September 29, 2015

29/09/2015: GAIN: The Arusha Statement on Food Fortification

The following statement was delivered by Her Excellency Tumusiime Rhoda Peace, Commissioner for Rural Economy and Agriculture, African Union on 11 September at the closing of the ♯FutureFortified Global Summit on Food Fortification in Arusha, Tanzania:

"I am pleased to make this Arusha Statement on Food Fortification on behalf of the Summit co-convenors in my capacity as a member of the board of directors of the Global Alliance for Improved Nutrition (GAIN).

"The first ever Summit on fortification was opened by the Prime Minister of the United Republic of Tanzania, the Rt Hon Mizengo Pinda, and addressed by HRH King Letsie III of the Kingdom of Lesotho, the African Union Nutrition Champion. 450 delegates from 57 countries attended, including 29 country delegations, as well as leaders from business, academia and international organisations.

"We took stock of global food fortification and assessed its role and potential in addressing public health goals, by tackling 'hidden hunger' or micronutrient deficiencies - which cause 10 percent of global disease, inhibit human development and perpetuate poverty and deprivation.

"Preventable deficiencies of critical vitamins and minerals such as Vitamin A, D, iron, iodine, folic acid and zinc contribute to up to 3m child deaths annually. The best available estimates are that 2 billion people are affected by micronutrient malnutrition, but the true burden is probably even greater, as we lack precise data. This has far-reaching effects on individuals and impedes the economic development of nations. GDP losses from undernutrition can be 2-3 percent per year.

"The central message of this Summit is that food fortification should become a critical pillar of national food and nutrition security plans. Unless we can rapidly scale up the availability and consumption of fortified foods in countries, the achievement of some Sustainable Development Goals (SDGs) will be impossible. Food fortification is a vital tool to make progress towards the World Health Assembly goal to reduce anaemia among women of reproductive age.

"In the words of HRH King Letsie III, the African Union Nutrition Champion, we need to put food fortification back on the development agenda.

"According to the Copenhagen Consensus, the return on investment of food fortification is one of the highest development dividends. For example, in the case of iodine, saving as much as US$30 in higher medical and non-medical expenditures for every US$1 spent. Salt iodisation costs pennies – US 20 cents per person per year. A rough estimate for low- and middle-income countries suggests the cost benefit of fortification is around 30:1.

"Progress has accelerated in the past decade. Today there are salt iodisation programs in approximately 140 countries worldwide, 83 countries have mandated at least one kind of cereal grain fortification, 20 countries edible oils, 9 countries sugar, and several others rice, milk, and condiments.

"But without further investment, we risk losing this momentum. We have the unprecedented opportunity to virtually eliminate iodine deficiency if we scale up salt iodisation efforts. Through effective fortification with iron of grains we can expect to achieve a 2.4 percent reduction per annum in anaemia. Fortification of wheat flour with folic acid in 18 countries in Africa and Asia could prevent over 50,000 debilitating neural tube defects annually. We cannot lose these opportunities.
Image: Rod Waddington
"Food systems and eating habits are changing rapidly due to urbanisation, changing climate, land and water use and a younger population. While food fortification alone cannot end malnutrition, it is critical to micronutrient deficiency prevention and control strategies, and is an underexploited public health tool.

"What are the critical areas for action highlighted at this Summit?

"First, modest but new investment is essential. Fortification is cost-effective and largely self-sustainable, costs are built into markets and typically do not require further or continuous public subsidy. Governments need to invest in technical support, oversight and compliance.

"The new investments are needed to build, improve and sustain fortification programs. They are small in relation to leveraged costs, cost per beneficiary and overall returns, and tiny as a proportion of health spending.

"For example, it was estimated that the additional donor costs over 15 years to build, improve and sustain fortification in 25 low- and middle-income countries for multiple food vehicles would be US$150m. This could effectively cover an additional billion people. Further investment in fortification would trigger significant co-investment by the private sector and motivate national governments to allocate resources.

"Second, there is need for a major effort to improve oversight and enforcement of food fortification standards and regulations. Poor compliance with laws and regulation limits potential for impact and undermines effectiveness. Available data show adequate compliance with standards as low as 50 percent in many contexts. Governments should improve their inspection and enforcement systems to ensure high quality fortification and a level playing field for the producers. Effective regulatory monitoring and enforcement will notably require more robust national budget allocations.

"Third, there is a need to generate more evidence to guide fortification policy and program design, to continually improve programmes and demonstrate impact. For example, there is a lack of detail of foods consumed by various target groups, limiting our understanding of potential food vehicles, use of fortified foods and quantification of the dietary gap we must address for some nutrients.

"Fourth, progress requires more transparent accountability and global reporting. We support the call for a global observatory or annual report of the state of fortification.

"Fifth, continuing advocacy is a high priority, and we will work together with stakeholders such as the SUN movement and African Union to advocate for greater attention by governments.

"Finally, we ask the Summit Technical Advisory Group to continue to work together post Summit, and to consolidate and elaborate these recommendations and chart a path forward by January 2016.

"Achievement of these recommendations needs to be underpinned by better leadership and accountability within the sector. Increased attention to policy support, quality control, monitoring compliance and assessing impact are needed to extend and maximise potential for health impact via food fortification.

"We leave Arusha with a determination to build a new movement, a future fortified with improved food and nutrition security. We have the tools, we need to finish the job started a hundred years ago and make the benefits of this simple and cost effective approach to an improved diet available to all."

Visit the GAIN website HERE.

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