Iodine Global Network

This is a Founders Pledge summary and interpretation of original research published by GiveWell, our research partner focused on global health and development. For GiveWell's full research see their review of Iodine Global Network.

Iodine Global Network (IGN) seeks to prevent serious physical and mental development problems in children caused by iodine deficiency, by advocating for salt iodization, monitoring progress on iodization, and providing global and country-specific research and technical guidance on related programmatic and scientific issues.

If you are interested in co-funding a portfolio of organizations like this one, please see our Global Health and Development Fund.

What problem are they trying to solve?

Iodine is necessary for healthy functioning of the thyroid, which produces vital hormones. These hormones control the rate of many important biological processes, including growth and development, metabolic rates, and even how fast the heart beats.¹ Iodine deficiency disorders arise when the thyroid does not have access to enough iodine. This can cause severe health problems and, particularly in children, developmental issues that severely impair mental function.² Iodine deficiency in pregnant women can also significantly impair both the mental and physical development of their children.³ This can have life-long effects on health and income.⁴

Iodine deficiency is particularly common in the Western Pacific, South-East Asia, and Africa, affecting as many as two billion people globally. Almost 200 million people are “severely” affected.⁵ Poor diets that lack variety are to blame, especially in remote inland areas where no marine foods are eaten.⁶ Vulnerable people who lack the means to adapt their diets are most at risk.⁷

The global problem of iodine deficiency is kept at bay because of widespread universal iodization of salt, but salt must be iodized forever to protect populations from deficiency, and some countries are sliding back. In addition, there are countries around the world where programs have not been implemented or are ineffective.

What do they do?

IGN aims to to reduce global iodine deficiency by advocating for government support for salt iodization, monitoring salt iodization and iodine levels in order to identify areas of deficiency, and providing global and country-specific guidance on salt iodization - including best practices for programmatic and scientific issues - to improve the work of government and private organizations.⁸ IGN works to convene a large global coalition to explore and address issues that inhibit national progress on universal iodization and that deal with salt iodization for processed foods.

IGN’s overarching goal is to ensure that all populations achieve and maintain iodine sufficiency and that the structures to do so are permanently established in all countries and regions. The organization is the convening center of a large global network/coalition and holds the institutional memory that informs and guides its work in a modern context. Its network of regional and national coordinators allows it to explore issues that inhibit or threaten national progress; to understand and recognize the effects of dietary changes such as use of iodized salt in processed foods and progress with salt reduction; and to sustain critical partnerships that provide support to address emerging issues. IGN has a deep understanding of the salt industry and its critical role in ensuring adequate iodine intake, and advocates for iodine nutrition as part of the broader nutrition and fortification agendas.

IGN’s salt iodization work includes:

• Advocacy for salt iodization in countries/regions of greatest need. This may include meeting with and lobbying government officials, educating policy-makers about key science, and creating and facilitating coalitions of key stakeholders (such as government agencies, salt producers, aid agencies, and non-profit organizations).⁹
• Monitoring progress in salt iodization and iodine status.
• Seeking targeted support from implementing agencies for specific countries when needed.¹⁰
• Serving as a liaison between the scientific community and the global health community for iodine issues.¹¹ For example, IGN helps the World Health Organization (WHO) maintain a database of iodine status for all countries,¹² publishes a quarterly newsletter on universal salt iodization programs and related research findings, and summarizes scientific research on questions that are relevant to salt iodization programs.¹³
• In 2019, IGN began a roadmapping process that is now under way in 5 regions, identifying gaps and weaknesses in regional efforts and national programs and facilitating the creation of a five-year, evidence-based strategic direction for annual country and regional activities.¹⁴

For further information on Iodine Global Network’s involvement in salt iodization programs, including a full list of implementation partners and specific interventions/case-studies, see GiveWell’s review of IGN.

Why do we recommend them?

• GiveWell, our research partner in global health and development, thinks IGN is a highly cost-effective global development organization, though they do not currently recommend IGN as a top charity.
• There is strong evidence that salt iodization programs have significant, positive effects on children’s cognitive ability.
• While IGN works in countries which have seen increases in salt iodization programs, we currently have a limited understanding of their contribution to these changes. This uncertainty has contributed to GiveWell’s rating of IGN as a standout (before they discontinued that designation), rather than top, charity.
• GiveWell reports that IGN is a strong, transparent, responsive, and impact-driven organization.

