Achieving Universal Salt Iodisation for Optimal Iodine Nutrition

Achieving Universal Salt Iodisation for Optimal Iodine Nutrition UNICEF, IGN, GAIN, MI EAP Regional Meeting 12 -14 October, Bangkok #commit 2 USI Review of salt iodisation legislation in the region Karen Codling IGN Regional Coordinator for Asia & Pacific UNICEF Consultant

BACKGROUND § 140 countries have USI programmes; 1 it is unknown how many of them have salt iodisation legislation § Review of salt iodisation legislation undertaken by UNICEF for the Southeast Asia and East Asia and Pacific region in 2012, updated 2015 § Information on legislation from UNICEF programme officers 1. Iodine Global (Quoted in EAP Regional Workshop on 12 -14 October 2015 Network (2014). Status by region, 2014. Available from http: //ign. org/p 142001046. html ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION Bangkok GAIN. Fortifying our Future: A snapshot report on food fortification) 2

CURRENT LEGISLATION § Situation in 36 countries reviewed (Rep of Korea excluded) –Existing, draft or planned legislation in 22 countries –No legislation in 15 countries • DPRK • Malaysia (sub-national only) • Maldives • Several Pacific Islands (Cook Is, Kiribati, Marshall Is, Micronesia, Nauru, Niue, Palau, Samoa, Tonga, Tuvalu, Vanuatu) 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 3

TIMELINE OF SALT IODISATION LEGISLATION 1980 s • Singapore (1988) • Bangladesh (1989) • • 1990 -1994 1995 -1999 Laos (1991) China (1994) Indonesia (1994) Thailand* (1994) • Papua New Guinea (1995) • Philippines (1995) • Fiji (1996) • Nepal (1996) • India* (1998) • Myanmar (1998) • Malaysia (1999)** • Sri Lanka (1995)* • Vietnam* (1999) 2000 s • • Brunei (2000) Cambodia (2003) Mongolia (2003) Afghanistan* (2007) • Solomon Islands (2010) Singapore & Brunei have food standards permitting voluntary fortification, rather than salt iodisation legislation *Initial legislation. These countries now have new legislation in force. ** State legislation 12 -14 October 2015 NB. Bangkok Bhutan, Pakistan and Timor Leste have “parliamentary decision” or draft legislation

MECHANISM OF SALT IODISATION LEGISLATION Stand alone Under existing law India Malaysia Sri Lanka Brunei Fiji PNG Singapore Solomon Is Thailand 12 -14 October 2015 Bangkok Food regulation under Food Act 3 11 6 Afghanistan Myanmar 2 Food Act Bangladesh Cambodia China Indonesia Laos Mongolia Nepal Pakistan Philippines Timor Leste Viet Nam EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 5

STAND ALONE LEGISLATION INCLUDES IMPLEMENTATION RULES § Coordination mechanisms § Registration/licensing of iodised salt producers “Stand alone” § Control of imports legislation has a § Control of transport of non-iodised salt propensity to § Differentiating between industrial and food-grade salt establish salt § Public information iodisation as a § Internal quality assurance vertical § External quality assurance programme § Special allowances for small producers § Penalties 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 6

MANDATORY OR VOLUNTARY? “The fundamental distinction between mandatory and voluntary regulation as it applies to food fortification is the level of certainty over time that a particular category of food will contain a predetermined amount of a micronutrient. By providing a higher level of certainty, mandatory fortification is more likely to deliver a sustained source of fortified food for consumption by the relevant population group, and, in turn, a public health benefit” (WHO/FAO Guidelines on food fortification with micronutrients) 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 7

MANDATORY OR VOLUNTARY? “In one decade, countries with mandatory legislation had a greater increase in household coverage (from 49% to 72%) than countries with voluntary iodisation (40% to 49%)” EAP Regional Workshop on October 2015 Ref: 12 -14 Horton S. , Mannar, V. & Wesley, A. (2008) Micronutrient. ACHIEVING Fortification (Iron and Salt Iodization) Copenhagen UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION Bangkok 8

