Fortifying a sustainable future

A local staff member from the Chadian Red Cross distributes fortified wheat to a refugee. How can food fortification be a powerful tool in the fight against undernutrition? Photo by: F. Noy / UNHCR / CC BY-SA

Last week, African policymakers gathered in Kampala, Uganda, for the 6th African Day for Food and Nutrition Security. Coming just weeks after the world finalized the Sustainable Development Goals, this was an important milestone as we transition from vision setting to action and implementation.

A clear road map to achieve the second goal — ending hunger — will be especially critical in Africa. But we know that ending hunger is only part of the answer. We will not be able to achieve the SDGs if we do not address the hidden hunger that is an underlying cause of nearly half of child deaths each year: malnutrition, including undernutrition and micronutrient deficiencies.

When people get the vital nutrients they need, they can reach their full potential and the effects are broad and lasting: children are healthier, they achieve more in school and earn higher income as adults. Micronutrients, in particular, play an important role in diets, especially for women of reproductive age and children.

Micronutrient deficiencies — or hidden hunger — still plague many countries in Africa and beyond, inhibit growth and pose a serious obstacle to achieving our development goals. The effects are broad and lasting: blindness, limited physical and cognitive development, weakened immune systems and even death. There is an economic toll as well. Countries can lose 2-3 percent of their gross domestic product as a result of iron, iodine and zinc deficiencies.

Fighting this hidden hunger may seem daunting, but we already have one powerful proven tool: food fortification.

Food fortification comes in many forms: soy sauce with added iron; vitamin A-fortified cooking oil and sugar; flour enriched with iron, zinc, folate and B vitamins. In the United States, across Europe and in many other countries, many of us take the hidden benefits of fortification for granted.

Fortification is one of the most cost-effective interventions we have to fight malnutrition. The annual cost of increasing iodized salt access is just 20 cents or less per person. The cost benefit from such an investment is as much as 30:1, resulting in significant health care savings and increased productivity.

Where investments are made in fortification, we’re seeing great progress. In Tanzania, a national food fortification program launched in 2011 reached millions with fortified wheat flour and cooking oil. In South Africa, a partnership to increase access to folate-fortified wheat and maize flour contributed to a more than 30 percent decline in neural tube defects in babies. A commitment by regional cooking oil producers in West Africa helped bring vitamin A-fortified oil to more than 80 million people across eight countries — now 14 countries in West Africa have legislation on the books for mandatory food fortification.

Last month, I joined leaders at the Global Summit on Food Fortification in Arusha, Tanzania, which mapped out an action plan for fortification’s contribution to the SDGs. The evidence shows three keys to expanding food fortification and reaching those most vulnerable to malnutrition:

1. Countries with the highest burden of micronutrient deficiencies need to establish clear regulatory frameworks for food fortification. Working with local communities, this should include deciding what to fortify, setting standards and ensuring quality and compliance.

2. Food producers must be part of the conversation about standards. Companies will not fortify foods if there are no market incentives for them to do so.

3. Development partners need to increase support for countries developing food fortification programs to help ensure that programs benefit everyone, including the poor.

In the 1830s, French chemist Jean Baptiste Boussingault found that goiter could be prevented by fortifying salt with iodine. It took nearly 100 years before this intervention was widely adopted, but today, iodized salt is a staple in kitchens.

Iodine is essential for healthy brain development. Think about the potential lost to micronutrient deficiency in the 100 years between Boussingault’s discovery and when iodized salt was broadly accepted. What great contributions did we miss then? And what great contributions do we continue to miss because more than 2 billion people are deficient in the vitamins and minerals they need?

As we embark on the implementation phase of the SDGs, nutrition will be foundational to truly sustainable success. We need to use every proven strategy we have, of which fortification is one. Let us recommit ourselves to the pursuit of better nutritional outcomes for all — and a more sustainable, thriving Africa.

Future Fortified is a special online series presented by Devex, in partnership with GAIN, exploring the impact and importance of food fortification to meet global development objectives. Visit the campaign site and join the conversation using #FutureFortified.

The views in this opinion piece do not necessarily reflect Devex's editorial views.

About the author

  • Chris Elias

    Chris Elias, MD, MPH, is president of the Global Development Program of the Bill & Melinda Gates Foundation. He leads the foundation’s efforts to accelerate the delivery of proven health care products and solutions to those who need them most — especially women and children. Chris recently served as the president and CEO of PATH, an international nonprofit organization dedicated to improving the health of people around the world by developing innovative health technologies, strengthening health care systems, and encouraging healthy behaviors.