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The third-best investment the world can make

© UNICEF Thailand

By Karen Emmons

The Filipinos adore their pan de sal, the Mongolians are fond of their bantam, the Thais love bread sugar sweetened, and the Chinese need their steamed mantou buns and dumplings. Baguettes have become a common sight on the roadside in Cambodia, Lao PDR and Viet Nam.

And then there are the noodles, especially instant ones – oodles of them throughout Asia.

In the great rice bowl of Asia, another grain is flowing in popularity and may be a vital link to mother and child nutrition – once a little spice of government intervention is added in.

Asia is the fastest-growing wheat market in the world according to U.S. Wheat Associates, especially where gross domestic product and urbanization have increased. In Indonesia, Japan, Republic of Korea, Malaysia, Philippines, Taiwan (China) and Thailand, half of the total wheat supply is consumed in the form of noodles and steamed breads.

Unfortunately, those foods bring little nutritional value to the table. Most of wheat’s crucial nutrients are stripped away as it is milled into flour.

Asia is the fastest-growing wheat market in the world according to U.S. Wheat Associates, especially where gross domestic product and urbanization have increased. In Indonesia, Japan, Republic of Korea, Malaysia, Philippines, Taiwan (China) and Thailand, half of the total wheat supply is consumed in the form of noodles and steamed breads. Unfortunately, those foods bring little nutritional value to the table. Most of wheat’s crucial nutrients are stripped away as it is milled into flour.

“Staple foods, such as rice, noodles and bread, make up a huge proportion of the average diet, especially for the poor, but these foods are not packed with much protein, vitamins or minerals,” says Karen Codling, a nutritionist who runs the Public Nutrition Solutions consultancy, based in Bangkok. 

However, some staple foods do not have to be a nutritional dead end, according to the Flour Fortification Initiative (FFI), a unique public-private partnership of more than 60 members from the flour milling industry, public health organizations, governments, academic and technical institutions, non-government organizations and international agencies, including UNICEF.

FFI’s members are working together to encourage governments to legislate the return of nutrients to wheat flour as an important and cost-effective strategy to improve global nutrition and social development.
 
This strategy is applauded by some of the world’s best minds. Economic experts, including five Nobel Laureates, commissioned by the Copenhagen Consensus Center in 2008 to analyse optimal ways to combat the world’s biggest problems, ranked fortifying staple foods with iron and salt with iodine as the third-best investment that governments and philanthropists could make (micronutrient supplements ranked first). 

“Fortification of flour becomes an even more important strategy for minimizing the impacts of the economic crisis on vulnerable populations, given that nutrition is typically the first causality among poor families,” says UNICEF Regional Director Anupama Rao Singh.

© UNICEF Mongolia

Micronutrient impact

Fortification replaces lost nutrients and makes staple foods far more nutritious without changing the taste or appearance. “This is particularly important when considering ways to improve the nutrition of the poor and in times of economic crisis when expensive, nutritious foods are replaced by cheaper staples,” says Codling, who worked for years in a similar initiative to iodize salt and who now works with FFI.

Lack of vitamins and minerals in the diet is detrimental to the physical and mental potential of up to one-third of the world’s population, UNICEF and the Micronutrient Initiative reported in 2004.

The World Health Organization recently endorsed guidelines for fortifying flour with iron, folic acid, zinc, vitamin B12 and vitamin A. Iron and folic acid are the two most commonly added nutrients, and these can be added to flour at a cost of about 10 US cents per person per year.
 
Fortifying flour with iron would help prevent a significant portion of the mental impairment that occurs among young children who do not consume an adequate level of iron. It would also increase adult productivity – thus raising incomes – and help reduce anaemia, which contributes to maternal mortality.

Women need folic acid during the first days of pregnancy to prevent neural tube defects, such as spina bifida that causes child death and a large proportion of child disabilities. Fortification is a particularly effective strategy because the alternative strategy of supplementation often only starts after women know they are pregnant – which is usually too late.

According to the FFI, an adolescent girl consuming 150 grams of fortified flour daily – about two slices of bread or two packs of instant noodles – gets about 50 per cent of her daily needs for iron and 84 per cent of daily needs for folic acid.

A Canada-based economist involved in nutrition issues, Sue Horton believes that a combination of vitamin A, iron, zinc, folic acid and iodine in the majority of diets in sub-Saharan Africa and much of Asia would result in an estimated US$5 billion in health-care savings and future earnings, and save around 3.5 million lives.

The few cost-benefit analyses available lean considerably in favour of fortification.  Researchers in Chile, for instance, found that every $1 spent to fortify flour with folic acid saved $11.80 in medical costs; in South Africa it saved $46 and in the US it was $40 (due to the higher costs of medical care in those two countries).


© UNICEF Indonesia

Countries that fortify

Globally, legislation in 57 countries requires the fortifying of flour with iron and/or folic acid. Some countries go further, requiring additional vitamins and nutrients, such as vitamins A and B, zinc and thiamine. Such legislation gives nearly 2 billion people access to fortified wheat and/or maize flour.

However, only five countries that make it mandatory are in the Asia–Pacific region: Australia, Fiji, Indonesia, New Zealand and Philippines. Malaysia may soon join them. Mongolia voluntarily fortifies and one miller in Viet Nam fortifies on a voluntary basis.  Yet, flour fortification is standard practice throughout the Americas and in about a third of the flour milled in African countries.

The Indonesian government was the first country in East Asia (1998) to see the value in fortifying. A year after the onset of the 1990s’ Asian financial crisis, the “nutrition status of women and children deteriorated significantly”, reported Nina Sardjunani, Indonesia’s Deputy Chairperson for Human Resources and Cultural Affairs within the National Development Planning Agency, during a gathering of FFI’s East Asia Leaders Group in February 2009.

According to Sardjunani, Indonesia learned that a government response to a financial crisis – and a way of buffering people from it – is to fortify food. “It is our duty as government and private sector alike to ensure that whatever food [people] buy should be nutritionally adequate,” Sardjunani said.

The need for legislation

FFI has learned that millers typically will not fortify on their own initiative, despite the low cost of the process. There is no marketing value to fortifying, explains Greg Harvey, CEO for InterFlour Group, one of the region’s largest millers and a private-sector partner with FFI. “To ensure it works,” he says, “it has to be mandatory.”

According to Singh, UNICEF’s Regional Director who co-chairs FFI’s East Asia Leaders Group with Harvey, the collaboration with the private sector has been crucial.

“It really makes a difference. While it’s the prerogative of governments to decide whether to make fortification mandatory, ultimately they have to have industry on their side and industry has to see there is a very sound business case for it,” she said. “There are marginal costs and they are contributing to the social good within a country.”

InterFlour is a good example. The company operates a mill in Indonesia where fortification is mandatory, but voluntarily restores the lost iron and folic acid to its milling process in Viet Nam. “I feel on a long-term basis it’s good business practice to serve our market – for women and children to get the maximum nutritional benefit from our product,” Harvey says of InterFlour’s unique commitment to fortify. 

 

 
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