310 lines
14 KiB
Markdown
310 lines
14 KiB
Markdown
---
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created_at: '2017-12-19T13:48:02.000Z'
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title: In Raising the World’s I.Q., the Secret’s in the Salt (2006)
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url: http://www.nytimes.com/2006/12/16/health/16iodine.html
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author: nabla9
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points: 255
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story_text:
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comment_text:
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num_comments: 197
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story_id:
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story_title:
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story_url:
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parent_id:
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created_at_i: 1513691282
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_tags:
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- story
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- author_nabla9
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- story_15960133
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objectID: '15960133'
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year: 2006
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---
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The most visible and severe effects — disabling goiters, cretinism and
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dwarfism — affect a tiny minority, usually in mountain villages. But 16
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percent of the world’s people have at least mild goiter, a swollen
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thyroid gland in the neck.
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“Find me a mother who wouldn’t pawn her last blouse to get iodine if she
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understood how it would affect her fetus,” said Jack C. S. Ling,
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chairman of the International Council for Control of Iodine Deficiency
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Disorders, a committee of about 350 scientists formed in 1985 to
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champion iodization.
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The 1990 World Summit for Children called for the elimination of iodine
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deficiency by 2000, and the subsequent effort was led by Professor
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Ling’s organization along with Unicef, the World Health Organization,
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Kiwanis International, the World Bank and the foreign aid agencies of
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Canada, Australia, the Netherlands, the United States and others.
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Largely out of the public eye, they made terrific progress: 25 percent
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of the world’s households consumed iodized salt in 1990. Now, about 66
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percent do.
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But the effort has been faltering lately. When victory was not achieved
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by 2005, donor interest began to flag as
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[AIDS](http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/aids/index.html?inline=nyt-classifier "Recent and archival health news about AIDS/HIV."),
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[avian
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flu](http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/avianinfluenza/index.html?inline=nyt-classifier "Recent and archival health news about avian influenza.")
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and other threats got more attention.
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And, like all such drives, it cost more than expected. In 1990, the
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estimated price tag was $75 million — a bargain compared with, for
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example, the fight against
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[polio](http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/poliomyelitis/index.html?inline=nyt-classifier "Recent and archival health news about polio."),
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which has consumed about $4 billion.
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Since then, according to David P. Haxton, the iodine council’s executive
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director, about $160 million has been spent, including $80 million from
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Kiwanis and $15 million from the Gates Foundation, along with unknown
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amounts spent on new equipment by salt companies.
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Advertisement
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[Continue reading the main story](#story-continues-4)
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“Very often, I’ll talk to a salt producer at a meeting, and he’ll have
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no idea he had this power in his product,” Mr. Haxton said. “He’ll say
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‘Why didn’t you tell me? Sure, I’ll do it. I would have done it
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sooner.’ ”
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In many places, like Japan, people get iodine from seafood, seaweed,
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vegetables grown in iodine-rich soil or animals that eat grass grown in
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that soil. But even wealthy nations, including the United States and in
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Europe, still need to supplement that by iodizing salt.
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The cheap part, experts say, is spraying on the iodine. The expense is
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always for the inevitable public relations battle.
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In some nations, iodization becomes tarred as a government plot to
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poison an essential of life — salt experts compare it to the furious
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opposition by 1950s conservatives to fluoridation of American water.
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Photo
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In others, civil libertarians demand a right to choose plain salt, with
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the result that the iodized kind rarely reaches the poor. Small salt
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makers who fear extra expense often lobby against it. So do makers of
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iodine pills who fear losing their market.
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Rumors inevitably swirl: iodine has been blamed for AIDS,
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[diabetes](http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/diabetes/index.html?inline=nyt-classifier "Recent and archival health news about diabetes."),
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seizures, impotence and peevishness. Iodized salt, according to
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different national rumor mills, will make pickled vegetables explode,
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ruin caviar or soften hard cheese.
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Breaking down that resistance takes both money and leadership.
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“For 5 cents per person per year, you can make the whole population
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smarter than before,” said Dr. Gerald N. Burrow, a former dean of Yale’s
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medical school and vice chairman of the iodine council.
