Flour fortification - still a long way to go

by Emily Buckley
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Flour Fortification — still a long way to go

Regional approaches to technical, financial and social challenges are the way forward for the global expansion of flour fortification programs

Fortifying flour with vitamins and minerals has the potential to prevent many crippling illnesses and improve the health and well being of millions of people worldwide, but there are technical, commercial and cultural issues that have to be solved if the project is to succeed.

Another step by the Flour Fortification Initiative to expand the practice to many more countries was reached at the International Grain Industry Forum in London, which brought together representatives from the world’s grain and flour industries, public health and development organizations such as the United Nation’s Children’s Fund, World Food Program, World Health Organization and the U.S. Centers for Disease Control.

The forum was held to coincide with the International Grain Council’s annual conference, when many representatives of the world’s grain trade were already in London. Two papers at the IGC conference, from Philip Purnama of Bogasari Flour Mills in Indonesia and Kul C. Gautam, deputy executive director of UNICEF, were devoted to flour fortification, while the concept was firmly backed by speakers from the Australian and Canadian Wheat Boards.

Opening the forum, Andrew Lindberg, managing director and chief executive officer of the Australian Wheat Board, said, "The challenge (for the forum) is to see what we can do as an industry to really help in a tangible way to improve the health of millions of people."

The concept of flour fortification has been known for about 70 years and has been in operation in a number of countries for the last 40 years. The most widely used additives are iron and folic acid.

Folic acid reduces the death rate of women in childbirth and the number of spina bifida birth defects. There is also evidence that it may help to pre-vent some types of heart disease and colon cancer.

Iron prevents anemia, which is estimated to reduce productivity in workers and the earnings capacity by 5%.

Many countries also add other vitamins and minerals, including zinc, thiamin, riboflavin, niacin, vitamins A, D, B6 and B12, calcium and selenium. They are added as a premix towards the end of the milling process. The aim is to replace and enhance the nutrients stripped out of grain in the milling process.

At present, only 48 countries out of a total of 189 where annual per capita flour consumption exceeds 20 kg have voluntary or mandatory fortification schemes. These include the U.S., Canada, most of Latin America, Australia, New Zealand, most of the Caribbean, South Africa and Indonesia. Yet these only account for about 17% of all wheat flour consumed.

The aim of the Flour Fortification Initiative is to extend the practice to many more countries. Although most fortified flour is wheat, some maize flour is also used, particularly in South Africa.

The flour project is using as an example the Universal Salt Iodization initiative, which was adopted in 1993 and has resulted in 75% of the world’s salt being iodized.

An enthusiastic supporter of the concept is Indonesia, which began fortifying flour in 1998. In his presentations at the IGC conference and at the Grain Industry Forum, Philip Purnama, chief commercial officer of Bogasari Flour Mills, said that with a population of 220 million and a per capita GDP below U.S.$3,000, Indonesia faced a significant "hidden hunger" problem and flour had been selected as a cost-effective vehicle to remedy this.

It was relatively easy to implement because the country is supplied by a small number of very large mills, Purnama said. The cost is relatively low at U.S.$0.15/kg of flour, making an overall annual cost of U.S.$5 million.

However, he pointed out that there is still a lot to do in terms of creating awareness levels among consumers and improving the techniques in the milling process. An international program would need a complex coalition of government and international agencies and grain and milling industries, he said.

Other speakers at the forum pointed out that there were a number of technical difficulties in adding micronutrients to the flour. Some iron supplements for instance create problems with flour magnets, and it is essential that the micronutrient mixes do not affect the color or taste of the flour.

In South Africa, for instance, problems have surfaced with the color of white maize flour. There also are problems with the formulation of micronutrients where the bioavailability of the various minerals and vitamins vary widely on analysis.

The financial considerations are also considerable, with costs of the pre-mix estimated to range from $0.33 to $2.35 per tonne of wheat excluding all overheads. It was pointed out that this in fact represented a significant amount against the often wafer-thin margins in the milling industry. Speakers said there was a need in most cases for a joint public/private initiative to fund the cost of fortification.

But the strongest message from the forum was the importance of perception and social and cultural acceptability. Otherwise, flour fortification could suffer the same problems as genetically modified crops.

Food is always an emotive issue and people are now very suspicious of what scientists say, the speakers noted. When flour fortification was first introduced in South Africa, many people thought the additives would affect their fertility. The speakers said it was vital to treat each country individually and even regions within countries where cultures were different.

"What works in one part of the world doesn’t necessarily work in another, and we may have to look at the issues on a regional basis," said forum facilitator, Peter Hindley of Fleischman-Hillard Inc.