Cost-effectiveness

GiveWell reports that the cost-effectiveness of salt iodization programs can be complicated to calculate,¹⁵ particularly due to the wide-ranging roles that IGN plays in different countries. Estimates for the cost to give access to adequately iodized salt for one person are in the range of $0.05-$0.10 per year.¹⁶

Is salt iodization effective?

GiveWell states that salt iodization is an effective intervention.¹⁷ Based on the available experimental evidence, we estimate that iodine supplementation of mild-to-moderately deficient children increases their IQ by approximately three points.¹⁸ Givewell also suggests that this effect is likely to be even greater where iodine deficiency is more severe, but there is not yet sufficient evidence to be certain of this.¹⁹ Similarly, GiveWell reports that two meta-analyses (Angermayr and Clar 2004 and Taylor et al 2013) identified 6 RCTs evaluating the effect of iodine supplementation of children on their mental function, and generally found significant positive effects.²⁰ This increase in mental function is likely to have positive effects on the children’s life outcomes.²¹

GiveWell also suggests that salt iodization has a positive impact upon the reduction of congenital iodine deficiency syndrome, a condition characterized by severe physical and mental stunting. They report that high quality reviews from Mahomed and Gulmezoglu 1997 and, more recently, Zhou et al 2013, identify evidence of a reduction in congenital iodine deficiency brought about by iodine supplementation. A quasi-randomized controlled trial, Pharoah, Buttfield and Hetzel 1971, was conducted in an area with severe levels of iodine deficiency and found a large reduction in congenital iodine deficiency syndrome in children born to women receiving iodine supplementation compared to the control group. Moreover, a long term follow up four years later, found that of 412 children born to mothers receiving iodine supplementation, only 7 suffered congenital iodine deficiency syndrome. This was compared to 26 cases out of 406 children in the control group, giving a relative risk of 0.27 (95% CI: 0.12 to 0.60). A further long-term follow up study found that just 3 of 274 children in the iodine supplementation group reported congenital iodine deficiency syndrome, compared to 16 out of 248 in the control group.²²

Additionally, the World Health Organization urges all countries to implement salt iodization as an effective intervention to address the problem of iodine deficiency.

Does IGN’s involvement improve access to iodized salt?

GiveWell has been informed by some of IGN’s partner organizations - including the United Nations Children’s Fund (UNICEF) and the Global Alliance for Improved Nutrition - that IGN’s work has been important for the salt iodization programs which they are involved in. However, it is difficult to determine exactly how important IGN’s role has been, or how successful some of these programs would have been without IGN’s involvement.²³ Uncertainty about the causal impact of IGN’s actions in particular has contributed to GiveWell’s rating of IGN as a standout, rather than top, charity.

IGN has provided case studies suggesting that they have been instrumental in getting significant portions of the population in a number of countries access to iodized salt. Their strongest example is their work in Madagascar, where they identified a collapse in access to iodized salt in 2014. They worked to consult the government, secure a potassium iodine donation, convene stakeholders, and successfully advocate for increased investment. This increased access to iodized salt from 21% to 40%, implying conservative estimates of costs per person iodized in line with our assumption of $0.10 per person.²⁴ We have not independently verified this information, but it has slightly increased our confidence in the likelihood of IGN’s impact. IGN’s roadmapping process, now under way in some 40 countries, has identified potential for similar progress in countries such as South Sudan, Sudan, Egypt, Morocco, Togo, Mozambique and Cambodia.

Why do we trust this organization?

This charity was assessed by GiveWell, our research partner for global health and development issues. GiveWell is a nonprofit dedicated to finding outstanding giving opportunities and publishing the full details of their analysis to help donors decide where to give. While IGN is not on GiveWell’s list of top charities, it was a GiveWell standout charity before they discontinued that designation.

GiveWell’s initial investigation of IGN was completed in 2014. GiveWell has since conducted annual check-in calls with IGN to learn about updates to their activities and room for more funding, but has not conducted substantial further investigation of IGN. Links to notes from GiveWell’s annual follow-up conversations with IGN are provided at the start of GiveWell’s report on IGN. We have also conducted an internal re-evaluation of IGN at Founders Pledge in 2022.

What would they do with more funding?

