The case for food fortification

A young girl eats a fortified lunch through the school nutrition program. Photo by: GAIN

That micronutrient deficiencies can cause irreversible damage to a child’s physical and mental development is well understood. Is food fortification one of the simplest and most cost-effective ways to improve people’s health?

In an ideal world, food fortification — adding essential micronutrients to basic staple foods — would be unnecessary. Everyone would have access to diverse diets, with a mix of fruits, vegetables and whole grains that provide the nutrients we need to live productive, healthy lives.

That ideal, however, is still some way off. Today, less than a quarter of developing countries are on track to achieve the Millennium Development Goal of halving undernutrition and approximately 2 billion people worldwide still lack key vitamins and minerals, particularly vitamin A, iodine, iron and zinc.

Food fortification in the developed world

Food fortification — the practice of adding small and safe amounts of micronutrients to staple foods and condiments — has been practiced in North America and Europe for decades. In many cases diseases resulting from micronutrient deficiencies have been all but eradicated. Today, the average person in the United States has not even heard of pellagra, goiter, beriberi or scurvy, all of which were once common diseases caused by micronutrient deficiencies.

A good example from the United States is the practice of fortifying salt with iodine, which has taken place since 1924. The result has been a drop in the number of cases of preventable mental handicaps due to iodine deficiency. A 2013 study went even further — revealing that iodine fortification may have boosted the Americans’ average IQ.

Ninety years after food fortification was first used in the United States, the practice is starting to achieve scale and impact in the developing world. Due to national salt iodization programs, the number of iodine-deficient countries decreased from 54 to 32 from 2003 to 2011. Similarly, with help from the Global Alliance for Improved Nutrition and other agencies, hundreds of mills are now adding micronutrients to wheat and maize flour. More than 70 governments have enacted laws for mandatory national flour fortification. However, many of these countries do not have effective monitoring systems and much of the fortifiable flour goes unfortified. Similarly, in many countries with widespread micronutrient deficiencies and suitable food vehicles, fortification has yet to be taken up.

Building consensus

In 2008, a meeting of some of the world’s most notable economists, known as the Copenhagen Consensus, declared adding micronutrients to staple foods as the most cost-effective way to help address the global malnutrition crisis. The question wasn’t whether to fortify, but how to urgently build national programs in countries and increase coverage to hard-to-reach populations.

Building support for national fortification projects is a multifaceted task, which requires collaboration between multiple players. GAIN helps establish alliances for fortification that bring together governments, the private sector (including food companies and millers), consumer groups or nongovernmental organizations, international agencies, development agencies and academia. Known as National Fortification Alliances, these groups enhance communication and collaboration and create an enabling environment for support and advice on the process. GAIN also serves as a technical adviser to food industries and as a partner to governments to improve the quality and monitoring of fortified foods.

As programs mature and reach scale, the evidence of the direct and indirect impact on people's health is starting to grow. GAIN-supported fortification programs have contributed to reductions in neural tube defects in South Africa; iron deficiency anemia in Nigeria, Jordan and Morocco; and vitamin A deficiency in Indonesia.

The question is not why food fortification, but rather why not?

Fortification offers significant payback for a relatively low cost. Iodizing salt, for example, can cost as little as 5 to 10 cents per person per year. The return on that investment is valued at more than $26, in the way of productivity and health care savings. In Chile, researchers compared the annual cost of the rehabilitation and treatment of children with spina bifida with the cost of adding folic acid to flour. The results showed that for every $1 invested in adding folic acid to flour, $12 were saved in medical treatment and care.

While food fortification is not a standalone tool — dietary diversity and affordable access to nutritious foods both remain crucial in the fight against malnutrition — it is a powerful tool enabling schoolchildren to learn better, prepares mothers for healthy pregnancies and fights disease.

We know malnutrition does not have a single solution. But by making smart investments in food fortification, we can improve the lives of more people in a shorter amount of time.

Want to learn more? Check out Feeding Development's campaign site and tweet us using #FeedingDev.

Feeding Development is an online conversation hosted by Devex in partnership with ACDI/VOCA, Chemonics, Fintrac, GAIN, Nestlé and Tetra Tech to reimagine solutions for a food-secure future from seed and soil to a healthy meal.

About the author

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    Greg S. Garrett

    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.