Ending Hidden Hunger through Food Fortification:A Challenge to the Grain Industry

Remarks by Mr. Kul C. Gautam
Deputy Executive Director
United Nations Children’s Fund (UNICEF)
At the IGC Grain Conference 2003; London, UK
25 June 2003

It is a great privilege for me as a representative of the United Nations to address this distinguished gathering of the International Grains Council.

At first, it might seem odd, why a UN official – especially a representative of UNICEF, the United Nations Children’s Fund – should be addressing this gathering of leaders of the world’s major grain producers, millers, exporters and importers, and Ministers of Agriculture and Trade.

You may be asking yourselves, “What do we have in common?”

One area we have in common, and for which I want to express our gratitude to the IGC, is the excellent work of your Food Aid Committee, which oversees food aid to developing countries. We are delighted that you direct much of this aid for the alleviation of poverty and hunger among the most vulnerable groups, especially in response to humanitarian emergencies.

But I am here today to explore and make the case with you that the United Nations and the organisations represented in the IGC have a great deal more in common.

In fact, I am here to try to convince you that if we combine our efforts and energy, we can make some extraordinary impact in the global fight against poverty, illiteracy, diseases and malnutrition in ways that few of us have imagined possible.

Today, the grain industry delivers more food to more people in more parts of the world than ever before.

However, while the foodstuff you supply – cereal grains, flour and other commodities – contribute greatly to reducing hunger, all of our collective efforts so far are grossly inadequate in protecting women and children from the “hidden hunger” of deficit in key vitamins and minerals or micronutrients.

The “hidden hunger” manifests itself in the deficiency of such micronutrients as iodine, iron, folic acid, vitamin A and zinc in the diets of millions of people.  The World Health Organization estimates that at least 1 in 5 people in the world suffer from such micronutrient deficiencies.

The most prevalent of these deficiencies is that of iron which leads to anaemia, particularly in developing countries, where half of all young children and women are anaemic.

The “hidden hunger” due to micronutrient deficiency does not produce hunger as we know it. You may not feel it in the belly, but it strikes at the core of your health and vitality. It is especially damaging to human brain, learning ability and productivity.

Unfortunately, the “hidden hunger” remains widespread, posing devastating threats to health, education, economic growth and indeed, to human dignity, in developing countries.

It is scientifically known today that very small quantities of vitamins and minerals – such as iodine, vitamin A, iron, folic acid and zinc – added to people’s daily diet can make a huge difference in human health, learning abilities and productive capacities.

Because the quantities needed are so small – these are called micronutrients.  But let the name micro not mislead us as to their great impact, for they are indeed worthy of being called the “super” nutrients.

I am here today to urge you – to appeal to you – leaders of the grain industry, to join us in ending this “hidden hunger,” or micronutrient deficiency, by fortifying cereal flours with the super-nutrients of essential vitamins and minerals and to provide a powerful impetus for global progress and prosperity.

As you know, well-nourished people are not only healthier and intelligent, they can also perform better in school and workplaces, which enables them to be more productive and creative, thus contributing to the wealth and well-being of their countries and the world.

We know more than 2 billion people in the world today suffer from vitamin and mineral deficiencies, most of them in developing countries.

We also know today that micronutrient deficiencies are subtle and insidious.  They can cause blindness and brain damage. They can induce stillbirths and abortions. They make people fatigued and lethargic.

They can make ordinary childhood diseases such as diarrhoea, malaria and measles fatal. They contribute to the high rates of maternal and child deaths.

Micronutrient deficiencies render investment in education less effective as children are unable to concentrate in their studies.

To further compound this human suffering, the economic losses attributable to micronutrient deficiencies are huge – up to 5% of the GDP of many countries.

The enormous impact of micronutrient deficiency is largely invisible.  Silently, micronutrient deficiencies trap people, communities and entire countries in a cycle of poor health, poor educability, poor productivity and consequent poverty, often without the victims ever knowing the cause.

According to WHO, iron deficiency is among the top ten contributors to the global burden of disease, constituting a threat as great as many notorious infectious diseases.

Iron deficiency anaemia is one of the major causes for lost productivity in adults and lost learning ability in children. As a result it accounts for a very high loss in gross national income in severely affected countries.

In a large country like India iron deficiency contributes to the loss of an estimated 4 billion workdays per year.

In my native country Nepal, where the prevalence of iron deficiency among women is over 50 percent, the gross national income loss is about 12%.

Because iron deficiency affects all age groups and both sexes, eliminating it can do more than any other single programme to achieve human development goals.

