October 31, 2000?With only 39 percent iodized salt coverage in 1995, China reached the first step of Universal Salt Iodization (USI) in 1999 with 91 percent of the entire population consuming iodized salt. The experience of this spectacular success was shared in an international workshop on Iodine Deficiency Disorder (IDD) Control in Beijing, October 27-29.

In China during this period, total goiter rates for children梠ne of the population indicators of IDD梔eclined from 20.4 percent to 8.8 percent. But the impact of IDD control is much greater in terms of reproductive health, intellectual capacity, and capacity to work. Studies across China during the 1980s demonstrated lower IQ among school children in IDD affected areas. This, among other things, prompted China to commit to the international goals of IDD control, with USI as the central strategy.

"By improving the coverage and the quality of iodized salt in China, we expect to see less spontaneous abortion, prematurity, and severe mental retardation," said Maureen Law, World Bank Sector Manager for Health, Nutrition and Population. "Control of IDD will help to ensure that individuals can achieve their full intellectual potential, increase the economic productivity and reduce the burden of care for disabled family members. Salt iodization is one of the most cost effective preventive health interventions available today." 

The World Bank contributed to China's successful effort through a $20 million credit for an IDD control project, which closes in December. The credit helped to mobilize more than four times this value in counterpart funds, for rationalization and upgrading of production, packaging and distribution of iodized salt. China's National Salt Industry Corporation is already reporting major efficiency gains from the project.

This month's remobilization event in Beijing, organized by the government of China, with assistance from UNICEF and other international partners, mirrored the high-level advocacy meeting of 1993, which launched China's National IDD Elimination Program.

The main purpose of the workshop was to recognize the efforts of many sectors and agencies at different levels which have contributed to China's success, and to take a closer look at the key elements of USI and IDD control, using China as a case study. Participants exchanged views on how best to move the USI agenda forward for their respective countries. This also helped China in defining the localized strategies for the remaining areas which have not yet been able to achieve IDD control.

While salt iodization is technically a straightforward process, large-scale implementation involves political, administrative, technical, and socio-cultural changes. Once iodization of salt is effectively established as a permanent measure, it eliminates iodine deficiency, and prevents recurrence. Country experiences indicate that effectiveness and sustainability of salt iodination depend on creating IDD awareness, ensuring easy access, promoting compliance in the industry, and enforcing quality control.

The Bank's involvement in IDD control until the 1990s mainly focused on funding surveys on goiter prevalence, providing technical advice, and capsule supplementation. During the 1990s, in addition to the China project, the Bank has supported salt iodization through another stand-alone project in Indonesia (1996?002) and as a component of larger health and nutrition projects in other countries.