IGN spent $1.8 million in 2021, after a dip to $1.5 million in 2020 due to COVID-19.²⁵ Their major categories of spending are:

• $1.1 million for Project Activity Costs
• $0.4 million for Secretariat and (Non project-funded work by Senior Advisers, Executive Director, Finance Manager, running expenses)
• $0.2 million for Regional Support in addition to Project Activity Costs above

All of these programs are directed towards monitoring iodization levels, advocating for iodization programs, and providing technical assistance.

IGN estimates that they can productively use an additional $1 million over the next three years:²⁶

• IGN needs funding of around $500,000 a year to allow their small, dedicated core team to continue to be able to provide focus, attention and support where it is required, without having to wait for project specific funds. This includes support for otherwise unfunded countries, conducting additional research, maintaining the global iodine status database, and advocating for salt iodization and broader fortification programs. They would not need to meet all of this funding gap through Founders Pledge.
• IGN needs funding of about $100,000 a year for 3 years to field-test and implement the work they are doing to establish new approaches for collecting data on progress (surveillance methods) and strengthening program review by developing indicators to assess different program elements, thus lessening the need for costly national surveys and enabling rapid response to crises or program slippage.

What are the major open questions?

GiveWell suggests that, because IGN’s activities vary between countries and are often undertaken alongside non-profit, governmental, or business partners, their precise impact upon salt iodization is very difficult to calculate.²⁷ Cost-effectiveness estimates are necessarily rough, due to differences between contexts, and it is unclear whether all of IGN’s interventions are similarly impactful.

There are also some open questions regarding the potential negative impacts of salt iodization. According to GiveWell, it is theoretically possible that an excess in iodine caused by salt iodization could result in similar mental impairment to iodine deficiency.²⁸ However, GiveWell has not found evidence to document this, and the levels of iodine present in most countries are not high enough to meet the probable threshold for these negative impacts.²⁹ The problem of excess iodine intake, which has occurred in some countries, can be addressed easily by reducing the amount of iodine in salt, and some countries have already adapted their iodization levels to address this.³⁰

Message from the organization

“Our vision is a world where all people attain optimal iodine nutrition and children can reach their full cognitive potential. Our mission is to be the authoritative voice for iodine nutrition. We support and catalyze global and national iodine programs, working with key public, private, scientific and civic stakeholders. We focus on universal salt iodization as the most cost-effective and sustainable solution for prevention of iodine deficiency disorders.”³¹

More resources

• GiveWell write up on Iodine Global Network
• GiveWell review of the evidence for Salt Iodization
• Iodine Global Network’s website

Disclaimer: We do not have a reciprocal relationship with any charity, and recommendations are subject to change based on our ongoing research.

Notes

1. "Your thyroid is a butterfly-shaped gland in your neck, just above your collarbone. It is one of your endocrine glands, which make hormones. Thyroid hormones control the rate of many activities in your body. These include how fast you burn calories and how fast your heart beats. All of these activities are your body's metabolism." Meadline. (2021). Hyperthyroidism. Meadlineplus.gov. Retrieved 4 March 2021. From https://medlineplus.gov/hypothyroidism.html ↩

2. “Iodine deficiency is the main cause of potentially preventable mental retardation in childhood, as well as causing goitre and hypothyroidism in people of all ages. It is still prevalent in large parts of the world.” Angermayr, L. and Clar, C. (2004). “Iodine supplementation for preventing iodine deficiency disorders in children.” in Cochrane Database Syst Rev. 2004;(2). ↩

3. Zhou, S., Anderson, A., Gibson, R., and Makrides, M. (2013). Effect of iodine supplementation in pregnancy on child developmentand other clinical outcomes: a systematic review of randomizedcontrolled trials. AGCN. ↩

4. Agueyo, V., Scott, S., and Ross, J. (2006). Sierra Leone – investing in nutrition to reduce poverty: a call for action. Cambridge: Cambridge University Press.https://www.cambridge.org/core/journals/public-health-nutrition/article/sierra-leone-investing-in-nutrition-to-reduce-poverty-a-call-for-action/99E67DAC608078A77B438635F8E3B371 ↩

5. Vos, T, et al. (2012). “Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010” in Lancet 380(9859). ↩

6. World Health Organization. (2013). Iodine deficiency. Who.int. Retrieved 4 March 2021. From https://www.who.int/data/nutrition/nlis/info/iodine-deficiency ↩