Nearly half a million children are born every year with severe birth defects. 75% of these birth defects are preventable by providing folic acid to mothers through fortification of cereal flours.

We have seen dramatic evidence of this effect in the USA and Canada which mandated folic acid fortification in the mid to late 1990s.

In less than a decade following folic acid fortification, birth defects in USA and Canada have gone down sharply by more than one-third.

Such dramatic evidence provides us not only a health and economic justification, but a moral imperative for action.

And you, members of the IGC can play a leadership role in ending this tragic hidden hunger and ushering in global prosperity.

Let me try to outline how it would be possible for organisations like IGC, the United Nations and other partners to make a significant impact in combating this pervasive “hidden hunger”.

Let us recall that over the past half a century, fortification of flour and other cereals has played a major role in delivering essential vitamins and minerals to consumers in the industrialized countries.  This has helped eliminate iron, folic acid and other nutritional deficiencies and contributed immensely to improving health and reducing diseases and mortality in those countries.

As food producers, millers, traders and policy makers, you can help improve the learning ability, productivity and prosperity of millions of consumers around the world, especially in developing countries, by supporting the fortification of cereal flours with essential micronutrients.

Flour is a food staple in more than 180 countries. The good news is that already, millers in about 30 countries fortify their flour with one or more of these essential vitamins and minerals.

The time has come now to support and expand flour fortification with essential micronutrients globally through a strong collaboration between the grain and flour industry, governments, UN agencies and other partners.

The benefit of expanding flour fortification worldwide is clear.  The technology is simple.  It costs only 50 cents to fortify one metric ton of cereal or flour.  So the cost per person per annum is only a few pennies.

I would like to share with you 2 exciting examples of great progress in combating hidden hunger to inspire us to take bold action.  In 1990 a World Summit for Children held at the United Nations set some ambitious goals to reduce iodine, Vitamin A and iron deficiencies.

Great progress was made in the past decade in combating IDD and Vitamin A. But alas, progress in reducing iron deficiency anaemia has been disappointing.

This is where you can come to the rescue.

Here is an enormous success story in combating IDD through salt iodization.

Fifteen years ago, less than 20 per cent of the world’s salt was iodized.  Working with the salt industry, governments, a businessmen’s service organization, the Kiwanis, and others, we have brought iodized salt to 70 per cent of the people in the world, protecting over 90 million newborns every year from significant loss in learning ability, mental retardation and cretinism.

We’re now going after the final 30 per cent.  Having already reached nearly 2 billion additional people in the last decade, your fellow industrialists – the salt producers – are now running the last stretch to reach an additional 1.5 billion people.

Likewise, the sugar industry has been a great partner in fortifying sugar with Vitamin A to combat that debilitating deficiency.

As you may know, Vitamin A is essential for the functioning of the immune system, and children deficient in vitamin A face a 25 per cent greater risk of dying from measles, malaria or diarrhoea and are susceptible to becoming blind and malnourished.

UNICEF estimates that thanks to a massive programme of vitamin A supplementation in the past few years, nearly half a million child deaths are now averted every year, and the health and nutrition of millions of children has been improved.

Inspired by these achievements, world leaders gathered at the United Nations General Assembly Special Session on Children last year set a number of goals aimed at creating a world fit for children – to give each child, everywhere, the best possible start in life.

Micronutrient deficiencies were very much on the minds of these leaders.

They set targets – for eliminating iodine deficiency disorders by 2005; vitamin A deficiency by 2010; reducing anaemia, including iron deficiency, by a third by 2010; and speeding up progress towards reduction of other micronutrient deficiencies.

An important strategy proposed for achieving these goals is food fortification.

Ladies and gentlemen, this is where you come in.

If these goals are to be achieved, we need a grand alliance of partners.  The International Grains Council and your member organizations and fellow industries can make a huge difference in achieving especially the goal of reducing iron and folic acid deficiencies on a massive scale.

Indeed those issues on which we have made the greatest progress in the last decade have been the ones in which public-private partnership has been particularly strong and imaginative.

What, specifically, do we want the grain and milling industry to do?

We would urge the grain industry to become an active partner in making flour fortification with iron and folic acid a reality in developing countries.

We would like to see fortification becoming a norm in all existing large and medium mills.  We would ask you to dramatically expand the production of fortified flours and cereals.

We want you to share your technical expertise and help transfer technology to the developing world.  We would like to see your production, distribution and marketing skills applied to make flour and cereals fortified with iron and folic acid to be made widely available to deficient population in developing countries.

