Iodine – Essential for Health

Iodine Deficiency Disorders (IDD) continue to pose a serious threat to the health, well being, economic productivity and advancement of several hundred million people worldwide. People living in iodine deficient environment suffer from reduced mental and physical abilities, cretinism, deaf-mutism, squint, still-birth, abortion, goitre of all ages, neuro-motor defects, etc. Even when born normal, young children whose diets are low in iodine have their lives trapped in mental dullness and apathy. IDD preys upon poor, pregnant women and preschool children, posing serious public health problems in more than hundred developing countries. Iodine deficiency was once considered a minor problem, causing goiter, it is now known that it affects developing brain much deadlier and thereby, constituting a threat to the social and economic development of many countries.

The magnitude of the IDD problem is quite high. This has led to an International focus on elimination of Iodine Deficiency Disorders and October 21 is observed as the Global Iodine Deficiency Disorders Prevention Day to create awareness towards this problem. Iodine is an essential component of thyroid hormones which are needed for optimal mental and physical development and regulation of body metabolism. Therefore, in iodine deficiency populations, it is critical to have effective universal salt iodisation. Iodine, a chemical element like carbon, oxygen or iron, is available in fairly constant amounts in seawater while it is found in an uneven distribution over land and fresh water.

It is an essential part of the chemical structure of thyroid hormones. It makes two hormones - thyroxine (T4) and triiodothyronine (T3). The thyroid hormones act in target organs by influencing many different chemical reactions, usually involving manufacture of key proteins. The body must have proper levels of thyroid hormone to work well. Recommended daily intake of iodine varies with age. To meet iodine requirements, the recommended daily intakes are - 50 micrograms for infants (first 12 months of age), 90 mg for children (2-6 years of age) 120 mg for school children (7-12 years of age), 150 mg for adults (beyond 12 years of age) and 200 mg for pregnant and lactating women. Most of it comes from what we eat and drink. Seafood is usually a good source because the ocean contains considerable iodine. Freshwater fish reflect the iodine content of the water where they swim.

Iodine contents in other foods vary depending on their source. Plants grown in iodine-deficient soil do not have much iodine, nor do meat or other products from animals fed on iodine-deficient plants. Iodized salt is a special case. With only a few isolated exceptions, edible salt (sodium chloride) does not naturally contain iodine. Iodine is added deliberately as one of the most efficient ways of improving iodine nutrition. Iodine exposure can come from many other sources too, for example certain food colorings (erythrosine), skin disinfectants, such as povidone iodine, is absorbed and reaches the bloodstream, health foods – certain types of kelp, dyes and medicines. People also get iodine from its use in farm animals, for cleansing udders or as part of iodine-containing medicines. Iodate has been used as a bread stabilizer in commercial baking, although this practice is less common now.

Though iodine deficiency has terrific negative effects, its excess can play havoc too. The excess of it causes thyroid under activity. Iodised and uniodised salt are sold simultaneously in the country. But the awareness of the health priority aspect of iodised salt among the public has resulted in the creation of a significant consumer demand for iodised salt. The World over, including China and the neighbouring countries like Bangladesh, Bhutan, Sri Lanka, Nepal, Maldives, Myanmar, Thailand, etc., are implementing compulsory salt iodisation for human consumption. Globally iodated salt is recognized as the cheapest and most sustainable way to prevent and control Iodine Deficiency Disorders.

Except few types of goiter, most of the iodine deficiency disorders are irreversible and permanent in nature, but they can be easily prevented by regular consumption of iodated salt daily. Realizing the magnitude of the problem, the Government launched a 100 per cent centrally assisted National Goitre Control Programme (NGCP) in 1962. In August 1992, the National Goitre Control Programme (NGCP) was renamed as National Iodine Deficiency Disorders Control Programme (NIDDCP) with a view to cover a wide spectrum of Iodine Deficiency Disorders. The Government’s goal of NIDDCP is to reduce the prevalence of Iodine deficiency disorders below 10 per cent in the entire country by 2012 A.D.

From Darkness to Light: National Programme for Control of Blindness

O loss of sight, of thee I most complain!....- John Milton

Milton was expressing a primal sentiment as ability to see is critical for realization of human potential. This sentiment is shared by at least 12 million people in India who fall in the category of blind (visual acuity less than 6/60). In many cases this fate is totally avoidable or can be corrected by simple interventions. For example, in the year 2008-09, the country performed nearly 5.8 million cataract surgeries with 94% inter-ocular lens (IOL) implantation. In layman terms this means blindness was either prevented or corrected in 5.4 million people in one year. This was one of the activities of National Programme for Control of Blindness (NPCB) which has made a commendable progress in terms of Cataract Surgical Rate and the momentum thus generated would continue in future also.