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“That has to be good for a country. But you need a government with the
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political will to do it.”
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**‘Scandal’ of Stunted Children**
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Advertisement
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[Continue reading the main story](#story-continues-5)
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In the 1990s, when the campaign for iodization began, the world’s
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greatest concentration of iodine-deficient countries was in the
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landlocked former Soviet republics of Central Asia.
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All of them — Kazakhstan, Turkmenistan, Tajikistan, Uzbekistan,
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Kyrghzstan — saw their economies break down with the collapse of the
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Soviet Union. Across the region, only 28 percent of all households used
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iodized salt.
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“With the collapse of the system, certain babies went out with the
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bathwater, and iodization was one of them,” said Alexandre Zouev, chief
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Unicef representative in Kazakhstan.
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Dr. Toregeldy Sharmanov, who was the Kazakh Republic’s health minister
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from 1971 to 1982, when it was in the Soviet Union, said the problem was
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serious even then. But he had been unable to fix it because policy was
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set in Moscow.
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“Kazakh children were stunted compared to the same-age Russian
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children,” he said. “But they paid no attention. It was a scandal.”
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In 1996, Unicef, which focuses on the health of children, opened its
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first office in Kazakhstan and arranged for a survey of 5,000
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households. It found that 10 percent of the children were stunted,
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opening the way for international aid. (Stunting can have many causes,
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but iodine deficiency is a prime culprit.)
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In neighboring Turkmenistan, President Saparmurat Niyazov — a despot who
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requires all clocks to bear his likeness and renamed the days of the
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week after his family — solved the problem by simply declaring plain
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salt illegal in 1996 and ordering shops to give each citizen 11 pounds
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of iodized salt a year at state expense.
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In Kazakhstan, the democratic credentials of President Nursultan A.
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Nazarbayev, who has ruled since 1991, have come under criticism, but he
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does not rule by decree. “Those days are over,” said Ms. Sivryukova of
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the confederation of Kazakh charities. “Businesses are private now. They
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don’t follow the president’s orders.”
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Importantly, however, the president was supportive. But even so, as soon
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as Parliament began debating mandatory iodization in 2002, strong
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lobbies formed against the measure.
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Advertisement
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[Continue reading the main story](#story-continues-6)
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The country’s biggest salt company was initially reluctant to cooperate,
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fearing higher costs, a Unicef report said. Cardiologists argued against
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iodization, fearing it would encourage people to use more salt, which
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can raise [blood
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pressure](http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/bloodpressure/index.html?inline=nyt-classifier "Recent and archival health news about blood pressure.").
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More insidious, Dr. Sharmanov said, were private companies that sold
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iodine pills.
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“They promoted their products in the mass media, saying iodized salt was
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dangerous,” he said, shaking his head.
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So Dr. Sharmanov, the national Health Ministry, Ms. Sivryukova and
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others devised a marketing campaign — much of it paid for by American
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taxpayers, through money given to Unicef by the United States Agency for
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International Development.
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Comic strips starring a hooded crusader, Iodine Man, rescuing a
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slow-witted student from an enraged teacher were handed out across the
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country.
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Photo
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A logo was designed for food packages certified to contain iodized salt:
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a red dot and a curved line in a circle, meant to represent a face with
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a smile so big that the eyes are squeezed shut.
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Also, Ms. Sivryukova’s network of local charity women stepped in. As in
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all ex-Soviet states, government advice is regarded with suspicion,
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while civic organizations have credibility.
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Her volunteers approached schools, asking teachers to create dictation
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exercises about iodized salt and to have students bring salt from home
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to test it for iodine in science class.
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Ms. Sivryukova described one child’s tears when he realized he was the
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only one in his class with noniodized salt.
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Advertisement
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[Continue reading the main story](#story-continues-7)
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The teacher, she said, reassured him that it was not his fault.
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“Children very quickly start telling their parents to buy the right
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salt,” she said.
