Where is Solomon?

Dealing with public health issues requires the wisdom of Solomon. Three recent public health issues come to mind: iodized salt, smoking, and iron fortification.

We all assumed that iodizing salt is a good thing, right? It is supposed to prevent unsightly goiter. In the second of my worlds there is a campaign in process to introduce iodinization. I recall a couple of young ladies going around house to house in a No village three years ago. At each house they would ask to borrow a little salt. When the people brought the salt they put it on a piece of paper and dripped a little liquid on it. If it turned purple it meant the salt was iodized and the family was praised. If it did not turn purple they were lectured on the value of buying iodized salt. Many people do now use iodized salt although coarse uniodized salt is still available and is still a little cheaper.

In the third of my worlds all salt is now iodized. If there is any uniodized salt at all, I do not know where to find it. But there has been an unanticipated side effect. According to a local endocrinologist who did research into the problem, this country never really had a problem with goiter. Most of the population also regularly eats fish and other seafood. (So I wonder why they decided to outlaw uniodized salt in the first place???) Since the phasing out of uniodized salt, however, they have seen a rash of cases of hyperthyroidism. According to the doctor, giving iodine to some people is like throwing fuel on a fire and the health problems that have resulted are worse than the problem that the iodinization was supposed to have helped.

A second public health issue is smoking. It is well known that many diseases are exacerbated by smoking. And smoke is certainly annoying to non-smokers. No one was happier than me when smoking was banned on airplanes. No more coughing and sneezing when everybody lit up after the meal (of course meals on planes are also a thing of the past it seems). Gradually the ban was extended to malls, large stores, restaurants, bars, until now about the only place you can smoke is in your own house. In one sense as a non-smoker, it’s fine with me if nobody ever smokes, but from the point of personal rights and freedom it does seem a bit overkill to not even be able to smoke outside. After all, a smoker outside is totally negligible in comparison to auto fumes and the constant burning of trash that goes on. (Did I mention that burning a smelly old tire is considered by some a way to cure disease? It is reputed to scare off evil spirits. I’d trade that foul smell for a smoker any day!)

The third public health issue that is currently underway is the requirement that all rice be fortified with iron. As mentioned in a previous post, a large percentage of people in this country are reputed to be anemic, so it was decided that the rice should be iron fortified. All stores and restaurants that sell rice are required by law to sell iron fortified rice, whether cooked or raw. As mentioned previously, people do not like the iron fortified rice. They say it looks dirty, doesn’t taste good and is gritty and they don’t like to buy it. So to maintain sales, stores have stopped premixing the iron pellets into the rice and instead include the pellet packets (1 packet per kilo) in the bags of rice so that people can mix it themselves. Of course it mostly ends up in the trash. (One more thing to burn???)

Apparently however, the law doesn’t require rice sold in the market to be iron fortified. Most poor people (who are more likely to be anemic) buy their rice at the market because they can find poorer grades of rice than what is sold in stores and so it’s a little cheaper. And now it’s even cheaper still because the stores have to pay for the iron fortifcation packets. Poor people also don’t tend to eat at restaurants. They are more likely to eat at little household run eateries which are not subject to the law. Those people also do not serve iron fortified rice because it is more expensive and they want to make a profit. So as it turns out, the poor who are anemic are not benefitting from the iron fortified rice. It is the middle class who probably is not anemic who is dealing with having to deal with the higher price and throw away the pellet packets.

So, three public health issues. Where is Solomon?