The Programme
National Programme for Control of Blindness (NPCB) is now more than thirty years old, launched in 1976 as 100% centrally sponsored scheme has the professed goal of reducing blindness prevalence to 0.3% by the year 2020. Blindness prevalence stood at 1% in 2006-07, down from 1.1% in the year 2001-02. Refractive errors are other important cause of vision impairment and are being addressed effectively through institutional and outreach activities. School Eye Screening is an important strategy wherein eyes of children studying in schools are screened for vision impairment and glasses distributed free of cost to students from poor socio-economic strata. Corneal blindness is being addressed through eye banking activities and a new thrust has been given for eye donation and corneal transplantation.

With the approval of Rs 1250 crores and implementation of Eleventh Plan (2007-12) the programme has taken a lead in addressing other issues of blindness in a comprehensive manner. These include Diabetic Retinopathy, Glaucoma, Childhood blindness, Low Vision and ocular injuries in a mission mode through successful Public Private Partnership. The endeavor of the programme is to eliminate all causes of avoidable blindness and to reach a sustainable level where-in all people have access to level appropriate eye care service. Tele-ophthalmology a new information technology tool has been introduced under the programmefor reaching the undeserved population in rural & tribal areas. The results are very encouraging and being scaled up in a phase manner.

NRHM Push
The programme has been fully integrated under National Rural Health Mission (NRHM) to enhance the reach and coverage including utilization of services of community link worker like Accredited Social Health Activist (ASHA) and Anganwadi workers. State Blindness Control Societies and District Blindness Control Societies have been merged State HealthSocieties and District State Societies formed under the NRHM umbrella. Under NRHM facility for IOL implantation are to expanded to at least Taluka level.

Other new initiatives include funding for construction of eye wards and dedicate eye OT especially in North East State and Hilly/underdeveloped States and appointment of eye surgeons, eye donation counselors and Para-Medical Ophthalmic Assistant (PMOA) especially for the new or district where there are none. The recurring expenditure of such workforce will be borne by Government of India till the term of eleventh plan period and thereafter it would be taken up by respective State/UTs. Funding for provision of latest equipment and instruments for establishing & strengthening eye care services in government institutions i.e. vision centre at Primary Health Centre (PHC), Community Health Centre (CHC) through district hospital and medical colleges are being developed into centre of excellence for providing pediatric ophthalmology retina units/low vision units.

Non-governmental sector providing free services to needy population are being supported through recurring and non-recurring grant as per the approved schemes. Capacity building of health personnel is another important strategy for improving their skills and updating them on issues relevant to the programme for delivery of eye care services. The Government coordinates the in-service training of eye surgeons working in public sector and provides funding to States/UTs for other health care staff including medical officers, paramedical and community link workers. Advocacy and social mobilization including Information, Education and Communication (IEC) activities have made a impetus in improving community awareness.

Encouraging Response
Funds utilization is an indicator for planned activities being under taken and during last five years utilization has been to the tune of nearly 100% of the allocation. National Programme for Control of Blindness (NPCB), through State/UTs and all other stakeholders and partners are consistently moving forward in advancement of comprehensive eye care services and hopefully would be able to bring the level of blindness in the country from current status of 1.0% to 0.3% by the year 2020.

*Based on Material from Ministry of Health & Family Welfare

Boosting foodgrain production for enhanced food security

by - Surinder Sud, Freelance Writer
“Achieving food security in times of crisis”. This is the theme for this year’s World Food Day being celebrated on October 16. This is as aptly relevant for India, grappling with drought this year, as for the world reeling under economic crisis that has hit the poor harder than the rich, jeopardising their livelihood and food security.

India has, no doubt, won the battle against famines and starvation deaths, which have become the thing of the past, thanks to spectacular upswing in foodgrain production since the green revolution of the late 1960s. The country’s grain coffers are brimming over, holding nearly 53 million tonnes of wheat and rice on July 1, 2009, as a result of consistent rise in foodgrainoutput in past few years. The food output has grown annually, on an average, by 1.98 per cent between 2004-05 and 2008-09, which is higher than the estimated population growth of 1.5 per cent during this period. Yet, there is rampant disguised hunger and malnutrition. More than one-fifth of the country’s population is reckoned to be undernourished in terms of energy and protein intake.

Globally, too, the picture is not too different. The United Nations Food and AgricultureOrganisation (FAO) reckons that nearly 105 million people have been added to the list of hungry in 2009 itself, swelling the total number of malnourished people in the world to whopping 1.02 billion. Simply stated, this means that almost one-sixth of all humanity is suffering from hunger.

This is the state of food intake alone. But the modern concept of food security goes far beyond the availability and accessibility of staple food. It includes the man’s need for safe drinking water, clean surrounding environment and health cover. Livelihood security, essential for ensuring economic access to food, is intricately related to food security. Sanitation and shelter are also part of the broad new concept of food security.

