Yes, Do other countries use iodized salt extensively?

December 7, 2025 •

4 min read

According to UNICEF, nearly 90% of the global population consumes salt that contains iodine, demonstrating a widespread international effort to combat iodine deficiency. This public health achievement reflects decades of collaborative work by governments, health organizations, and industries to fortify a common dietary staple and protect cognitive and physical development.

Quick Summary

Most countries use iodized salt, with many implementing mandatory fortification programs to combat iodine deficiency disorders. The strategy has been highly effective globally, though some regions still face challenges with inconsistent coverage and lack of access. Policies vary significantly, from universal laws to voluntary availability in different nations.

Key Points

Global Adoption: Nearly 90% of the world's households consume some form of iodized salt, a major public health victory over iodine deficiency disorders (IDDs).
Mandatory Legislation: Many nations, including China, India, and Canada, enforce mandatory salt iodization laws to ensure widespread, consistent iodine intake across the population.
Voluntary Programs: Some countries, like the United States and the United Kingdom, have voluntary iodization programs, which can lead to inconsistent coverage, especially with the increased use of non-iodized salt in processed foods.
Persistent Gaps: Despite high global coverage, significant gaps remain, particularly in low-income regions like parts of Sub-Saharan Africa and among marginalized communities.
Ongoing Challenges: Monitoring effectiveness and ensuring fortification of salt used in processed foods are major ongoing challenges for sustaining iodine sufficiency worldwide.

A Global Health Success Story

Universal salt iodization (USI) is widely regarded as one of the most successful and cost-effective public health interventions in modern history. By adding a small amount of iodine to salt, a staple commodity consumed by nearly everyone, nations have dramatically reduced the incidence of iodine deficiency disorders (IDDs), such as goiter and cretinism. The strategy is particularly critical in inland areas where natural sources of dietary iodine are scarce, due to low iodine levels in the soil and food crops. The global effort, driven by organizations like UNICEF and the World Health Organization (WHO), has seen the proportion of households consuming iodized salt rise from less than 20% in 1990 to approximately 89% in 2021.

However, the implementation of this strategy varies significantly from one country to another, with different approaches ranging from mandatory legislation to voluntary market-based programs. This variation impacts the level of household coverage, the inclusion of processed foods, and the long-term sustainability of iodine sufficiency.

Mandatory vs. Voluntary Iodization: Country Approaches

Countries worldwide have adopted two main strategies for salt iodization: mandatory and voluntary. Mandatory programs, which are more prevalent and generally more effective, legally require all salt for human consumption to be iodized. Voluntary programs, in contrast, allow producers to choose whether or not to iodize their salt, and often rely on consumer choice to drive demand.

Examples of Mandatory Iodization

China: With a large population historically vulnerable to iodine deficiency, China made iodization mandatory in 1994 and has since cracked down on the smuggling of non-iodized salt.
India: The sale of non-iodized salt for human consumption is banned, although enforcement is not always perfect, and a small percentage of the population still uses insufficiently fortified salt.
Canada: For household use, salt sold to consumers must be iodized, though sea salt and other specialty salts are often exempt.
Switzerland: As the world's first country to introduce iodized salt in 1922, Switzerland has successfully eliminated endemic goiter.

Examples of Voluntary Iodization

United States: While iodized salt has been widely available since the 1920s, fortification is not mandatory. Much of the salt used in processed foods is not iodized, which can lead to insufficient intake for some populations, including pregnant women.
United Kingdom: Iodized salt is not as readily available as in other countries, and the majority of salt consumed comes from processed foods using non-iodized varieties.
Germany: The use of iodized salt is voluntary, and a significant challenge is its low use in the production of processed foods.

Coverage Gaps and Remaining Challenges

Despite the remarkable progress, universal coverage is not a reality everywhere. UNICEF estimates that nearly 1 billion people may still lack access to iodized salt. Regions with lower household coverage often face significant socio-economic barriers.