Through your Food Aid Committee I believe you can also influence the decisions of donor countries to provide fortified cereal flours or support the fortification of the grains that they donate in the recipient countries.

We are not asking you to do this alone.  UN organizations like UNICEF, WHO, FAO, WFP, UNDP, the World Bank and regional development banks would be happy to partner with you.

Non-governmental organizations such as the Micronutrient Initiative (MI) and the Global Alliance for Improved Nutrition (GAIN) and a number of university-based institutions that are present at this meeting are eager to work you.

We have strong commitment of major bilateral donors such as the Canadian CIDA, the US AID and CDC and others who are with us today and are willing to be your partners in this effort.

These organizations and agencies can bring a high degree of credibility, legitimacy and visibility to our partnership with the grain industry in the eyes of national governments.

We would be happy to bring our comparative advantage in terms of policy advocacy, technical assistance to governments, creation of demand for consumption of nutritionally fortified foods by consumers, monitoring and evaluation and positive regulatory frameworks in support of this partnership.

We are excited about this potential partnership with you.

We believe that now, as the milling industry modernizes and consolidates, as technology exchange and transfer proliferates, as changing food consumption patterns give more people access to centrally processed foods, the time has never been more right for an initiative aimed at fortifying all flour with essential micronutrients, especially iron and folic acid.

I believe this can be a “win-win” proposition.  For the UN, it enables us to reach those who need help in achieving internationally agreed development goals.  For you, it helps to enhance your products in the market place and your image as good global corporate citizens. And it will help governments, which have the mandate to improve the lives of their peoples.

During this decade we would like to see the benefits of cereal flour fortification expanded from a few countries to the whole world.

To achieve this lofty goal, governments will need to adopt supportive policies, legislation and regulatory practices. And the grain trade and milling industry will need to adopt fortification as a global norm.

Right now, only about 80 million metric tons out of the 400 million tons of wheat consumed around the world each year are fortified with any micronutrients. I hope we can discuss together how we can change that.

I understand that we will start that process tomorrow, with a half-day forum on the Flour Fortification Initiative, organized by the Australian Wheat Board, U.S. Wheat Associates, American Ingredients Company and the Wheat Foods Council and joined by several of us from the UN, donor agencies and our non-governmental partners.

Dear friends, with your help, I believe we can achieve great progress in ending hidden hunger through food fortification, without draining the development budgets of developing countries or their donor partners.

Yes, there maybe some small additional cost to you the producers and to consumers of your products. But these can be readily offset by the huge gains in people’s health, nutrition and productivity.

As we have seen in the case of salt and sugar industries, this can be done without endangering the profit margins of private companies operating in the food sectors and without over-burdening the consumers.

Together, we have the power to advocate globally for food fortification if we work with governments, industry and other stakeholders to place fortification high on the political agenda of nations.

What is needed is extensive cooperation and commitment to make this happen, combining the strengths of donors with recipients, private sector with the public, governments and nongovernmental organizations.

I believe that such a partnership will benefit the private sector not just to improve its performance in the marketplace, but also to show that the private sector has social as well as economic interests.

We at the United Nations believe that no single agency or organization, or indeed the marketplace alone, can solve the problems of hunger, ill health and poverty that beset large parts of the world today.

It is to address such issues that the Secretary-General of the United Nations, Mr. Kofi Annan, has launched a Global Compact that fosters partnership among public and private sector organizations and the United Nations to promote world peace, development and protection of human rights.

We invite you to join this Global Compact which I believe is fully consistent with the sense of corporate social responsibility that exists at your conference today.

Indeed, food fortification can make an important contribution to a set of broader goals for humanity adopted at the Millennium Summit of world leaders at the United Nations in 2000.

The Millennium Development Goals aim to achieve significant, measurable improvements in people’s lives, including halving poverty, ensuring that all girls and boys complete a full course of primary schooling, reducing maternal and child mortality and preventing and reversing the spread of HIV/AIDS, among others.

Your conference is about rising to the challenge of meeting consumer needs.

Ending micronutrient malnutrition would truly meet consumer needs for health, well-being and prosperity.

I would urge IGC to review progress towards flour fortification by your member organizations a regular item in your annual conference.  This would be a small gesture by you, which could produce huge benefits for the well-being of the world’s children.  We would be happy to collaborate with you in monitoring progress.

I hope every one of you will join us in this greatest challenge confronting humanity today – the fight against poverty, illiteracy, ill health and malnutrition – so essential to create a world fit for our children.

Thank you.