Section III The Global Partnership People & Governments/Salt Industry UN System/AusAID/CIDA/ Kiwanis International/Global Network/ ICCIDD/IRLI/Research Centres/MI 1. Introduction 2. People in Countries where IDD is a Public Health Problem 3. Governments of Countries where IDD is a Public Health Problem 4. The Salt Industry 5. The Role of UNICEF and WHO in Eliminating Iodine Deficiency Disorders 6. Bilateral Aid (Development) Agencies 7. Kiwanis International First Worldwide Service Project 8. The Global Network for the Sustainable Elimination of Iodine Deficiency 9. The International Council for Control of Iodine Deficiency Disorders (ICCIDD) 10.The International Resource Laboratories for Iodine (IRLI) Network 11.Research Centres that have made major contributions to IDD research 12.The Micronutrient Initiative (MI) 40 Global Elimination of Brain Damage Due to Iodine Deficiency 1. Introduction Great progress has been made in the development of IDD Elimination Programs through an informal Global Partnership that has developed following the World Summit for Children in 1990. In this Section III the various partners describe their role which has led to the development of coordination and effective action towards the great goal of elimination. The partnership includes the following - 2. People in countries where IDD is a public health problem. 3. Governments of countries where IDD is a public health problem. 4. Salt Industry has an important role to play in achieving effective Salt iodization 5. The Role of the UN System particularly WHO and UNICEF, which are specifically committed to assisting countries achieve the goal of elimination of IDD. The World Bank has provided major funding support to the development of the salt industry in Indonesia and China. The United Nations Agencies FAO, WFP and UNIDO have also been involved. 6. Bilateral Aid (Development) Agencies of developed countries which have included support of national programs for IDD control in their development programs. These include Australia, Belgium, Canada, Germany, Holland, Italy, Sweden and the United States of America. The role of Australia and Canada will be described in detail. 7. Kiwanis International-an international world service club which has adopted the elimination of IDD, through UNICEF, as its First worldwide service project. 8. Global Network for the Sustainable Elimination of Iodine Deficiency, including the Salt Industry at international level. 9. International Council for Control of Iodine Deficiency Disorders (ICCIDD) which has provided an expert scientific advisory role in the establishment of effective national programs and in the monitoring of progress towards the goal of elimination of IDD at country level. 10. International Resource Laboratories for Iodine (IRLI) Network has at international and national levels been recently established to assist the development of laboratories for the determination of salt iodine/urine iodine within national elimination programs. The Global Partnership 41 11. Research Centres where important IDD research has been carried out that has made possible this global program for the elimination of brain damage due to iodine deficiency. These institutions are situated in both developed countries and developing countries. 12. The Micronutrient Initiative (MI) was established in 1992 as an international secretariat by its principal sponsors: Canadian International Development Agency (CIDA), International Development Research Centre (IDRC), United Nations Children’s Fund (UNICEF), United Nations Development Program (UNDP) and the World Bank. The mission of the MI is to facilitate the achievement of the goals related to elimination of micronutrient malnutrition accepted by the World Summit for Children. 42 Global Elimination of Brain Damage Due to Iodine Deficiency 2 People in Countries where IDD is a Public Health Problem The leaders in this partnership are clearly the people themselves who have the problem. It is a tragic fact that the people of many countries including both the developed and developing countries are not fully aware of the problem that they have. The deadening effects of iodine deficiency combined with the geographic isolation of so many iodine deficient communities mean that the problem is just not known to the people most affected. This is even true of Europe where there is still widespread ignorance of the effect of iodine deficiency on brain development in foetal life and early infancy. This indicates that arousing community awareness is a major step required in country programs. This applies to the local community and to the wider regional and international community. Different methods of awareness are required at each level. The tragic situation shown in the photograph (Section I) of the Chinese mother with four sons, three of them cretins, is reproduced over and over again throughout the large populations at risk all over the world. The message that such situations can be totally prevented needs to be broadcast using every media resource. Now that transistor radios and television are so widely available there are new opportunities for effective media campaigns. Such campaigns are of course already operating in developing countries for the sale of aerated beverages, cigarettes, beer and other widely used products of Western civilization and are very effective! There should be no hesitation in spelling out the personal and social dimension of the tragedies consequent on mental deficiency as the major effect of iodine deficiency on human development. The impact of iodine deficiency on a village community and the benefits of its correction are vividly shown from the experience of the villages in Indonesia, China and India that is reported in Section I. There are significant community groups, which could provide leadership in arousing awareness about IDD. The problem is above all one affecting women and children. The IDD problem is now being taken up by well-organised women’s movements in many countries. The Global Partnership 43 Another resource would be groups of disabled persons. An example is the Chinese Disabled Persons Federation of which the Chairman is Mr. Deng Pu-fang, son of Deng Tsaioping the former paramount leader of China. In the field of mental deficiency there is the International League against Mental Handicap composed of national groups in both developed and developing countries. These groups often include people in leadership positions. A well informed community can apply significant political pressure for effective IDD control programs at regional and national level. This has already been noted in considering the model of a national program. The perception of IDD at community level as affecting productivity, quality of life, and the school performance of children can be very persuasive with politicians especially when accompanied by data on the economic costs of not having an IDD control program as outlined in Section I of this book. An educated community will create demand for iodized salt and the salt industry will respond to this demand as has occurred in developed countries. The consumer organizations and social educationists play a very important role in this aspect. They communicate easily and directly with people at all levels transcending socio-economic and academic barriers. The achievement of correction of iodine deficiency is often not sustained due to political instability affecting the public health sector, or there may be ineffective and inefficient monitoring and many other problems may occur. The only insurance in the long term is the awareness of the community at risk of the proven means by which this risk can be removed. This question of sustainability is considered fully later in this book in Section IX. An adequate dietary intake of iodine is just as important for the maintenance of health and wellbeing as many other public health measures such as clean water, clean food and public hygiene. In concluding this discussion of the “People” it is useful to remind ourselves of the new importance of “People Power” in causing social and political change in our world today. The collapse of the communist regimes in Eastern Europe and the former USSR, the collapse of the Marcos dictatorship in the Philippines and more recent developments in a number of countries, all indicate the “power of the people”. The influence 44 Global Elimination of Brain Damage Due to Iodine Deficiency of the international media has undoubtedly been very important in all these developments. At their best, they indicate awareness of human values as being in the end the highest priority. We can confidently expect an increasing momentum in the drive for improved public health including the elimination of IDD as a result of this new climate of “people power”. The Global Partnership 45 3 Governments of Countries where IDD is a Public Health Problem The responsibility for decision about the introduction and maintenance of an effective national IDD elimination program rests ultimately with the government of the country. Governments are sovereign and it is to governments that the case has to be made and won! Governments in their decision making are influenced by community perceptions as well as the advice of professionals, together with economic considerations. As already pointed out one reason for the neglect of the IDD problem has been the fact that it is often found in the more remote parts of a country-where people have little political influence. Another reason has been the lack of perception of the importance of the IDD problem in human, social and economic terms. This limited perception has now been revised as the evidence mounts of the personal and social and economic cost of IDD to the people of the country affected. This cost has been spelled out in detail in Section I of in this book–costs are very high for developed countries as well as developing countries as the data already cited from Germany indicates. By contrast the cost of IDD control programs is indeed modest. The cost of not having a program is very very great compared to the cost of the program.