Salt Iodization into the Modern Era and Beyond

  • Frits van der HaarEmail author


Following from the history described in Chap.  1, the present chapter describes the scientific basis for, and the worldwide acceleration of, national IDD prevention programs from the continuous expansion of salt iodization strategies in country upon country starting from the mid-twentieth century. The vision of global IDD prevention and control was first formulated in 1960 by the World Health Organization (WHO). Commitments made by the heads of state and government at the World Summit for Children in 1990 prompted a 10 year period of multisector collaborative actions especially in the developing world, which raised the coverage and access of adequately iodized consumer salt to 70 % worldwide by 2000. The period after the year 2000 witnessed a slower but continued increase in the worldwide iodized salt supplies, along with a steady reduction in the number of countries still considered deficient. The chapter outlines the up-to-date insights into the modern methods and approaches to establish true universal salt iodization (USI). Again in 2014 and based on a meta-analysis of research findings, WHO strongly recommended the mandatory iodization of all dietary salt to prevent iodine deficiency disorders (IDD). Current program management concerns include an increase in the salt intake from processed foods that occurs with economic development and the challenges in aligning the two salt-based strategies of salt intake reduction and salt iodization. The chapter ends with a premonition that the sustained prevention of IDD requires assurance that USI has become established as a habitual norm in iodine nutrition policy and practice worldwide.


Iodine Universal salt iodization World Summit for Children Public-private partnership Sustained success 



