The inevitability of proper nutrition

Through our projects in what those of us from urban geographies normally classify as “remote rural areas,” it’s difficult not to be baffled by the development contradictions found on the birth beds of our plates of food. Okay, maybe not on our rich colorful plates, but on theirs, in those countries, in some countries. They are one of us; they are utilizing our land; and they are the people who produce our food. If they are lucky enough to have (1) one daily plate of varied, nutritious food, composed (2) of fresh, locally sourced ingredients, they may still fall short of the small things that matter most on your plates.

It might be the colors, or it might be the plethora of local smells missing in this daily meal. They certainly remember these attributes from the last festive season, and they are making plans to source them from the local shop—if only they weren’t cash-strapped because of the last short crop and the planning ahead for the next one… By the way, it’s the dry season; so better stick to your own (last season’s) stored maize, cassava, rice, or the wheat flour you managed to buy, or whatever seasonally available starch crop to which you have access. And they still too often miss the invisible nutrients that will make them give birth to healthier babies, grow them stronger, withstand disease, and cultivate normal cognitive development.

The storytelling changes according to the latitude, but you get the point. Addressing the global challenge of micronutrient deficiency requires short- and intermediate-term and, equally, long-term sustainable approaches. The ideal diet is diverse and adequately dense in micronutrients to meet needs without excess energy intake, not an easy task even with those fertile plains and ancient cultures that sparked (and have survived) our civilization. To improve the access to healthy foods and reduce undernutrition and overnutrition, it is essential to understand how food supply relates to the changing forms of malnutrition.

We certainly need more comprehensive multisectoral approaches, such as well-documented food fortification projects, agricultural interventions in biofortification, dietary diversification and modification, to attain this common goal, the declared basic human right to food and adequate nutrition.

The right to food concept has a long history. In 1948, the Universal Declaration of Human Rights asserted, in article 25, that "everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food."

Fast forward to 1974, when the World Food Conference issued the Universal Declaration on the Eradication of Hunger and Malnutrition, which states that "every man, woman and child has the inalienable right to be free from hunger and malnutrition in order to develop fully and maintain their physical and mental faculties." This declaration was endorsed by the United Nations General Assembly in Resolution 3348 (XXIX) of December 17, 1974, and has since been followed by many other laudable declarations and action plans. While the argument continues about the many nutrition programs, within countries and internationally, still provided as a matter of charity, and not entitlement, there are certainly some actions that have a direct, measurable impact on this agenda.

The industrial fortification of foods was launched almost 100 years ago to address diseases and disorders of public health concern, and it continues to be a key strategy to ensure the required intake of nutrients where they are not adequately supplied by the normal diet.

The triple burden of malnutrition includes undernutrition, overnutrition, and micronutrient deficiencies. These deficiencies or hidden hunger, a lack in key vitamins and minerals, can affect both undernourished or overweight people and translate to diseases if they become acute. What causes these deficienciess? Lack of dietary diversity because of the limited availability, affordability, access to, and utilization of nutritious foods. The lower the income, the less diversity in diets. Approximately two billion people suffer from iron deficiency. More than 300 million children in Africa and Southeast Asia suffer from acute vitamin A deficiency. An estimated two billion have inadequate iodine status. And the list goes on.

Food fortification is a cost-effective solution to addressing hidden hunger. IFC believes in the power of the private sector and continues to partner effectively on the most relevant projects, where it is able to connect the needs with the means among those people who might succeed in changing the local nutritional landscape, even if only modestly on local market shelves, with local staple food products that are now properly fortified.

Why food fortification? These are the main takeaways:

·        Food fortification is scalable, allowing a large number of people to be reached

·        It’s highly customizable, allowing country-specific needs to be efficiently targeted

·        It is not expensive; it’s a significant cost-effective solution to micronutrient deficiencies

·        It’s not necessarily intrusive in food plant production because can be included as an independent dosing system, even in continuous production lines

·        Food fortification has proven to be efficient (salt iodization) and cost-effective (larger number of people reached per US dollar spent)

·        Fortification can be carried out at the point of cultivation (biofortification), at the point of food processing (food fortification), or at the point of consumption

Large-scale food fortification targets (1) staple foods, such as grains: wheat and maize flour, rice, vegetable oils and margarine, and (2) condiments: bouillon cubes, soy sauce, fish sauce, and salt. Smaller-scale food fortification can widen the scope.

Because processed foods and beverages represent a larger share in the consumption of low- and middle-income countries, they can become vehicles for fortification: (1) dairy products: milk, ghee, (2) processed foods: noodles, biscuits, and so on, and (3) beverages: fruit juice, nondairy beverages.

Through a team of experts (industry and private sector specialists), IFC has developed an ambitious food fortification program focused on the flour and rice milling industry. The program acts beyond only the concepts and guides private sector partnerships and all relevant stakeholders on the implementation of an industrial food fortification program, structured on three pillars:

·        General milling best practices

o  An externally supported, specialized technical assessment that pinpoints, organizes, and executes specific projects with plant-limited resources

·        Food fortification best available technologies (flour and rice milling)

o  A professional technical assessment of the client’s micronutrient handling system (or future project) and a look at the plant installation against the best technology available

·        Tailored training programs (client-process specific)

o  A training program that focuses on the plant shortcomings, helps drive excellence in their industrial processes, and, ultimately, raises internal awareness on the need for commitment to better nutrition in their final products

The IFC fortification program is immediately actionable, measurable through industry-specific key performance indicators, and replicable for implementation among other processing units of the client, positively affecting the contribution to better nutrition for everyone.

Despite the enduring pandemic, 2021 delivered so many valuable events, such as the Second Global Summit on Food Fortification Virtual Series, the United Nations Food Systems Summit in September, and the Tokyo Nutrition for Growth Summit 2021, where David Malpass, World Bank president, reiterated that the World Bank, including IFC and MIGA, remain strongly committed to including nutrition as a key part of Universal Health Coverage and the pandemic response (1).

Will you stand up and champion this cause?

References:

Barth Eide, Wenche. 2002. "Nutrition and Human Rights.” In “Nutrition: A Foundation for Development,” Brief 10, 1–4, Sub-Committee on Nutrition, Administrative Committee on Coordination, United Nations, Geneva.

FAO (Food and Agriculture Organization of the United Nations), IFAD (International Fund for Agricultural Development), UNICEF (United Nations Children’s Fund), WFP (World Food Programme), and WHO (World Health Organization). 2020. The State of Food Security and Nutrition in the World 2020: Transforming Food Systems for Affordable Healthy Diets. Rome: FAO.

IFC (International Financial Corporation). 2018. “Food Fortification: Global Agribusiness.” IFC, Washington, DC.

IFC (International Finance Corporation). 2020. Food Safety Handbook: A Practical Guide for Building a Robust Food Safety Management System. Washington, DC: IFC

IFC (International Financial Corporation). 2021. “Promoting Positive Nutritional Impacts in IFC’s Agribusiness Projects.” IFC, Washington, DC.

Kent, George. 1994. “Children's Right to Adequate Nutrition.” Food and Nutrition Bulletin 15 (4 ). United Nations University, Tokyo.

(1) Food Systems Summit 2021, United Nations, New York, https://www.un.org/en/food-systems-summit; Second Global Summit on Food Fortification Series, Global Alliance for Improved Nutrition, Geneva, https://www.gainhealth.org/second-global-summit-food-fortification-series; Tokyo Nutrition for Growth Summit 2021, International Coalition for Advocacy on Nutrition, https://nutritionforgrowth.org/events/.