By Anna Verster with Smarter Futures and the Flour Fortification Initiative
In the village in Tanzania where I lived, people grew their own maize and relied on the village mill to make that into flour. Maize flour porridge was the main staple and women went to great length to make sure they offered their families the best. Before taking the maize grain to the mill, it had to be cleaned, thoroughly washed and dried. At the mill, the maize was de-hulled and then ground into beautiful, white flour, pictured here, perfect to make delicious “ugali,” a stiff porridge. Unfortunately, the process of making the beautiful white flour for ugali removed important vitamins from the maize grain.
Preferably ugali was eaten with a spicy relish of meat, onions and tomatoes or with a delicious sauce of groundnuts and cassava leaves or spinach. These provided essential nutrients, but as life became harder and food more expensive, the size of the relish portion dwindled and meat was rarely found. People could still fill their stomach with ugali - they were food secure - but the nutritional value of their diet had dramatically deteriorated.
This is an example of how it is quite possible to go to bed with a full stomach and wake up the next day without the energy to perform manual labour or concentrate in school due to iron deficiency. Children can eat until they are content but not get enough zinc to reduce their bouts with diarrhoea, and they may not get enough vitamin A to prevent blindness. A woman can be completely satisfied at every meal and still not consume enough folic acid to prevent certain birth defects like spina bifida.
It is regretful that food security has been a recurring issue during the 40 years I have worked in public health, and it is equally regretful that this issue is not balanced with attention to nutrition. Food security should always be paired with nutrition security.
These issues are not limited to people in developing countries. Consumers facing economic struggles in any part of the world are less likely to buy the more costly, more nutritious fresh fruits, vegetables and meat. Consequently, basic food items such as wheat and maize flours, rice, salt, edible oils, sugar, and milk need to be fortified to deliver all the nutrients possible.
My work now is focused on efforts to fortify wheat and maize flour, which is most commonly fortified with iron, zinc, folic acid, and other B vitamins. Foods made with flour are consumed throughout the world in bread, pasta, tortillas, porridge, and noodles. When vitamins and minerals are added to the flour, these foods become vehicles for essential nutrients. Vitamin A is often added to oils or sugar and Vitamin D is more common in milk, but these vitamins can be added to flour as well. Iodine is routinely added to salt. Fortifying these staple foods and condiments enhances nutrition security for all consumers.
Three steps the nutrition community could take toward nutrition security are:
- Review and seek improvement in the nutritional quality of commodities provided to people in a food crisis
- Help countries determine their food consumption patterns to identify which commonly consumed foods are most practical to fortify in that setting
- Assist government leaders in setting appropriate fortification standards to maximize the health impact
Floods, fires and famine, along with wars and inflation, drive the concern about whether people will have enough to eat. This is a valid fear, and certainly the global community must work together to create food security for all people. While we work on agriculture practices, food distribution patterns, and economic policies to improve food security, we must remember that having enough food to eat is only part of the problem. We must also improve the nutritional quality of the available food. Our world is too rich in combined resources to allow nutrition insecurity to continue.
Anna Verster is a senior advisor to Smarter Futures, a collaborative effort focused on fortifying flour in Africa, and the Flour Fortification Initiative, a network of public, private and civic sector network working together to make flour fortification standard milling practice globally. She is retired from the World Health Organization where she worked primarily in the Eastern Mediterranean Region and in East Africa.