Effective Technical Assistance Towards the Elimination of Iodine Deficiency the role of the Iodine Global Network

Transcription

1 Effective Technical Assistance Towards the Elimination of Iodine Deficiency the role of the Iodine Global Network Jonathan Gorstein Clinical Associate Professor, Department of Global Health/ Nutrition Science Program Executive Director, Iodine Global Network UW Nutrition Think Tank Technical Symposium Friday, 13 November 2015 / BMGF

2 Outline 1. Importance of Iodine 2. Historical developments moving from evidence to elimination 3. Global progress 4. Key Factors for Successful Scaling up

3 Outline 1. Importance of Iodine 2. Historical developments moving from evidence to elimination 3. Global progress 4. Key Factors for Successful Scaling up

4 Why is iodine important Iodine deficiency disorders Caused by a lack of thyroid hormone due to inadequate iodine for synthesis World s most preventable cause of brain damage Public health problem since ancient times On verge of global elimination

5 Outline 1. Importance of Iodine 2. Historical developments moving from evidence to elimination 3. Global progress 4. Key Factors for Successful Scaling up

6 From Evidence to Elimination First records of goiter and cretinism date back to Chinese, Hindu cultures Switzerland implemented salt iodization, saw drop in goiter and cretinism Ancient David Marine studied impact of iodized oil on goiter in Akron, Ohio Iodized salt first introduced in USA WHO published first global review on goiter, highlighting magnitude and severity of the problem

7 From Evidence to Elimination Intervention trial demonstrated impact of iodized oil in pregnancy in preventing mental disability Observational studies confirmed presence of cretinism in China, Nepal, India and Pakistan ICCIDD founded to bridge gap between evidence and programs s Basil Hetzel observed cretinism and goiter in Papua New Guinea Term IDD coined to capture the full range of effects of deficiency, focusing on brain development

8 From Evidence to Elimination World Summit for Children adopts plan of action calling for elimination of IDD by 2000 National program started in China with endorsement of Vice Premier (700 million people deficient), by 2000 USI had eliminated IDD WHO Resolution requiring reporting on iodine nutrition status every three years rd WHA recognizes IDD elimination as a public health priority, recommends USI. Global coverage of iodized salt about 20% UN General Assembly Special Session on Children adopts A World Fit for Children. Declaration that set the goal of sustainable elimination of IDD

9 From Evidence to Elimination BMGF funded GAIN and UNICEF to implement USI Partnership Project ICCIDD changes its name to IGN as the landscape to achieve optimal iodine nutrition matures Copenhagen Consensus recognizes USI as one of the most cost-effective intervention to improve development IGN links USI and iodine to the broader nutrition agenda (SUN) and salt reduction efforts

10 Iodine Global Network

11 Iodine Global Network (IGN) Multi-layered governance model: global Multi-sector representation on the Board Implementing Agencies Normative Agency Foundation Aid Agency Private Sector Academia UNICEF GAIN MI U.S. CDC WHO Kiwanis USAID Salt Univ. Washington Industry ETH Zurich China India Brazil Univ. Sydney AIIMS Delhi Tianjin Univ. 11

12 Iodine Global Network (IGN) Multi-layered governance model: national Multi-sector representation on the national level Government bodies Implementing Agencies Foundations Private Sector Aid Agencies National Coalition Academia 12

13 Simple Operating Framework Clear health impact: iodine deficiency causes loss of IQ points, impairs social and economic development Effective intervention: direct impact of iodine repletion

14 in utero iodine deficiency damages the developing brain 14 Iodine repletion significantly reduces goiter and cretinism DQ/IQ points higher in children born to supplemented mothers Reduced risk of: goiter RR = [depending on study design] cretinism OR = 0.13 low intelligence (IQ<70) RR = [depending on study design] Aburto NJ, et al. Geneva: WHO, 2014 Pharoah et al, 1971; Thilly et al,1994; Cao et al, 1994

15 Simple Operating Framework Inexpensive and sustainable intervention: USI, to effectively increase iodine intakes World Bank and the Copenhagen Consensus list USI as one of the best development investments Lancet Series emphasizes importance of multi-sector partnerships and collaboration Growing political consensus that development funds should address health and nutrition

16 Remarkably high cost-effectiveness of iodized salt Iodized salt 2x more cost-effective than Fe fortification or Zn supplements Intervention Iron Cost per child covered (US$) Supplements Cost per DALY averted Fortification Iodine Salt Fortification Zinc Health (DALYs) Supplementation Productivity gains Example: West Africa Region Assumptions Annual per capita GNP US$430 Wage share of GNP 40% Goiter rate 15% Births to women with goiter average productivity loss 11% If cost of iodized salt is $0.10 pp/y, benefit-cost ratio is 26.5:1 If costs are $0.01 pp/y (as in Central America) benefit-cost ratio is 265:1 WHO Food Fortification Guidelines, 2006 Disease Control Priorities in Developing Countries 2nd Ed The World Bank 16

17 1 Best investment Copenhagen Consensus 2008: Micronutrients for children IMPROVED CHILD GROWTH AND HEALTH, BETTER SCHOOL LEARNING $ 35 1 Best investment Copenhagen Consensus 2012: Micronutrient interventions LEADS TO EQUALS PAY-OFF HEALTHIER PREGNANCIES INCREASED WORK PRODUCTIVITY $1

18 Outline 1. Importance of Iodine 2. Historical developments moving from evidence to elimination 3. Global progress 4. Key factors

19 Household Coverage with Iodized Salt <50 % % 90 % 2014 No data UNICEF, State of the World s Children,

20 Progress Towards the Elimination of IDD Severe Moderate Mild Adequate No data Iodine Global Network, : 113 countries iodine deficient

21 Progress Towards the Elimination of IDD Severe Moderate Mild Adequate No data Iodine Global Network, : 54 countries iodine deficient

22 Progress Towards the Elimination of IDD Severe Moderate Mild Adequate No data Iodine Global Network, : 47 countries iodine deficient

23 Progress Towards the Elimination of IDD Severe Moderate Mild Adequate Excess No data Iodine Global Network, : 30 countries iodine deficient

24 Progress Towards the Elimination of IDD Severe Moderate Mild Adequate Excess No data 2015: 25 countries iodine deficient

25 Outline 1. Importance of Iodine 2. Historical developments moving from evidence to elimination 3. Global progress 4. Key Factors for Successful Scaling up

26 Scaling Up Critical Factors Implementation through public-private partnership model of collaboration between Governments, private sector (salt industry), international agencies, scientific community and donors (Kiwanis, USAID, BMGF) Persistent advocacy - Use of data on program process (coverage) and impact (iodine status) have enabled advocacy, to celebrate and sustain success, we well as to raise urgency

27 Program Maturation and Changing Landscape Sustainability iodine deficiency cannot be eradicated and requires continuous commitment and vigilance Harmonization link USI with other fortification activities to the broader nutrition and development agenda Salt consumption patterns changing salt consumption patterns (processed foods, condiments) requires a shift in strategy to true USI Synergy with salt reduction USI and salt reduction strategies should be aligned through integrated monitoring and program implementation

28 Thank you