see wound, insert (new, improved, foreign) salt

perhaps like many people in public health, i take the fortification of salt with iodine – the prevention of several thyroid-related disorders and the widespread return of the neck ruff – as one of public/global health’s major achievements. up there with smallpox, water treatment (for sanitation and potentially with fluoride) and really-we-are-nearly-there-but-stuff-keeps-happening polio. 

the WHO declared a universal salt iodization strategy in 1993 (in quito, if you try to keep up with the location-names of these declarations). there have been recent successes in central asia, among other places, in reversing the cognitive and other negative effects of iodine deficiency. iodization of salt is an appealing strategy to promoting public health because it requires very little effort from front-line workers or potential users. fortification is a neat, technocratic solution to a serious problem. people use salt regularly, out of necessity (though often use more than is necessary), and – viola! – unconsciously ingest something extra that’s good for them. salt’s pretty important; of course, it used to be traded for gold (and human beings) and as a recent poetic-wax highlighted, salt is constitutive of human emotions and activities, in the form of sweat and tears. and, though i am not sure it has inspired poetry (perhaps among campers?), iodine has to be ingested because human bodies do not produce it on their own though they need it.

but iodization is a technocratic solution only right up till you recognize the politics behind it (as with most technical solutions to development). it had not fully registered to me until i re-read kurlansky’s salt – despite the proliferation of a rainbow of artisanal and heirloom sea salts, rock salts, probably moon salts, at whole foods and trader joe’s – precisely what mass iodization meant for local salt works around the world. kurlansky notes that country decisions to ban non-iodized salt are “popular with health authorities, doctors and scientists, but very unpopular with small independent salt producers.” India banned iodized salt in 1998, only to repeal the ban in 2000. among other arguments for repeal, the ban went against “Gandhi’s assertion that every Indian had a right to make salt.” oops. that old controlling-salt-production-is-and-always-has-been-super-political thing.

kurlansky suggests that small salt works have neither the money nor the knowledge to iodize their own salt up to government standards, so good salt comes from large national manufacturers and from outside. but deficits of knowledge and money are generally fixable problems, so this answer to combating iodine deficiency seems… deficient. 

partly, at issue is the silo-ed approach to development, where very few projects link directly with national strategies for economic development, though many projects note that poverty reduction and growth promotion *are* national priorities. we might just skip the contents of their actual strategy. we talk about country ownership (hey paris, hey accra), we talk about local capacity-building, we talk about alignment with, say, national health and education priorities, but we don’t talk enough about furthering development through all these projects by buying local (meaning more than that one shirt you bought from that one women’s co-op that one time you were visiting that one project in that one country — which especially doesn’t count if that project was focused on SMEs or entrepreneurship and your shirt is not from one of them).

we don’t, i believe, talk as much as we should about the use of locally manufactured products in global health and development projects more generally. there are, to be sure, political and economic difficulties to a work-local-buy-local approach, since donor countries also have national self-interest to consider. and there are technical and logistical difficulties because many places arguably in need of development projects also don’t have manufacturing processes that are up to global standards, perhaps coddled too long by import substitution strategies that did not have an eye towards exporting and competing. it would take time and effort to build local production capacity and supply chains — and we need to work quickly!

so, health commodities come in, building materials come in, food supplies come in, machinery and equipment comes in, often human capital comes in — and development is meant to logically follow. but bringing stuff ‘in’ has big implications for local livelihoods. a comment this week about a large development project in timor-leste describes the “lost opportunity” of not using local materials that would support local employment or small businesses. earlier this year, julie walz and vijaya ramachandran at cgd wrote about promoting local procurement in haiti, noting that this would do “double duty” by “purchas[ing] immediately needed goods or services [and helping] grow the private sector, creat[ing] jobs, and encourag[ing] entrepreneurs.”

two-birds, one stone sounds pretty good. so… can we start talking about this as part of the post-2015 discussions? over probably-not-iodized but tres-good gourmet sel gris popcorn? it supports this adorable old french salt harvester.


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