NICHOLAS D. KRISTOF


Saving millions from retardation for just pennies per person.


RAWALPINDI, Pakistan

Travelers to Africa and Asia all have their favorite forms of foreign aid to “make a difference.”One of mine is a miracle substance that is cheap and actually makes people smarter.

Unfortunately, it has one appalling side effect. It is just about the least sexy substance in the world. Indeed, because it’s so numbingly boring, few people pay attention to it or invest in it. (Or dare write about it!)

It’s iodized salt.
Almost one-third of the world’s people don’t get enough iodine from food and water. The result in extreme cases is large goiters that swell their necks, or other obvious impairments such as dwarfism or cretinism. But far more common is mental slowness.

When a pregnant woman doesn’t have enough iodine in her body, her child may suffer irreversible brain damage and could have an I.Q. 10 to 15 points lower than it would otherwise be. An educated guess is that iodine deficiency results in a needless loss of more than 1 billion I.Q. points around the world.

Development geeks rave about the benefits of adding iodine and other micronutrients (such as vitamin A, iron, zinc and folic acid) to diets. The Copenhagen Consensus, which brings together a panel of top global economists to find the most cost-effective solutions to the world’s problems, puts micronutrients at the top of the list of foreign aid spending priorities.

“Probably no other technology,” the World Bank said of micronutrients, “offers as large an opportunity to improve lives... at such low cost and in such a short time.”

Yet the strategy hasn’t been fully put in place, partly because micronutrients have zero glamour. There are no starlets embracing iodine. And guess which country has taken the lead in this area by sponsoring the Micronutrient Initiative- Hint: It’s earnest and dull, just like micronutrients themselves.

Ta-da - Canada!
(Years ago, The New Republic magazine held a contest for the most boring headline ever. The benchmark was from a Times Op-Ed column - not mine - that read “Worthwhile Canadian Initiative.” Alas, that’s salt iodization!)

Pakistan is typical of the challenges. Until recently, 6 in 10 Pakistani schoolchildren were iodine-deficient. Iodine just wasn’t on anyone’s mind.

“I had never heard of iodized salt,” said Haji Sajjawal Khan, a 65-year-old owner of a small salt factory here, near the capital of Islamabad. Officials from the Micronutrient Initiative and other aid agencies reached out to factory owners like Mr.Khan and encouraged them to iodize salt, in part to help make Pakistanis healthier and more intelligent.

“It will prevent people’s necks from being swollen and will make people smarter,”Mr.Khan said. So he agreed to add an iodine drip into his salt grinder.

One of the obstacles is the rumor that iodized salt is actually a contraceptive, a dastardly plot by outsiders to keep Muslims from having babies. That conspiracy theory spread partly because the same do-good advertising agency that marketed iodized salt also marketed condoms.

Yet progress is evident. One attraction is that a campaign to iodize salt costs only 2 to 3 cents per person reached per year.“We are spending very little, but the benefit is enormous,” said Dr.Khawaja Masuood Ahmed, an official of the Micronutrient Initiative here.

“We’re preventing people from becoming mentally retarded.”

Indeed, The Lancet, the British medical journal, reported last month that “Iodine deficiency is the most common cause of preventable mental impairment worldwide.”

Occasionally in my travels I’ve been unnerved by coming across entire villages, in western China and elsewhere, eerily full of people with mental and physical handicaps, staggering about, unable to speak coherently. I now realize that the cause in some cases was probably iodine deficiency.

Indeed, the problem used to be widespread in the Alps. The word“cretin” is believed to come from a mountain dialect of French, apparently because iodine deficiency in the Alps produced so many cretins. The problem ended when food was brought in from elsewhere and salt was iodized.

There is talk that President-elect Barack Obama may reorganize the American aid apparatus, perhaps turning it into a cabinet department. There are many competing good causes - I’m a huge believer in spending more on education and maternal health, in particular - but there may be no investment that gets more bang for the buck than micronutrients.

So, yes, salt iodization is boring. But if we can add 1 billion points to the global I.Q., then let’s lend strong American support - to a worthwhile Canadian initiative.