Lack of Access to Iodized Salt in 2018

Djibouti: 0%
Somalia: 1%
Haiti: 3%
Sudan: 10%
Guyana: 11%

While these numbers may have improved in recent years, they highlight persistent issues in reaching vulnerable populations. Other challenges include inconsistent monitoring, particularly in countries with less robust public health infrastructures, and the increasing consumption of processed foods that often use non-iodized salt.

Comparison Table: Mandatory vs. Voluntary Programs


Feature	Mandatory Iodization Programs	Voluntary Iodization Programs
Country Examples	China, India, Canada, Argentina	United States, United Kingdom, Germany
Legal Requirement	All or specified salt for human consumption must be iodized by law.	Producers choose whether to iodize; no legal obligation.
Household Coverage	Often results in very high household coverage (e.g., >90% in China and India).	Coverage is generally lower and can fluctuate based on market dynamics and consumer awareness.
Processed Food Use	Can be structured to include salt used in processed food manufacturing.	Fortification is often inconsistent, as manufacturers may use non-iodized salt.
Program Sustainability	Highly durable, often withstanding political and economic crises once established.	Can be vulnerable to changes in market factors, consumer habits, and dietary trends.
Effectiveness	Considered the most effective strategy for ensuring adequate population-level iodine intake.	Less effective for achieving universal iodine sufficiency, potentially missing vulnerable subgroups.

Conclusion

In summary, the use of iodized salt is a global norm, driven by decades of public health efforts to eliminate iodine deficiency. While the strategy has achieved remarkable success in most parts of the world, variation in approach—specifically, the difference between mandatory and voluntary iodization programs—leads to differences in effectiveness and coverage. The majority of countries have adopted mandatory programs, ensuring broad population coverage and reducing the prevalence of IDDs. However, in countries with voluntary programs or weaker monitoring, challenges persist, particularly concerning processed foods and marginalized communities. Sustained monitoring and targeted interventions remain crucial to consolidating these gains and reaching the estimated 1 billion people still affected by insufficient iodine intake. To learn more about the global context of food fortification, exploring resources from the World Health Organization is highly recommended(https://www.who.int/data/nutrition/nlis/info/iodine-deficiency).

Frequently Asked Questions

No, not all countries use iodized salt, and even in those that do, household coverage and program implementation vary widely. While nearly 90% of households globally have access, some countries, particularly in Sub-Saharan Africa, have very low coverage.

Yes, many countries have implemented mandatory salt iodization laws. Examples include China, India, Kazakhstan, Argentina, and several nations in Southeast Asia. Mandatory legislation is considered the most reliable approach for broad-based iodine sufficiency.

The United States, Germany, the United Kingdom, and Singapore are among the countries where salt iodization is voluntary rather than mandatory. In these nations, consumers can choose between iodized and non-iodized salt products.

Iodized salt is primarily used to prevent iodine deficiency, which is most common in inland regions with iodine-poor soil. Public health policies, government commitment, and economic factors influence a country's adoption and enforcement of iodization programs.

The practice of fortifying salt with iodine began in the early 20th century. Switzerland was the first country to introduce it in 1922, followed by the United States and other nations in the 1920s. The World Health Organization (WHO) and UNICEF later promoted universal salt iodization globally.

If a country stops using iodized salt, or if fortification levels decline, iodine deficiency can reappear rapidly. A case study in Cambodia showed that reliance on external funding and a lack of enforcement led to the return of iodine deficiency when aid was withdrawn.

Yes, iodized salt is a primary tool used to prevent goiter, which is a symptom of iodine deficiency. The successful implementation of iodization programs in countries like Switzerland and Iran has led to a significant drop in goiter prevalence.

No, salt iodization is not mandatory in the United States. While iodized salt is widely available, much of the salt used in processed foods is non-iodized. Many gourmet, kosher, and sea salts are also not iodized.

There is a potential conflict between salt reduction campaigns and iodization efforts, as lower salt intake could mean lower iodine intake. The WHO has emphasized that the two programs are compatible but require careful alignment, such as increasing iodine concentration in salt as overall consumption decreases.