CS122586

1. FFI Global Update CS122586

2. What is Flour Fortification? Fortification is adding vitamins and minerals to flour during the milling process so that staple foods are more nutritious. Modern mill with three feeder lines

3. 120% 100% Thiamin 80% Riboflavin Vit. B6 60% Folate Iron 40% Niacin 20% 0% Wholemeal Normal white flour Essential Nutrients Wheat and maize lose much of their nutrients in the milling process. Fortification replaces those and can add other vitamins and minerals as needed. Nutrient Retention

4. Burden of Deficiencies Vitamin and Mineral Deficiencies: • Impair millions of growing minds and lowers national IQ • Cause damage to immune systems and deaths of more than a million children a year • Cause 300,000 serious birth defects annually • Contribute to the death of approximately 60,000 young women a year during pregnancy and childbirth Micronutrient Initiative, UNICEF, and March of Dimes

5. Burden of Iron Deficiency • Leading cause of anemia which: • Reduces work capacity • Impairs a child’s physical and intellectual development • Contributes to 20% of all maternal deaths • World Health Organization: http://www.who.int/nutrition/topics/ida/en/index.html

6. Economic Burden of Anemia • 17% lower productivity in heavy manual labor • 5% lower productivity in other manual labor • Estimated 4% loss of earnings due to lower cognitive skills. The Economics of Food Fortification (2006) by Sue Horton

7. Burden of Folic Acid Deficiency • Leads to neural tube defects (NTDs) such as spina bifida and anencephaly. • 50% to 70% of these birth defects are preventable. Spina bifida is malformation of the baby’s spine. It causes permanent disability. Anencephaly is malformation of the baby’s brain. It is always fatal. • Centers for Disease Control and Prevention: http://www.cdc.gov/ncbddd/folicacid/faqs.html

8. 15.8 17.0 14.1 9.7 8.6 10.1 9.8 6.3 Birth Defect Reduction 18 16 14 -37% - 46% - 35% - 41% - 31% 12 10.8 Neural tube birth defects per 10,000 live births 10 8 6.6 6 4 2 0 USA Canada 1998 Costa Rica 1998 Chile 1998 South Africa 2000 2003 Before fortification After fortification • Centers for Disease Control and Prevention , “Folic Acid in the Prevention of Birth Defects” • Public Health Grand Rounds, February 18, 2010

9. Savings From Preventing Spina Bifida Chile United States South Africa • Economic Burden of neural Tube Defects and Impact of Prevention With Folic Acid: A Literature Review • European Journal of Pediatrics published online 19 May 2011

10. FFI Network FFI is network of partners working together to make flour fortification standard milling practice so that people worldwide are smarter, stronger and healthier.

11. FFI Stimulates Network Interaction Disability groups, advocacy associations, other civil organizations Civic Sector FFI Agencies of the United Nations, government agencies and other national entities, non-government organizations, academic organizations Millers, equipment and flour-product companies, wheat traders and baking organizations, other affiliated businesses Private Sector Public Sector

12. Flour Fortification Status June 2011: Fortifying with at least iron and/or folic acid

13. Flour Fortification Progress Since 2004: • Nearly 2 billion people now have potential access to fortified flour - 858 million more than in 2004. • Growth in fortified flour from roller mills increased from 18% to 30% • The number of countries with documented national regulations for mandatory wheat flour fortification increased from 33 to 60.

14. Oil Sprinkles Wheat & Corn Rice Supplements Condiments Multi-faceted Approach PopulationWith Market Access PopulationWithout Market Access

15. Impact on Nutrition Security As food prices go up, consumers often stop buying as many meats, fruits and vegetables Fortifying flour puts more vitamins and minerals in staple foods which people continue to purchase and consume during economic downturns.

16. Cost to Fortify Recurring costs of buying quality premix ranges from US$2 to US$3 for iron, folic acid, and other B vitamins. The per person, per year cost to fortify wheat flour may be as little as eight to ten cents. One metric tonne of flour is about 2,200 pounds, as pictured here.

17. Nutrition interventions are five of the top 10 most cost effective means to address global challenges, according to the 2008 Copenhagen Consensus

18. Flour fortification is most successful when it is driven by national leaders. Multiple sectors must work together. Success of flour fortification in one country can have an accelerating influence in the region. A national standard approach is the most effective way forward. Reaching the top decision makers is essential. Focus On National Partnerships

19. FFI Strategies STRATEGY 1. Catalyse, support and sustain the operation of national partnerships STRATEGY 2. Create and disseminate communication & training and technical support materials in key areas STRATEGY 3. Through the Leaders’ Group ensure that organizations are enabled to work together STRATEGY 4. Secure adequate human and financial resources at national and global levels both for national activities and for the network in total. STRATEGY 5. Monitor all national fortification programmes.