine is an essential nutrient for human survival and development,” says Kochupillai.

“Experience has shown time and again in India and elsewhere that withdrawal of universal salt iodisation leads to re-occurrence of iodine deficiency disorders and causes brain damage in children,” he adds.

Kochupillai’s colleagues Umesh Kapil and C. S. Pandav, both of whom are also internationally recognised IDD experts, agree.

Iodine is necessary for the production of thyroxine — a hormone which plays a pivotal role in foetal growth and development and in childhood and adolescence, besides keeping the body warm and active through the life span.

Varying degrees of thyroxine deficiency at the foetal and neonatal stage can thwart mental growth. This ranges from loss of intellectual potential to extreme forms of irreversible brain and body defects.

Sales of iodised salt in India began as early as 1962 while the production of iodised salt jumped from 300,000 tonnes in 1983 to 4.2 million tonnes by 1997.

This has not been easy considering that only 850 of the estimated 10,000 common salt factories in the country, are registered producers. Branded salt made by the big companies accounts for less than a fifth of total output.

The cottage salt industry – historically supported by Mahatma Gandhi in his fight against British colonial taxes – enjoys the advantage of the sheer cheapness of its product which sells at a third of the 20 cents it costs for a kilogram of branded salt.

According to Kochupillai, it is the 40 percent Indians living below the poverty line and already nutritionally deficient, who are likely to buy the cheaper, non-iodised salt.

However, political leaders in several coastal states have been protesting against the ban on the sale of uniodised salt, saying it has snatched away the traditional livelihoods of tens of thousands of people who make salt from seawater.

Ram Vilas Paswan, an influential politician and Minister for Communications has argued in parliament that the ban only helped big-time manufacturers who could afford to import iodine and add value to table salt by iodising and packaging.

But critics say that, in fact, the ban hurts traders and retailers rather than traditional salt-makers. Before the introduction of the ban, retailers were known to make large profits by lifting cottage salt dirt-cheap directly from traditional salt-makers and selling it dear in the cities.

Traders also took advantage of the high priority and cheap tariffs for the movement of iodised salt on India’s railway system.

The government justifies its decision by saying “a public health measure should not be enforced through statutory provisions.” Officials argue that “compulsion in such matters of individual choice is undesirable.”

But public health experts disagree. Retorts Kochupillai:”If the government argues that no public health policy should be enforced then what about universal immunisation or chlorination of drinking water.”

Leading Indian IDD expert V. Ramalingaswami, one of the pioneers of research on hyperthyroidism who linked it to iodine deficiency in the 1950s, thinks the same.

“In the Indian context it is not possible to leave the choice of using iodised salt or non-iodised salt to individuals because it would involve considerable inputs from the point of view of public education and public health,” says Ramalingaswami.

Those in favour of lifting the ban include a section of urban health care professionals catering to rich Indians who say that their affluent clientele suffers hormonal imbalances from excess iodine.

According to R P Singh, endocrinological consultant to the two-billion-dollar super-speciality, Apollo Hospitals in the Indian capital, the diet of affluent urban Indians is already rich in iodine and does not require supplementation.

Many of his patients suffer from hyperthyroidism caused by excess dietary iodine and manifest as hirsutism among women and enlarged breasts in men, he says.

But Kochupillai counters that hyperthyroidism cannot be caused by excess of iodine unless it is taken in extremely large doses. “Anything taken in excess is likely to be harmful,” he points out.

Salt iodisation is now compulsory in 110 countries. Recent reports from several developed nations indicate a re-emergence of iodine deficiency, prompting the U.S. government to sanction five million dollars for tackling this problem in that country.