7. Bai, Y., Naumove, E., and Masters, W. (2020). “Seasonality of diet costs reveals food system performance in East Africa” in Science Advantages 6(49). ↩

8. ICCIDD conversations with GiveWell in Zurich, April/May 2014 ↩

9. Ibid. ↩

10. Ibid. ↩

11. ICCIDD slides on partnership with WHO 2014, Pg 2. ↩

12. ICCIDD slides on partnership with WHO 2014, Pg 5 ↩

13. For example, IGN conducted a study on the upper limits of safe iodine consumption, which was funded by the United Nations Children's Fund (UNICEF). ICCIDD conversations with GiveWell in Zurich, April/May 2014 The study can be found here: Zimmerman et al 2013. ↩

14. Founders Pledge email exchange with Joyce Greene on July 27, 2022. ↩

15. “Key questions include: How critical is IGN’s work to the existence and quality of salt iodization programs? How much has IGN spent in the past to achieve these results? To what extent do IGN funds leverage other sources of funding, from implementing partners, governments, and others? Are future projects likely to be more, less, or similarly cost-effective as past projects?” GiveWell. (2014). Iodine Global Network (IGN). Givewell.org. Retrieved 5 March 2021. From https://www.givewell.org/charities/IGN#What_do_you_get_for_your_dollar ↩

16. Ibid. ↩

17. GiveWell. (2014). Salt Iodization. Givewell.org. Retrieved 4 March 2021. From https://www.givewell.org/international/technical/programs/salt-iodization ↩

18. “We would guess that iodine supplementation of mild-to-moderately deficient children increases their IQ by somewhere around 4 points on average.” Ibid. ↩

19. Ibid. ↩

20. GiveWell. Analysis of studies on the effects of iodine supplementation of children on their mental function. files.givewell.org/files/DWDA%202009/Interventions/Iodine/Analysis%20of%20studies%20on%20the%20effect%20of%20iodine%20supplementation%20of%20children%20on%20their%20mental%20function.xlsx ↩

21. There is overwhelming evidence from a wide variety of experimental and observational studies that IQ has an independent effect on a wide range of life outcomes (an experimental study, for example, might randomly assign subjects to tasks with varying demands on cognition and then examine the differences in performance between low IQ and high IQ groups on the different tasks). Some researchers have tried to think of variables confounded with IQ that would explain different life outcomes, but there is always variation in outcomes that can only be explained by IQ differences. IQ is also mostly stable throughout one's life; possible confounders then have to both predict life outcomes and remain relatively stable throughout one's life.” GiveWell's non-verbatim summary of a conversation with James Flynn, Emeritus Professor of Political Studies and Psychology, University of Otago, New Zealand, October 17, 2014, Pg. 2 ↩

22. Analysis 01.03, Mahomed and Gulmezoglu 1997, Pg. 8 "This paper presents the final follow-up results on the children born between 1966 and 1972. The children were last examined in 1982 when they were aged between 10 and 16 years." Pharoah and Connolly 1987, Pg. 68 ↩

23. GiveWell. (2014). Iodine Global Network (IGN). Givewell.org. Retrieved 5 March. From https://www.givewell.org/charities/IGN ↩

24. Founders Pledge email exchange with Joyce Greene on June 24, 2022. ↩

25. IGN 2021 financial statement. ↩

26. Founders Pledge email exchange with Joyce Greene on June 24, 2022. ↩

27. “We have thus far been unable to document a demonstrable track record of impact; we believe IGN may have had significant impacts, but based on our current information we are not confident in this conclusion.” GiveWell. (2014). Iodine Global Network (IGN). Givewell.org. Retrieved 5 March. From https://www.givewell.org/charities/IGN ↩

28. “Salt iodization programs may result in excessive iodine intake, which could plausibly cause impairments in mental function analogous to those caused by iodine deficiency.” GiveWell. (2014). Salt Iodization. Givewell.org. Retrieved 4 March 2021. From https://www.givewell.org/international/technical/programs/salt-iodization ↩

29. Andersson, M., Karumbanathan, V, and Zimmermann, M. (2012). “Global Iodine Status in 2011 and Trends over the Past Decade” in The Journal of Nutrition. ↩

30. Founders Pledge email exchange with Joyce Greene on July 27, 2022. ↩

31. IGN. (2021). About the IGN?. Retrieved 8 March 2021. From https://www.ign.org/about.htm ↩