Population

Population:   7.3 million
Population growth rate:  0.27%
Population < 15 years:  17.0%
Birth rate:  10.1 per 1000
Life expectancy at birth:  79.9 years
Infant mortality:  4.48 per 1000

Prevalence of Goiter/ UIE

Median urinary iodine: 115 mcg/L.

In past, goiter and cretinism existed in most areas ( Rhone , Val d'Entremont, Alps ). Any goiter still observed is in older populations from past iodine deficiency, but no goiter among children.  In a national survey in 1999, a representative sample of schoolchildren found no goiter using the 1997 WHO/ICCIDD criteria.

Cretinism was previously common, none since prophylaxis.

Median blood TSH concentration (range) of pregnant women was 0.6 mU/L (0.2-2.1) in 1999.  Of 396 pregnant women only three had elevated values (1.9-2.1 mU/L).

In 1999, median urinary iodine (range) of 600 children and 511 pregnant women was 115 mcg/L (5-413) and 138 mcg/L (5-1881), respectively.  Expressed by gram creatinine, the median urinary iodine (range) was 123 mcg/g (22-2256) for children and 207 mcg/g (5-4216) for pregnant women.

Iodized salt Coverage

Salt Situation Analysis

Production

Salt is iodized both for household and food industry use. In 2001, 67% of all salt for human consumption was iodized, including 94% of household salt.  Almost all of the cantons have transferred their salt monopoly to the United Swiss Rhine Salt Works of which they are the exclusive shareholders.  The potassium iodide content of table salt has been increased progressively over the last four decades. The last raise in iodine content from 15-20 ppm (legal requirement 20-30 ppm) was in 1998.  The iodization of all salt for human consumption (includes salt for food industries and restaurants) is voluntary. 

10% (mainly sea salt) of salty imported from France .

Consumption

• Estimated daily per capita salt consumption: 10g.
• Estimated % of all salt consumed by people which is adequately iodized (household level): 94%

Iodine Procurement and Utilization

KI at 20-30 ppm. 67% of the salt produced for food is iodized.

Universal Salt Iodization Program

Information, Education, Communication (IEC) Activities

Legislation

• Legislation: Yes; iodized salt use is voluntary.
• Legislation for Animals: no data.
• Year Enacted: 1998

Program Monitoring and Evaluation

Supervision of the IDD program rests in the Fluorine/Iodine Commission of the Swiss Academy of Medical Sciences; this Commission reports to a larger Federal Commission of Nutrition, which in turn recommends legislation and executive action to the conference of the 26 Cantonal Health Ministers.

The following indicators are available to monitor the IDD control program:

• Goiter: Establishing a monitoring system based on 1999 data.
• Urinary Iodine:   See above

Other Interventions

None

Key Lessons Learned

Challenges and Constraints

While the Swiss program has been quite successful, it is threatened by impending international trade regulations that block monopolies and prevent "artificial" low pricing of iodized salt.

Future Plans for Sustained IDD Elimination

Sources:

Hess SY, Zimmermann MB , Torresani T, Burgi H, Hurrell RF 2001 Monitoring the adequacy of salt iodization in Switzerland :  a national study of school children and pregnant women.  Eur J Clin Nutr 55:162-166.

IDD NL 7(3):17, 1999

IDD NL 12(3):52, 1996

IDD NL 9(1):10, 1993

IDD NL 8(1):12, 1992