Chernobyl and iodine deficiency in the Russian Federation: An environmental disaster leading to a public health opportunity

Journal of Public Health Policy,  2002  by Jackson, Richard J,  DeLozier, David M,  Gerasimov, Gregory,  Borisova, Olga,  Et al

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INTRODUCTION

IODINE deficiency (ID) can impede the neurologic development of infants and children, resulting in impaired intellectual function and ultimately in poor performance in school, work, and society. Widespread deficit risks the health and prosperity of afflicted populations. The Chernobyl nuclear disaster of April 26, 1986, alerted the world community to ID in the area and motivated US-Russian collaborative efforts for its prevention. In this paper, we will expand on the role of the disaster in drawing attention to ID in the Russian Federation. We will describe the catalytic bi-national efforts that stimulated prevention of ID in the Russian Federation.

BACKGROUND

The Chernobyl Disaster

The Chernobyl disaster, the largest on record (Table 1) (1), released an estimated 40-50 million curies of 1-131 (with a half-life of about 8 days) and 100 million curies of shorter-lived radioiodines (1-133 and 1-132 Te, the precursor of 1-132) (2) before the fires were brought under control (3). It resulted in mortality, morbidity, and great economic and social upheaval for millions of people from Ukraine, Belarus, western Russia, and the surrounding countries. The political and environmental visibility of the Chernobyl disaster highlighted many underlying problems and triggered a chain of events, including, by 1992, dramatic increases of thyroid cancer in children living in Belarus (4), Ukraine (5), and Russia (6). This unexpected finding led to several hypotheses, including the possible heightened vulnerability of iodine-deficient populations to the hazards of exposure to radioactive iodine (1-131). Further examination led to firm evidence of ID and iodine deficiency disorders (IDD) in the population. ID, although a less dramatic threat than the immediate challenges of the Chernobyl incident, had the potential for a long-term impact on the population if it had remained unrecognized and unattended. Concern about these risks led the countries in the area to investigate the nutritional status of those populations.

IODINE STATUS IN THE RUSSIAN FEDERATION

During most of the era of the former Soviet Union, systematic large-scale efforts were made to assess and control goiter through the State Anti-goiter Commission within the Ministry of Health. In the 1970s, Russia, Belarus, and Ukraine ceased active programs aimed at production and distribution of iodized salt when ID was believed to be under control. Because of the economic conditions following the collapse of the Soviet Union, these countries did not join the global effort to eliminate IDD until the late 1990s. Between 1992 and 1994, organizations such as the World Health Organization (WHO) and the Program Against Micronutrient Malnutrition (PAMM) tried, with little success, to reintroduce iodized salt in the Russian Federation. In 1996, less than 1% of salt sold on the Russian market was iodized, and that salt was sold only in specialty shops at a higher cost (7).

The definition of adequate iodine nutrition and ID in a population is based on the preval ence of goiter and the urinary concentration of iodine (8) (Table 2). Since 1990, several regional studies conducted by the Russian Endocrinology Research Center (in cooperation with the International Council for the Control of Iodine Deficiency Disorders [ICCIDD]) showed that the prevalence of goiter and ID remained high. The four provinces most affected by the Chernobyl fallout in Russia had goiter rates and urinary iodine measurements indicating a deficiency (9) (Table 3), and other urban and rural areas were also deficient (10-12).

STATUS OF OTHER MICRONUTRIENTS IN THE RUSSIAN FEDERATION

In addition to iodine, Russian health officials reported that selenium was also low in soil, water, and food products, putting 50% of the Russian population at risk for selenium deficiency. Sixty percent of Russian territories were described as fluoride-deficient (drinking water fluoride concentration

POPULATION EFFECTS OF IODINE DEFICIENCY DISORDERS (IDD)

ID affects humans in many ways over a lifetime (16,17) (Table 5), and is recognized as the world's leading cause of preventable mental retardation (18). Populations with even mild ID result in reduction in children's IQ of 10%-15%. It is estimated that IDD affects 600 million people globally and contributes to problems in intellectual development for an estimated 1.5 billion children worldwide (16,19-2.1).

ID has repercussions not only on health but also on economic and social development for affected countries and the global market. Decreased intellectual capacity leads to lower educational status, and hypothyroidism reduces an individual's vitality, work capacity, and earnings. ID can result in a 5%-50% loss of individual productivity depending on severity (22). To prevent ID, a small amount of iodine is added to foodstuff. Iodine fortification of salt is a convenient and inexpensive way to improve iodine intake in a deficient population. The costs for these programs are small, estimated at less than five cents (U.S.) per capita per year (23). The World Bank ranks the elimination of ID by fortifying salt as one of the most cost-effective interventions for public health in the developing world (24).