Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
The benefits of Iodised salt in prevention of Iodine deficiency disorders
- Umesh Kapil (15 October 2004)
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Salt Tax: Lessons from history?
- Sanjith Kamath, Vishelle Ramkisson, Senior House Officer in Psychiatry (15 October 2004)
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Author reply – Salt tax may still make good sense
- Nick Wilson (25 October 2004)
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Umesh Kapil, Professor, Deaprtment of human Nutrition All India Institute of Medical Sciences, New delhi , India
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Dear Sir, Iodised salt consumption is the best and most cost effective method of of prevention of Iodine deficiency disorders .Iodine deficiency disorders (IDD) constitute the greatest cause of preventable brain damage in the fetus and infant, and of retarded psychomotor development in young children. It remains a major threat to the health and development of population the world over, but particularly among pre-school children and pregnant women in low-income countries. It results in goiter, stillbirth and miscarriages, but its most devastating toll is mental retardation, deaf-mutism and impaired learning ability. While cretinism is the most extreme manifestation, of considerably greater significance are the more subtle degrees of mental impairment that lead to poor school performance, reduced intellectual ability and impaired work capacity. The main WHO intervention strategy for IDD control – universal salt iodization (USI) – was adopted by the Health Assembly in 1993 and established as a World Summit for Children Goal in 1995. Salt was chosen for a number of reasons, two being that it is widely consumed by most people in a population and the costs of iodizing it are extremely low around five US cents per persons per year. In high-risk areas, where populations cannot be reached by iodized salt, the alternative is to administer iodine directly either as iodide or iodized oil with a focus particularly on women and children. Cardiologists want the reduced intake of salt for prevention of cardiac diseases while nutritionists want that the salt should continue to be consumed in quantity as traditionally consumed. There are no international guidelines / consensus on how much quantity of salt shoudl be consumed for healthy living. the reduction in salt intake would lead to change in the policy of fortfication of salt with iodine in different countries. We will be gaining health benefits from one hand and losing from the other. We need to look at health holistically rather than tubular vision of our own speciality. Prof Umesh Kapil Department of Human Nutrition, All India Institutwe of Medical Sciences, New Delhi, India , 110029 Competing interests: None declared |
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Sanjith Kamath, Specialist Registrar in Psychiatry Peterborough PE3 6DA, Vishelle Ramkisson, Senior House Officer in Psychiatry
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EDITOR It was with great interest and much amusement that we read Nick Wilson’s letter proposing the introduction of a ‘salt tax’.1 If it were to accept his advice, then it would be the second time in the last one hundred years that the British Government introduced a system of taxation on the production and sale of salt for different but ultimately convergent reasons. Any Indian worth his salt (pardon the pun) will be aware of the Dandi March of 1930 initiated by Mahatma Gandhi in response to the tax on salt levied by the British Government in India. The tax was apparently an important source of income for the government and one could speculate that it afforded a measure of control over the Indian people who were perhaps unwilling subjects of the erstwhile British Empire. Such was the resentment to this tax that the Dandi march was the catalyst for the Civil Disobedience movement which eventually led to Indian independence. Dr Wilson has briefly pointed out both the health and economic advantages of levying a salt tax in the present age. While it is unlikely that we will see armies of potential hypertensives marching in protest through the streets of London in emulation of the Mahatma, the tax, indirect as it may be, will certainly appear to be another form of control introduced by the ‘Nanny State’ and as such may have consequences similar to those seen in India all those years ago. 1. Wilson N. Salt tax could reduce population's salt intake BMJ 2004;329: 918-c Competing interests: None declared |
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Nick Wilson, Senior Lecturer (Public Health) Wellington School of Medicine, Otago University, Wellington
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The rapid responses to the letter suggesting a tax on salt, raise some good points. Firstly the iodisation of salt is certainly an extremely effective and cost-effective public health intervention. However, the appropriate response to any declining population salt intake could be to either increase the iodisation level of salt or to ensure that iodised salt is specifically used in bread manufacturing (eg, as in Tasmania [1]). Such modifications will need to be country-specific given variation in levels of iodine in local produce and national dietary patterns. For example, the increased consumption of takeaway Japanese food in some countries may be contributing to increased dietary iodine intake for some populations (ie, from iodine in seaweed and other seafood products). Secondly, there is no doubt that the British Government used unjust and oppressive taxes on the people of India last century (as have many other governments throughout history). However given our current knowledge about the health risks of excess salt, taxation policy can be more sophisticated and even contribute to reducing health inequalities. A more sophisticated approach to tax policy is seen in the shift that has occurred in many countries away from income tax towards the greater use of smart taxes that protect health and/or the environment. These include taxes on tobacco, alcohol, gambling, greenhouse gases, unleaded petrol, and high-sulphur coal. Such an approach can potentially be extended to such products as saturated fat and salt. But to ensure that such new taxes do not contribute to the overall tax burden, the revenue could be used to fund the provision of nutritious foods to schoolchildren or else be accompanied by reductions in sales taxes (eg, VAT) or in income tax for low-income citizens. In such ways these new taxes can be made to be fiscally neutral while potentially improving public health and reducing costs for the health sector. Reference 1) Seal JA, Johnson EM, Doyle Z, Shaw K. Tasmania: doing its wee bit for iodine nutrition. Med J Aust 2003;179:451-2. Competing interests: None declared |
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