The widely accepted definition of food security in the modern context is: ‘physical, economical, social and environmental access to balanced diet and clean drinking water for all and forever’. This is slightly different from classical concept of food security which, in simple terms, deems it a situation where all people at all times have sufficient food to meet their dietary and nutritional needs to lead a healthy and productive life. This makes it imperative to ensure food security at least at three levels – national level (macro level food security), household level and individual level (micro level food security to facilitate equal access to food to women, especially pregnant women, and young girls).

Where macro level food security is concerned, India is well protected. While the country’s population has nearly doubled between the initial years of the 1970s (when the fruits of the green revolution had begun to accrue) and now, the foodgrain production has increased more than that – from about 90 million tonnes then to nearly 134 million tonnes now.

This has transformed the country from a net food importer to an occasional food exporter. More importantly, this has increased the per capita availability of foodgrains – from 183 kg in 1971-1975 to 193 kg in 2006-07 – despite the increase in the population.

What is highly significant here is that the output of relatively more nutritious food items, such as fruits, vegetables, fish, milk, meat and eggs, has risen faster than that of staple foods. This has implications for nutrition security. Reduction in poverty and improvement in income levels have, together, made food economically accessible to more people. This is reflected in decrease in the per capita consumption of cereals and increase in that of non-cereal foods like fruits, vegetables, fish and animal products. The bitter truth, however, is that neither poverty has totally been eliminated nor food could be made economically accessible to all. As a result, ensuring food security to all is still a challenge.

Fortunately, the need for enhancing food security has seldom been lost sight of by successive Governments in India ever since Independence. This has been sought to be achieved through several policy initiatives and administrative measures. Besides consistent efforts to boost foodgrain production and augment food availability through imports, when necessary, a massive public food distribution system (PDS) has been created to provide physical access to food throughout the country. Massive subsidies are given on food items for different classes of people, depending on their income level to make the food economically affordable for them.

Moreover, social welfare schemes, involving food as a component of assistance, and food-for-work kind of programmes are launched with the dual objective of providing food and alleviating poverty. The most significant recent initiatives in this direction that have attracted attention worldwide are the passage of the National Rural Employment Guarantee Act (NREGA) and proposal to pass a similar law for guaranteeing statutory right to food. Such measures can potentially take care of both food security and livelihood security. Presently, over half of the country’s population is covered by one or the other scheme in which subsidized food is made available to the beneficiaries.

Another significant recent measure is the setting up of a National Food Security Mission (NFSM) which essentially aims at boosting the production of foodgrains like rice, wheat and pulses. This mission already seems to have made an impact on the output of rice and wheat though the production of pulses still continues to fluctuate widely from year to year.

However, there are several formidable threats to food security. The physical health of soil, including its fertility, is deteriorating due to extraction of more nutrients from it than are added to it annually. The carbon content of the soils is decreasing due to lesser than required application of organic manures. Several micronutrients, vital for getting good crop yields, are becoming deficient. The yields of several key food crops are tending to reach the plateau. Water is also becoming scarce. Achieving a quantum jump in food production is difficult under such circumstances.

The biggest challenge to food security has been posed by the global warming and the resultant climate change. The studies conducted by the New Delhi-based Indian Agricultural Research Institute (IARI) have indicated the possibility of around 4 to 5 million tonnes loss in the country’s overall annual wheat production with every rise of 1 degree Celsius in temperature. The output of other food crops is also likely to be hit by the climate change-induced erratic weather, more frequent droughts and floods and other stresses caused to the food crops.

Though the climate change has begun to create problems for food production all over the world, but the developing countries, especially of South Asia, are believed to be the most vulnerable to its adverse affects. A recent comprehensive assessment of the impact of climate change on agriculture, made by the International Food Policy Research Institute (IFPRI), has indicated that the yield of wheat may drop by as much as 50 per cent by 2050 from 2000 levels in South Asia. The productivity of rice is projected to dip by 17 per cent and that of maize by 6 per cent by that time. This study has also indicated that the prices of food crops like wheat, rice, maize and others will rise by between 121 per cent and 194 per cent by 2050 due to factors related to climate change. This, coupled with decreased yields of these crops, will threaten food security of some 1.6 billion people in South Asia and render 25 million more children malnourished world wide by 2050.

Calculations by the FAO have indicated that agriculture in developing countries would need an investment of around US $ 30 billion to achieve the goal, set by the World Food Summit in 1996, of reducing the number of hungry people by half by 2015. However, the FAO has also said in a statement on the occasion of the World Food Day 2009 that the world has the ability to find money to solve problems if these problems are considered important. “Let us work together to make sure hunger is recognised as a critical problem, and solve it,” the global food body has asserted.
Disclaimer : The views expressed by the author in this feature are entirely his own and do not necessarily reflect the views of PIB
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