India's salt wars

When Gandhi famously defied the British salt ban, he created an enduring symbol of purity and independence. But today, pure, locally-grown salt is threatening the health of tens of millions of India's children.

Written and photographed by Gordon Weiss

Aug. 20, 2001 | In 1930, Mahatma Gandhi and 78 followers marched 241 miles across the state of Gujarat to the sea. When he reached the coastal saltpans, Gandhi scooped up and held aloft a handful of salt -- proclaiming resistance not just to Britain's ban on the private production of salt, but to its colonial reign. In a famous photograph taken during what became immortalized as the Salt March he is shown being led by a child -- symbol of an independent India that would soon be born.

Salt is a powerful symbol of purity, tradition and freedom for Indians. But today, it has come to symbolize something darker: the catastrophic consequences of adhering to tradition in the face of scientific knowledge. In a bitter irony, the traditional harvesting and marketing of salt -- a tradition whose defenders claim honors the independent spirit of Gandhi -- is threatening to blight the lives of tens of millions of Indian children.

The villain is iodine deficiency, one of the world's oldest and most devastating nutrition-related health problems. Iodine deficiency disorders (IDDs) are the leading cause of mental retardation in the world. In India, 70 million people suffer from IDDs, with 200 million more at risk. A 1995 UNICEF report estimated that 900 million people around the world suffer from iodine deficiency; 5 million of them are cretins, with millions more suffering lesser mental and neurological problems. 1.6 billion people, almost a third of the global population, are at risk.

Iodine deficiency causes severe hormone-induced physiological damage to fetuses and newborns, resulting in a terrible list of problems: cretinism, stunting, deaf-mutism, malformed limbs, spastic motor disorders, stillbirths, reproductive failure, poor vision and goiter (a grotesque swelling of the thyroid gland on the neck), as well as milder forms of mental and physical impairment.

Iodine is a micronutrient, a trace element that occurs naturally in the soil. Although replenished somewhat by the cycle of evaporation and rain, the earth's soil is gradually being stripped of iodine. Because the human body cannot retain iodine (unlike most other micronutrients), the vegetables and pulses that are iodine-rich must be consumed daily. Hence the worst cases of iodine deficiency are found in the highland regions of the world, areas of greatest soil degradation, where vegetables and pulses have the lowest content of iodine (seaweed, which was used in ancient times as a cure for goiter, has the highest iodine content). However, there is no region in India free of IDD: It is found in the major cities as well as in distant villages.

The tragedy is that iodine deficiency disorders are easily preventable. Studies in highland Guatemala, and in the Himalayan regions of India and Sikkim in the 1950s, proved unequivocally that iodized salt -- salt treated with potassium iodine or iodide -- dramatically reduces the incidence of IDDs. Mandatory iodization of salt, which was introduced by Switzerland in 1922, virtually eliminated the "village idiot" from the gallery of European archetypes, although IDD lingers on in pockets there and is quite severe in poorer countries such as Bulgaria and Romania. The United States and a few other developed nations, including Australia and the Scandinavian countries, have completely conquered the problem.

In the developing world, the roadblocks to wiping out such a widespread public health scourge are much higher. Sub-Saharan Africa, China, Indonesia and the vast region bordering the Himalayas are particularly affected. But there, too, the disease is on the run: UNICEF, which has led the international battle against IDDs, estimates that iodized salt programs have protected 12 million children a year from brain damage.

In 1997, after decades of activism by health experts and international development agencies, India enacted its own Universal Salt Iodization code. At a cost of about a penny per person per year, the program promised to free the world's second most populous country of a scourge that has blighted millions of young lives. In May 2000, in an address at The Hague which referred to India's two-year-old mandatory salt iodization legislation, the noted Indian nutritionist Professor V. Ramalingaswami said that "India is on the brink of the elimination of Iodine Deficiency Disorders as a public health problem."

But in July 2000, only two years after passing the code, the Indian government repealed it -- surrendering to pressure from the highly vocal small salt producer's lobby, as well as to widespread arguments that mandatory iodization was coercive, unfair and an act of multinational exploitation.

Curiously, the statement issued by the Ministry of Health and Family Welfare repealing the legislation said nothing about the overwhelming body of scientific evidence that supports iodization, making only vague references to the "point of principle [that] such a public health measure should not be enforced through statutory provisions."

The decision to repeal the iodization laws appalled the nation's doctors and scientists. Some pointed out that the repeal would not affect the rich, who would continue to buy iodized salt, but the poor, who would be unaware of the risk of using the slightly cheaper salt. The Indian Medical Association, saying the repeal "re-imposes a serious public health burden," lamented that the laws should have stood "for the next century."

Next page: Cretinous children in a dying village