Guest blog post by Robert Baldwin with the Flour Fortification Initiative
In October I was in Albania on a joint mission between the Flour Fortification Initiative and UNICEF to advance flour fortification in that Balkan nation. Throughout the week, our team met in small groups with more than 35 decision and policy makers and policy shapers in the public, private and civic sectors. We were impressed with their willingness to work together to make it happen. The Ministry of Health, acknowledged by all as the entity to lead the effort, was confident that it could embrace and engage all other sectors in working together to achieve the goal.
Albanian leaders proved once before that they could work together to fortify a staple food when in 2008 they successfully undertook a salt iodization program. At week’s end our team was confident that these folks were on the right path toward fortifying flour. While there are a number of ways to decrease micronutrient deficiencies, the Albanians recognized that flour fortification is a cost efficient, technologically simple way to improve the nutrition status of a great number of people in a short timeframe.
Their commitment to work together to accomplish that goal shows that they understand micronutrient malnutrition is a multi-sector problem that demands a multi-sector response.
Oftentimes, when speaking to a group about micronutrient malnutrition, I ask the question “Do you think that micronutrient deficiencies are primarily a health sector problem?” Invariably, more than half respond with a “Yes” answer.
My response is that it is not exclusively a public health problem, but more of a societal problem. This issue of hidden hunger impacts almost all aspects of a society’s lifecycle:
- It impacts the education sector—the intellectual development of children is impaired, creativity is diminished, inventiveness is stifled.
- It affects the labor sector—nutritionally impoverished adults can’t perform at full capacity, lose time from the job, and thus are not a productive as they can be.
- It impacts the economic sector—lost productivity leads to lower wages which restrict purchasing power— these and other factors contribute to lowering a country’s GDP.
- It does affect the health sector by contributing to blindness, lowering immunity to disease, contributing to childhood morbidity and maternal mortality, increasing the incidence of debilitating birth defects, while contributing to the overall increased cost of health care.
If you buy the argument that this is a problem across society, then it is unreasonable to expect the health sector alone to deal with and solve the problem. The public health sector often provides the leadership necessary to alleviate the problem. Yet to effectively combat micronutrient malnutrition, it must muster the collaboration of other agencies within the public sector, as well as involving, from the start, the energies, experience and skills of the private and civic sectors.
This formula soon becomes apparent to those engaged in the effort to achieve national-scale flour fortification in a country. Collaboration among representatives from multiple sectors is not easy to accomplish at first and requires great effort on the part of all involved. Working together, however, they have greater strength than any one partner working alone.