1. Elimination of Iodine Deficiency in Lithuania: Comments for policy-making Frits van der Haar Associate Professor International Health Emory University School of Public Health Atlanta, Georgia, U.S.A.

2. Changes of nutrition policy are influenced by: Nutrition needs in the population Available information, technology and resources Food Industry concerns Public Health views Opinions among Gatekeepers Attitudes among Decision-makers

3. IDD: What significance? Iodine Deficiency causes diminished educability, productivity and earnings from: – Brain damage in newborns (up to 15% IQ loss for life), and – Apathy in adolescents and adults Pregnancy wastage, infant mortality Higher health care cost among elderly Effects are not trivial for the nation

4. On the other hand: Correction is do-able and OK! Universal Salt Iodization is Safe Simple Economical Equitable Self-financed “Salt iodization: The most elegant among all nutrition solutions”

5. The “do-ability” of Salt Iodization Science is known and available Technology is established > 50 years Experience worldwide associated Costs are minimal The practice is self-financing Salt industry leaders of Lithuania are ready to assist

6. What may be some reasons to worry? Progressing requires Partnership Questions about cost-benefits Clinical side-effects may arise Success doesn’t occur overnight Development is a social process, and always risks running into obstacles

7. Private Sector Civic Sector Public Sector Enhancing Alliances Opening the channels of communication Increasing the Capacity for Problem Solving Partnerships.... are hard work

8. What if they get “too much”? Technical answer is Quality Assurance of salt supplies: People can’t eat too much iodine from using iodized salt Political answer is to establish national policy on a balanced trade-off between benefits and risks among different groups

9. Cost-benefit is an over-arching consideration The public investment is minimal Salt iodization pays itself Modern health care of thyroid patients is in place and effective Population benefits accumulate Returns will “last a lifetime”

10. Good policy provides guidance and protection GroupResponsibilityRight Government Apply the law equitably and educate the public Insist on protecting the population by sufficient, good quality iodized salt Producers Deliver and promote only iodized salt Insist on fair and equal treatment of all actors in the salt industry Consumers Accept and consume only iodized salt Insist on permanent national oversight to ensure nation’s success