1. Review of salt iodisation legislation in the region
Achieving Universal Salt Iodisation for Optimal Iodine Nutrition
UNICEF, IGN, GAIN, MI EAP Regional Meeting
12-14 October, Bangkok
#commit2USI
Review of salt iodisation legislation in the region
Karen Codling
IGN Regional Coordinator for Asia & Pacific UNICEF Consultant

2. Information on legislation from UNICEF programme officers
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 Network (2014). Status by region, Available from (Quoted in GAIN. Fortifying our Future: A snapshot report on food fortification)
EAP Regional Workshop on
ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

3. 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)
EAP Regional Workshop on
ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

4. Timeline of salt iodisation legislation
Singapore (1988)
Bangladesh (1989)
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)
2000s
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
NB. Bhutan, Pakistan and Timor Leste have “parliamentary decision” or draft legislation

5. mechanism of salt iodisation legislation
EAP Regional Workshop on
ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

6. Stand alone legislation includes implementation rules
Coordination mechanisms
Registration/licensing of iodised salt producers
Control of imports
Control of transport of non-iodised salt
Differentiating between industrial and food-grade salt
Public information
Internal quality assurance
External quality assurance
Special allowances for small producers
Penalties
“Stand alone” legislation has a propensity to establish salt iodisation as a vertical programme
EAP Regional Workshop on
ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

7. 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 pre- determined 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)
EAP Regional Workshop on
ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

8. 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%)”
1. Horton S., Mannar, V. & Wesley, A. (2008) Micronutrient Fortification (Iron and Salt Iodization) Copenhagen Consensus Best Practice Paper Available at:
Ref: Horton S., Mannar, V. & Wesley, A. (2008) Micronutrient Fortification (Iron and Salt Iodization) Copenhagen Consensus Best Practice Paper 2008.
EAP Regional Workshop on
ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

9. 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.
EAP Regional Workshop on
ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

10. Malaysia experience: importance of mandatory legislation
Ref: Selamat et al. Iodine deficiency status and iodised salt consumption in Malaysia: findings from a national iodine deficiency disorders survey. Asia Pac J Clin Nutr. 2010

11. 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)
EAP Regional Workshop on
ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

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

13. 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
WHO, UNICEF & ICCIDD. Assessment of iodine deficiency disorders and monitoring their elimination: A guide for programme managers. Third Edition. WHO 2007.
WHO. Guideline for fortification of food-grade salt with iodine for the prevention and control of iodine deficiency disorders. Geneva, WHO 2014
WHO, UNICEF & ICCIDD. Assessment of iodine deficiency disorders and monitoring their elimination: A guide for programme managers. Third Edition. WHO 2007.
WHO. Guideline for fortification of food-grade salt with iodine for the prevention and control of iodine deficiency disorders. Geneva, WHO 2014
EAP Regional Workshop on
ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

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

15. Salt iodisation standards
Majority set in separate regulation, rather than Law/Act
Wide range of iodisation standards (15-70mg/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
EAP Regional Workshop on
ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

16. Importance of legislation, in particular mandatory legislation
Lessons learnt
Importance of legislation, in particular mandatory legislation
Political commitment necessary for legislation
Legislation only effective if enforced; weak enforcement and low penalties are common
Mechanism of legislation has implications for implementation and enforcement mechanisms  regulation under Food Act
EAP Regional Workshop on
ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

17. Strongest legislation bans/only allows iodised salt
Lessons learnt
Strongest legislation bans/only allows iodised salt
Setting conditions for salt iodisation hinders iodisation of all salt
Scope of legislation is important; inclusion salt for food processing
Levels of iodine in this region possibly too high; need to review in light of urinary iodine levels
EAP Regional Workshop on
ACHIEVING UNIVERSAL SALT IODISATION FOR OPTIMAL IODINE NUTRITION

18. #commit2USI