International Council for Control of Iodine Deficiency Disorders


Iodine deficiency disorders


Iodine Global Network


Institute of Nutrition in Central America and Panama


Pan-American Health Organization


United Nations Children’s Fund


Universal salt iodization


World Health Assembly


World Health Organization


World Summit for Children


  1. 1.
    Multhauf RP. Neptune’s gift. A history of common salt. Baltimore: Johns Hopkins University Press; 1978.Google Scholar
  2. 2.
    Holman JCM. Preparation of iodized salt for goiter prophylaxis. Bull World Health Organ. 1953;9:231–9.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Holman JCM. Iodized salt. Bull World Health Organ. 1958;18:255–73.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Murray MM. The effects of administration of potassium iodate to man and animals. Bull World Health Organ. 1953;9:211–6.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Arroyave G, Pineda O, Scrimshaw NS. The stability of potassium iodate in crude table salt. Bull World Health Organ. 1956;14:183–5.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Scrimshaw NS. INCAP studies of endemic goiter and its prevention. Food Nutr Bull. 2010;31(1):111–7.CrossRefPubMedGoogle Scholar
  7. 7.
    Kelly FC, Snedden WW. Prevalence and geographical distribution of endemic goitre. In: Clements FW, et al., editors. Endemic goitre, Monograph series 44. Geneva: World Health Organization; 1960. p. 27–233.Google Scholar
  8. 8.
    Langer P. History of goitre. In: Clements FW, et al., editors. Endemic goitre, Monograph series 44. Geneva: World Health Organization; 1960. p. 9–25.Google Scholar
  9. 9.
    Lowenstein FW. Iodized salt in the prevention of goiter: a worldwide survey of present programs. Am J Public Health Nations Health. 1967;57(10):1815–23.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kevany JP. Prevention of endemic goiter in Latin America. In: Stanbury JB, editor. Endemic goiter, Scientific Publ No. 193. Washington, DC: PAHO; 1969. p. 78–84.Google Scholar
  11. 11.
    Dunn JT, Medeiros-Neto GA, editors. Endemic goiter and cretinism: continuing threats to world health, Scientific Publ No. 292. Washington, DC: PAHO; 1974.Google Scholar
  12. 12.
    DeMaeyer EM, Lowenstein FW, Thilly CH. The control of endemic goitre. Geneva: World Health Organization; 1979.Google Scholar
  13. 13.
    Stanbury JB, Hetzel BS. Endemic goiter and endemic cretinism: iodine nutrition in health and disease. New York: Wiley & Sons; 1980.Google Scholar
  14. 14.
    Dunn JT, Pretell EA, Daza CH, Viteri FE. Towards the eradication of endemic goiter, cretinism and iodine deficiency, Scientific Publ No. 502. Washington, DC: PAHO; 1986.Google Scholar
  15. 15.
    Hetzel BS. Iodine deficiency disorders (IDD) and their eradication. Lancet. 1983;1983(8359):1126–9.CrossRefGoogle Scholar
  16. 16.
    Pharoah POD, Buttfield IH, Hetzel BS. Neurological damage to the fetus resulting from severe iodine deficiency during pregnancy. Lancet. 1971;297:308–10.CrossRefGoogle Scholar
  17. 17.
    World Health Organization. Report to the 43rd World Health Assembly (Resolution WHA 43.2). Geneva: World Health Organization; 1990.Google Scholar
  18. 18.
    UNICEF. First call for children. World declaration and plan of action for children. New York: United Nations Children’s Fund; 1990.Google Scholar
  19. 19.
    Ramalingaswami V. Challenges and opportunities – one vitamin, two minerals. World Health Forum. 1992;13:222–31.PubMedGoogle Scholar
  20. 20.
    World Declaration and Plan of Action for Nutrition. Rome, Food and Agricultural Organization of the United Nations and World Health Organization, December 1992.Google Scholar
  21. 21.
    WHO/UNICEF/ICCIDD. Global prevalence of iodine deficiency disorders, MDIS working paper #1. Geneva: World Health Organization; 1993.Google Scholar
  22. 22.
    Lamberg BA. Effectiveness of iodized salt in various parts of the world. In: Hall R, Kobberling J, editors. Thyroid disorders associated with iodine deficiency and excess. New York: Raven Press; 1985. p. 81–94.Google Scholar
  23. 23.
    UNICEF-WHO Joint Committee on Health Policy Special Session. World Summit for Children mid-decade goal: iodine deficiency disorders (IDD). Geneva: World Health Organization; 1994.Google Scholar
  24. 24.
    UNICEF/WHO/World Bank. Ending iodine deficiency forever – a goal within our grasp. New York: United Nations Children’s Fund; 2000.Google Scholar
  25. 25.
    Maberly GM, Haxton DP, van der Haar F. Iodine deficiency: consequences and progress toward elimination. Food Nutr Bull. 2003;24(4):S91–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Van der Haar F, De Jong JM, Haxton DP, Mannar V. Salt2000: marking and sustaining global progress in universal salt iodization. IDD Newslett. 2000;16(3):33–7.Google Scholar
  27. 27.
    World Bank. Enriching Lives. Overcoming vitamin and mineral malnutrition in developing countries. Chapter 4: successful fortification. Washington, DC: The World Bank; 1994.CrossRefGoogle Scholar
  28. 28.
    WHO, UNICEF, ICCIDD. Recommended iodine levels in salt and guidelines for monitoring their adequacy and effectiveness, Doc. No. WHO/NUT/96.13. Geneva, World Health Organization; 1996.Google Scholar
  29. 29.
    Van der Haar F, Gerasimov G, Tyler VQ, Timmer A. Universal salt iodization in the Central and Eastern Europe, Commonwealth of Independent States (CEE/CIS) region during the decade 2000–2009: experiences, achievements and lesson learned. Food Nutr Bull. 2011;32(4):S175–294.CrossRefPubMedGoogle Scholar
  30. 30.
    WHO. Guideline: fortification of food-grade salt with iodine for the prevention and control of iodine deficiency disorders. Geneva: World Health Organization; 2014.Google Scholar
  31. 31.
    Gorstein J, van der Haar F, Codling K, Houston R, Knowles J, Timmer A. Performance of rapid test kits to assess household coverage of iodized salt. Publ Health Nutr Advance Pub. 2016. doi: 10.1017/S1368980016000938.
  32. 32.
    Maberly GF, Trowbridge FL, Yip R, Sullivan KM, West CE. Programs against micronutrient malnutrition: ending hidden hunger. Annu Rev Public Health. 1994;15:277–301.CrossRefPubMedGoogle Scholar
  33. 33.
    Van der Haar F, Gerasimov G, Tyler VQ, Timmer A. Universal salt iodization in the Central and Eastern Europe, Commonwealth of Independent States (CEE/CIS) region during the decade 2000–2009: experiences, achievements and lesson learned. Food Nutr Bull. 2011;32(4); Chapter 2: an analysis of USI strategies, S181–3.Google Scholar
  34. 34.
    Iodine Global Network. See
  35. 35.
    WHO, UNICEF, ICCIDD. Assessment of iodine deficiency disorders and monitoring their elimination: a guide for programme managers. 3rd ed. Geneva: World Health Organization; 2007.
  36. 36.
    UNICEF. Sustainable elimination of iodine deficiency: progress since the 1990 World Summit for Children. New York: United Nations Children’s Fund; 2008.
  37. 37.
    Rohner F, Zimmenmann M, Jooste P, Pandav C, Caldwell K, Raghavan R, Raiten D. Biomarkers for development – iodine review. J Nutr. 2014;144(8):1322S–42S.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    WHO. Salt reduction and iodine fortification strategies in public health. Report of a joint technical meeting convened by the World Health Organization and The George Institute of Global Health in collaboration with the International Council for Control of Iodine Deficiency Disorders Global Network, Sydney, Australia, March 2013.Google Scholar
  39. 39.
    Zimmermann MB, Hussein I, Al Ghannami S, El Badawi S, Al Hamad NM, Hajj BA, Al-Thani M, Al-Thani AA, Winichagoon P, Pongcharoen T, van der Haar F, Qing-Zen J, Dold S, Andersson M, Carriquiry AL. Estimation of the prevalence of inadequate and excessive iodine intakes in school-age children from the adjusted distribution of urinary iodine concentrations from population surveys. J Nutr. 2016. doi: 10.3945/jn.115.229005.
  40. 40.
    Vὃlzke H, Caron P, Dahl L, de Castro JJ, Erlund I, Gabersceck S, Gunnarsdottir I, Hubalewska-Djdejczyk A, Laurberg P, Lazarus JH, Markou KB, Moreno-Reyes R, Nagy EV, Peeters RP, Pirags V, Podoba J, Rayman MP, Rochau U, Siewert U, Smyth PP, Thuesen BH, Troen A, Vila L, Vitti P, Zamrazil V, Zimmermann MB, for the Iodine Global Network (IGN) West Central Europe Group and the EUTHyroid Consortium. Ensuring effective prevention of iodine deficiency disorders. Thyroid. 2016;26(2). doi: 10.1089/thy.2015.0543.
  41. 41.
    World Health Organization. Sustaining the elimination of iodine deficiency disorders. Progress report submitted to the 69th World Health Assembly, 23–28 May 2016. IDD Newslett. 2016;44(2):5.Google Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Rollins School of Public HealthEmory UniversityAtlantaUSA

Personalised recommendations