Despite positive developments in reducing malnutrition over the last few decades, hundreds of millions of people globally still do not consume adequate amounts of essential vitamins and minerals in their diets to sustain good health and development. This is referred to as “hidden hunger,” a major public health problem that is holding back entire communities.
Those suffering from hidden hunger may not appear acutely malnourished, but may suffer the consequences of poor brain development, immune function, and work productivity. Especially within the first 1,000 days “window of opportunity” of a child’s life — from conception to the age of 2 — a lack of key micronutrients contributes to adverse physical and cognitive growth can have drastic, irreversible and lifelong impacts.
Communities also suffer from reductions in economic growth and a health care system overburdened by the medical treatment of preventable nutrition-related health problems.
A proven, scalable and cost-effective nutrition intervention
Salt tends to get a bad rap, but it plays a crucial role in reducing iodine deficiency worldwide. GAIN, through its partnership project with UNICEF, has helped protect an additional 466 million people, including 113 million children, against brain damage and other debilitating effects from iodine deficiency.
Iodine deficiency can lead to serious health issues and salt is also one of the only foods that consistently reaches groups with high risk of iodine deficiency, including poor, rural communities. Iodine deficiency during pregnancy can result in stillbirth, spontaneous abortion, and congenital abnormalities such as cretinism, a severe and irreversible mental condition.
However, these issues are easily preventable by simply adding iodine to salt — a cheap and effective solution. In addition, adding iodine to salt does not change its color, odor or taste.
GAIN has warmly welcomed the government of Pakistan’s proposal to exempt vitamin premixes, as well as food grade minerals and micronutrients, from customs duties and sales tax in its 2016-2017 Finance Bill. Working with Pakistan’s Ministry of National Health Services, GAIN has provided leadership and support, along with other partners, in advocating for the removal of taxes on the import of micronutrients for food fortification. This initiative would reduce the cost of fortifying staple foods with vitamins and minerals that are essential for improving the health of the people of Pakistan, especially women and children.
What does it cost not to fortify flour? That’s the question government, flour millers, economists and other health and nutrition experts asked themselves during a workshop in Dushanbe, Tajikistan, in March. By conducting an analysis on the costs and benefits of fortifying wheat flour with essential micronutrients, they found that failing to tackle the problem of micronutrient malnutrition will lead to economic losses of $878 million over the next decade. The consequences of vitamin and mineral deficiency include neonatal and maternal deaths, neural tube defects like spina bifida, and iron deficiency anemia in children and adults. A successful wheat flour fortification program would reduce these losses by $302 million and cost just $32 million over the 10-year period.
Given this context, food fortification — the practice of adding small and safe amounts of micronutrients to staple foods and condiments — is a powerful nutrition success story that is reaching billions across the world. It is simple, scalable and among the world’s most cost-effective development interventions.
The fortification of staples and condiments has been practiced in North America and Europe since the 1920s, and it has greatly contributed to the virtual eradication of diseases like pellagra, goitre, beriberi and scurvy.
But over the last decade, food fortification has gained global traction and its positive impact on the health of people in low- and middle-income countries is growing. More than 140 countries have national salt iodization programs, 85 mandate at least one kind of cereal grain fortification with iron and folic acid, and more than 50 mandate the fortification of at least one kind of edible oil and ghee with vitamin A. Important experience is now being accrued globally in reducing the prevalence of micronutrient deficiencies through fortification.
Despite this, many fortification programs require targeted and aligned efforts by government, the private sector, academia, consumer groups, international agencies and donors to ensure effective coverage, and in order to achieve optimal and sustained impact.
The aim of the event was to review achievements and challenges, understand the current evidence, and align ourselves with partners on the way forward.
The event led to the Arusha Statement on Food Fortification, outlining priorities for the sector. Following the summit, a fortification Technical Advisory Group comprising more than 20 development agencies that are engaged in fortification, expanded on the five recommendations that emerged from the summit, including regulatory monitoring, evidence and guidelines, advocacy, resourcing and transparent reporting.
We are therefore in an unprecedented position to be able to deliver solutions together, which can lead to long-term impact in sustainable intakes of essential vitamins and minerals. In this way, we will have far-reaching effects on economies by improving overall physical health and, in due course, work productivity.
It is intended that this report will help implementing agencies, policymakers and donors, in particular, to improve coordination in the nutrition and food sectors.
This, in turn, will help expand, improve and sustain national fortification programs, and ensure that they help achieve public health objectives and relevant Sustainable Development Goals.
Greg S. Garrett is director of food fortification at the Global Alliance for Improved Nutrition. He has been working in international health and nutrition for 15 years, five of which were spent in Asia. At GAIN he oversees a portfolio of projects in more than 20 countries, which reach an estimated 900 million people with more nutritious foods. Before joining GAIN in 2011 he worked for over a decade with international technical agencies Abt Associates, Futures Group and Population Services International. Greg serves on the Boards of the Iodine Global Network and the Food Fortification Initiative. Greg holds a B.A., and an M.S.c in international development from the University of Bath, U.K.
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