Time for Public to Join the Fight for Iodized Salt

Edward Carlson

Preventing iodine deficiency disease in Bangladesh is not complicated. It requires no more than government regulators making sure salt manufacturers pour legally-required quantities of iodine into their salt before they send their salt to the market. As for the iodine, it's readily available. UNICEF donates it to licensed salt manufacturers.

The current situation of uniodized salt remaining widely available in the Bangladesh market exemplifies the truism that legislation does not result in compliance. Parliament may pass a law, but, without government enforcement, that law will exist in a vacuum. So when the Bangladesh Legal Aid and Services Trust (BLAST), together with the Consumer Advocates of Bangladesh (CAB), learned that salt manufacturers were not following Bangladesh's law requiring iodization of salt, they decided to catalyse action. They filed a writ petition requesting the court to direct ministries, manufacturers, and regulators to comply with the law. And in 2005, the High Court gave a judgment in their favour. (BLAST vs. Bangladesh 2005 BLD (HCD) 83).

'We can't expect good things from bad governance,' said Advocate Md. Ruhul Quddus, who litigated the case on BLAST's behalf, appearing with his senior Mr. Farooqui before the court.

'Many of the manufacturers don't sell salt with the required quantity of iodine, and they do so for illegal profit. And even though they are operating in this manner, it is not an active concern of the authorities to prosecute them.'

Whether or not the authorities uphold the iodine laws, iodine deficiency should be an active concern of the Bangladeshi public - because it is the Bangladeshi public who suffers as a result of failed implementation. Recent tests reveal that, in spite of BLAST's legal victory, salt in the marketplace is still not being properly iodized. And as this article illustrates, there is increasing recognition amongst doctors and advocates that the public must become involved in the struggle for iodized salt for there to be any positive change.

Iodine and Bangladesh
Iodine is essential for human survival at all stages of life. According to Dr. Quazi Quamruzzaman, Chairman of Dhaka Community Hospital, humans need iodine for the production of thyroid hormones. Thyroid hormones are necessary for mental and physical development, and iodine deficiency impairs the function of these necessary hormones.

'Illnesses resulting from iodine deficiency are many, including goiter, weight gain, hypertension, heart failure, depression, psychosis, anemia, vitiligo, menorrhagia, infertility, impotence, growth retardation, and low IQ,' Dr. Quamruzzaman said. Serious effects of deficiency also include retarded brain development in children and slowed metabolism in adults.

UNICEF estimates that every year iodine deficiency impairs 250,000 people and kills 33,000 infants in Bangladesh. According to a survey titled the National Iodine Deficiency Disorders Survey in Bangladesh 1993, 69 percent of Bangladeshis have biochemical iodine deficiency.

Geography is partly to blame. The ocean is nature's primary source of iodine, and rain clouds that form over the ocean replenish the soil's iodine via precipitation. But Bangladesh's annual floods, through erosion and dilution, wash away the naturally-occurring iodine in the soil. As a result, food raised and grown in flood-prone areas lacks sufficient iodine for healthy human development. Many Bangladeshis who live in rural areas and who rely on locally-grown food for sustenance suffer illness and retardation as a result.

Against this backdrop of biological necessity and geographic misfortune, Bangladesh's government passed two laws requiring salt manufacturers to iodize their salt: the Iodine Deficiency Disease Prevention Act in 1989 and the Iodine Deficiency Disease Prevention Rules in 1994.

The laws were meant to both educate consumers and provide them with iodine. The 1989 law requires manufacturers sell iodized salt and declare on their packaging that iodine has been mixed with the salt according to the provisions of the 1989 Act. The 1994 Rules call for the creation of a Salt Committee with statutory authority to implement the legal requirements set forth in the act.

'Iodine deficiency can be prevented in two ways,' Dr. Quamruzzaman said. 'The first way is eating foods and vegetables containing iodine. The second way is making sure that salt is properly iodized.'

Because salt is commonly used in cooking, many governments require salt manufacturers to iodize their salt in order to provide consumers with iodine. It is a tested method of combating iodine deficiency disease. In passing these laws, Bangladesh followed well-established, successful international practice. And this proven success in using salt to combat iodine deficiency, coupled with failed implementation in Bangladesh, frustrates Dr. Quamruzzaman and other healthcare providers who know the importance of iodizing salt.