MANDATORY OR VOLUNTARY? § Salt iodisation is mandatory in all countries with existing legislation except: –Brunei & Singapore – have voluntary food regulations that allow salt iodisation –Viet Nam – current legislation encourages iodisation but does not mandate it. New mandatory legislation is currently being drafted. 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 9

MALAYSIA EXPERIENCE: IMPORTANCE OF MANDATORY LEGISLATION Ref: 12 -14 Selamat et al. Iodine deficiency status and iodised salt consumption in Malaysia: findings from a national iodine deficiency October 2015 disorders survey. Asia Pac J Clin Nutr. 2010 Bangkok

OBJECTIVE OF SALT IODISATION LEGISLATION § prohibits non-iodised salt or allows only iodised salt § requires the iodisation of all salt within the scope of the legislation § guides the production of iodised salt § sets standards if salt is iodised (voluntary) 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 11

OBJECTIVE OF SALT IODISATION LEGISLATION Non-iodised salt banned or only iodised salt allowed Bangladesh Cambodia China Fiji India Malaysia Mongolia Myanmar Pakistan (draft) Papua New Guinea Solomon Islands 12 -14 October 2015 Bangkok Sri Lanka All salt must be iodised Bhutan (interpreted) Laos Nepal Philippines Thailand Timor Leste (draft) Viet Nam (draft) Guides production of iodised salt Afghanistan Indonesia Voluntary iodisation Brunei Singapore Viet Nam (current) EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 12

SCOPE OF SALT IODISATION LEGISLATION § WHO, UNICEF and the ICCIDD (now the Iodine Global Network) define universal salt iodisation as “the iodisation of all human and livestock salt, including salt used in the food industry. 1 § Recent, updated guidelines for the fortification of food grade salt with iodine emphasise the importance of fortifying salt in food processing. 2 1. WHO, UNICEF & ICCIDD. Assessment of iodine deficiency disorders and monitoring their elimination: A guide for programme managers. Third Edition. WHO 2007. 2. WHO. Guideline fortification of food-grade salt with iodine for the prevention and control of. EAP iodine deficiency 13 Regional Workshop on 12 -14 October 2015 ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION Bangkok disorders. Geneva, WHO 2014

SCOPE OF SALT IODISATION LEGISLATION Universal salt iodisation legislation Food processing salt specifically included Food processing salt excluded Salt for animals excluded Afghanistan Bhutan (interpreted) Cambodia China Mongolia Pakistan (draft) Bangladesh India Indonesia India Malaysia Mongolia Sri Lanka Fiji Philippines Laos Sri Lanka Myanmar Thailand Imported salt excluded Nepal Timor Leste (draft) None Pakistan (draft) Papua New Guinea Philippines Solomon Islands Timor Leste (draft) 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 14

SALT IODISATION STANDARDS § Majority set in separate regulation, rather than Law/Act § Wide range of iodisation standards (15 -70 mg/kg) § Standards higher than recommended in several countries § Usually set standard at production level; some set more than one level & some did not specify at which level standard applies § Some did not indicate maximum level 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 15

LESSONS LEARNT 1. Importance of legislation, in particular mandatory legislation 2. Political commitment necessary for legislation 3. Legislation only effective if enforced; weak enforcement and low penalties are common 4. Mechanism of legislation has implications for implementation and enforcement mechanisms regulation under Food Act 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 16

LESSONS LEARNT 5. Strongest legislation bans/only allows iodised salt 6. Setting conditions for salt iodisation hinders iodisation of all salt 7. Scope of legislation is important; inclusion salt for food processing 8. Levels of iodine in this region possibly too high; need to review in light of urinary iodine levels 12 -14 October 2015 Bangkok EAP Regional Workshop on ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION 17

Thank you! #commit 2 USI