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One female volunteer went to a bus company and rerecorded its
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“next-stop” announcements interspersed with short plugs for iodized
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salt. “She had a very sexy voice, and men would tell the drivers to play
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it again,” Ms. Sivryukova said.
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Even the former world chess champion Anatoly Karpov, who is a hero
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throughout the former Soviet Union for his years as champion, joined the
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fight. “Eat iodized salt,” he advised schoolchildren in a television
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appearance, “and you will grow up to be grandmasters like me.”
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Mr. Karpov, in particular, handled hostile journalists adeptly, Mr.
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Zouev said, deflecting inquiries as to why he did not advocate letting
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people choose iodized or plain salt by comparing it to the right to have
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two taps in every home, one for clean water and one for dirty.
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By late 2003, the Parliament finally made iodization mandatory.
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**In Aral, Mountains Made of Salt**
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Today in central Kazakhstan, a miniature mountain range rises over Aral,
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a decaying factory town on what was once the shore of the Aral Sea, a
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salt lake that has steadily shrunk as irrigation projects begun under
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Stalin drained the rivers that feed it.
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Drive closer and the sharp white peaks turn out to be a small Alps of
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salt — the Aral Tuz Company stockpile. Salt has been dug here for
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centuries. Nowadays, a great rail-mounted combine chews away at a
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10-foot-thick layer of salt in the old seabed, before it is towed 11
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miles back to the plant, and washed and ground. Before it reaches the
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packaging room, as the salt falls through a chute from one conveyor belt
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to another, a small pump sprays iodine into the grainy white cascade.
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The step is so simple that, if it were not for the women in white lab
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coats scooping up samples, it would be missed.
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The $15,000 tank and sprayer were donated by Unicef, which also used to
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supply the potassium iodate. Today Aral Tuz and its smaller rival,
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Pavlodar Salt, buy their own.
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Asked about the Unicef report saying that Aral Tuz initially resisted
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iodization on the grounds that it would eat up 7 percent of profits, the
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company’s president, Ontalap Akhmetov, seemed puzzled. “I’ve only been
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president three years,” he said. “But that makes no sense.” The expense,
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he said, was minimal. “Only a few cents a ton.”
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Advertisement
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[Continue reading the main story](#story-continues-8)
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Kazakhstan was lucky. It had just the right mix of political and
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economic conditions for success: political support, 98 percent literacy,
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an economy helped along by rising prices for its oil and gas. Most
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important, perhaps, one company, Aral Tuz, makes 80 percent of the
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edible salt.
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That combination is missing in many nations where iodine deficiency
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remains a health crisis. In nearby Pakistan, for instance, where 70
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percent of households have no iodized salt, there are more than 600
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small salt producers.
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“If a country has a reasonably well-organized salt system and only a
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couple of big producers who get on the bandwagon, iodization works,”
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said Venkatesh Mannar, a former salt producer in India who now heads the
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Micronutrient Initiative in Ottawa, which seeks to fortify the foods of
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the world’s poor with iodine, iron and other minerals. “If there are a
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lot of small producers, it doesn’t.”
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Now that Kazakhstan has its law, Ms. Sivryukova’s volunteers have not
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let up their vigilance. They help enforce it by going to markets, buying
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salt and testing it on the spot. The government has trained customs
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agents to test salt imports and fenced some areas where people dug their
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own salt. Children still receive booklets and instruction.
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Experts agree the country is unlikely to slip back into neglect. Surveys
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find consumers very aware of iodine, and the red-and-white logo is such
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a hit that food producers have asked for permission to use it on foods
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with added iron or folic acid, said Dr. Sharmanov, the former Kazakh
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Republic health minister. And the salt is working. In the 1999 survey
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that found stunted children, a smaller sampling of urine from women of
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child-bearing age found that 60 percent had suboptimal levels of iodine.
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“We just did a new study, which is not released yet,” said Dr. Feruza
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Ospanova, head of the
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[nutrition](http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/diet/index.html?inline=nyt-classifier "Recent and archival health news about diet and nutrition.")
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academy’s laboratory. “The number was zero percent.”
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[Continue reading the main story](#whats-next)
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