'For health care providers, if the law is not implemented properly, then the health careprovider is totally frustrated and helpless,' Dr. Quamruzzaman said. 'He or she can only inform the community about the ill effects. Then, the community needs to organize to make the necessary changes.'

Flouting the law

To build a strong case in court, BLAST and CAB filed a joint writ petition requesting the High Court to order salt manufacturers, the Ministry of Health and Family Welfare, the Ministry of Industry, and the BSTI (Bangladesh Standard and Testing institute) to enforce and comply with the 1989 and 1994 iodine laws. By addressing these numerous parties, BLAST covered all stages of the marketing of salt to the Bangladeshi public - from packaging to human consumption.

'The situation exists because the salt and iodine levels are not properly proportional, as they should be by law. Then the manufacturers are claiming one thing on the label but inside the contents are different,' said CAB general secretary Mr. Quazi Faruque.

'And it is especially frustrating because UNICEF is giving the manufacturers free iodine to add to the salt, and they're either not adding it, or not adding it in the proportion required by law.'

To begin the process of rectifying the iodine deficiency, CAB and BLAST didn't need new laws passed. They needed judicial enforcement of the laws already in existence. So BLAST filed a writ petition under Article 102 of Bangladesh's Constitution requesting the High Court to issue directions on the government, manufacturers, and regulatory bodies to ensure legal compliance.

Under Article 102, an aggrieved party can file a writ petition with the High Court requesting the court issue certain orders. For BLAST's purposes, the applicable part of Article 102 states that the High Court can order anyone, including government bodies, to act 'as may be appropriate for the enforcement of any of the fundamental rights' conferred in Part III of the Constitution. BLAST argued that the manufacturers', government's, and regulators' failure to perform their statutory duties had the effect of denying, subverting, and undermining the right to protection of law and life guaranteed under Articles 31 and 32 of the Constitution.

BLAST's legal challenge had two prongs - one evidentiary, the other procedural. First, BLAST tested salt on the market to determine whether manufacturers added iodine in amounts required by law. Second, after establishing empirically the lack of manufacturers' compliance, BLAST challenged government ministries and regulatory bodies for failing to enforce the law. The writ petition left no loop-hole for manufacturer, government ministry, or regulatory body to escape scrutiny.

Advocate Quddus recognized the importance of focusing on all parties to have any hope of effecting real change.

'Not only is there bad governance,' he said. 'But we are also dealing with a shortage of manpower, a weak monitoring system, and inefficient authorities. Many of the manufacturers are not honest and most of the consumers are not conscious.'

Frustrated next steps

Though the High Court ordered the regulators to regularly test salt, as of July 2006 only one round of testing has been completed.

BLAST has communicated with the regulatory bodies, particularly BSTI, to inform them of the High Court's directive that BSTI comply with the testing order and submit salt analysis reports to the court twice a year. However, only one report has been submitted since the High Court issued its decision. Of 59 samples, only eight producers' specimens were up to standard.

'If there were penalties or punishment from the ministries for failure to comply, then the manufacturers would act,' said CAB general secretary Quazi Faruque.

When asked what next steps he thinks need to be taken to implement the laws, Advocate Quddus ran off a list of suggestions.

'There needs to be more supervision in retail marketing, monitoring the production of iodized salt, and taking action against the manufacturers and sellers who are violating the law,' Mr. Quddus said. 'There should be an orientation program for the manufacturers, and training programs for salt mill managers and operators.'

But there is also increased recognition that it's time for the public to become involved and demand properly-iodized salt. Full implementation of the laws requires public awareness. And until the public is aware of the harm resulting from lack of iodine, the battle will be waged in the courts, rather than the markets.

'BLAST can take further steps in court and CAB can work to build consensus among consumers,' Mr. Quddus said. 'But ultimately the public is going to have to become involved to push for these laws to take effect.'

Edward Carlson, a law student at Temple University USA, currently is on a legal internship in Bangladesh

Source: New Age, 12 June 2006


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