corporAID: The current “Nutrition for Growth” campaign year as well as two major international nutrition summits in the second half of 2021 aim to draw attention to the problem of malnutrition. Is the problem being underestimated?
Blüthner: We need this year of action to draw attention to the central importance of nutrition in achieving the global goals for sustainable development. Poor nutrition remains the leading cause of nearly half of all child deaths worldwide, yet less than one percent of development cooperation is focused on nutrition. And we see worrying trends in donor engagement, even though the pandemic is undoing the successes of the past decade. So this year is crucial in order to generate a dynamic and to make concrete commitments to end hunger and malnutrition in all its forms by 2030. The UN Food Systems Summit in New York and the Nutrition for Growth Summit in Tokyo are two of the most significant events of the year because they bring together key players from all sectors.
What are the consequences of the pandemic?
Blüthner: The dietary effects are devastating, compounding deficits in health and food systems around the world. Vulnerable populations simply do not have the incomes and resources to eat healthily, let alone receive quality health care. There are already as many hungry and undernourished people as there have been for years - studies estimate that an additional 140 million people will live below the poverty line and 265 million people will experience acute food insecurity due to the pandemic if action is not taken quickly. In any case, a further dramatic increase in malnutrition is expected by 2022. An additional 168.000 children under the age of five will die, 9,3 million will be emaciated and 2,6 million will be underdeveloped. This has lifelong, cross-generational consequences. It has also been proven that there is a direct connection between diet and people's ability to survive infectious diseases such as Covid-19. So doing nothing is simply not an option.
You have been in the food sector for two decades. Have the challenges and solutions changed significantly during this time?
Blüthner: Well, one thing hasn't changed: nutrition remains one of the most powerful and cost-effective investments in human development. Over the past twenty years I have seen isolated approaches become real barriers to progress. We cannot afford to see nutrition as just a matter of health or the food system. We cannot neglect the role of social safety nets any more than the role of markets. In any case, our current food system fails to provide safe, nutritious and affordable food for people of all income levels, leading to micronutrient deficiencies and more. By coupling proven interventions such as food fortification with health system interventions, we can improve nutrition more holistically.
Is food fortification the big "quick fix" measure in the fight against malnutrition or does it also have its own challenges?
Blüthner: Food fortification is undoubtedly one of the best investments to make in micronutrient supply: on average, every dollar invested brings an average return of 27x in preventing disease and increasing income and labor productivity. With food fortification, a broad population can be supplied with essential micronutrients at low cost. It is also a unique intervention because it is a public health action carried out by the private sector. As long as there is supply and demand, the measure can be maintained and expanded. Although the benefits are high and the costs are low, there are still challenges. Today 80 countries enrich wheat, maize or rice, but only 26 percent of the wheat, 68 percent of the maize flour and less than one percent of the rice that is ground in industrialized plants are fortified. And only half of the standards meet the quality requirements of the WHO. At the national level, political responsibilities over nutrition are often fragmented and a third of low and middle income countries do not mandate large-scale fortification at all. So we still have a lot of work to do.
What approaches does the Gates Foundation use here?
Blüthner: In any case, we take a holistic approach and look at what it takes to provide people with both the high quality food and high quality health care they need. For example, we need to make sure that women receive multiple micronutrient supplements during pregnancy and that they also eat foods rich in iron and folic acid. It takes both approaches. As part of this broader consideration, our large-scale food fortification strategy for which I am responsible is aimed at ensuring that people of all income levels eat staples that are rich in vitamins and minerals. In rich countries it is often taken for granted that our salt is iodized or our milk is fortified with vitamin D, but in many low and middle income countries this is not the case.
What specific projects are you doing?
Blüthner: We address a number of challenges in enrichment - such as weak national standards, lack of compliance with standards, low technical capacities or significant data gaps. In India, for example, food fortification standards are voluntary. We are working with Indian authorities to strengthen standards and compliance, we are expanding programs to reach the most vulnerable populations, and we are taking care of the proliferation of double fortified salt and fortified rice. In Nigeria, Kenya and Tanzania we are again working with TechnoServe and Partners in Food Solutions to network African processors with international producers. The aim is to provide technical support to local companies in the production and sale of fortified foods in local markets. Whether it is putting in place quality assurance measures to ensure that the correct amounts of micronutrients are added to foods, or tools to ensure that the information is reported transparently, local manufacturers are happy about this technical support. Ultimately, however, it is the consumer who really benefits.
Where do you see the role of companies in the fight against malnutrition, especially in poorer countries?
Blüthner: Progress cannot be made without the full commitment of the private sector. In recent years, the role and responsibility of the private sector in producing safe, affordable and nutritious food has also been increasingly recognized - but it needs to be a collaborative effort through cross-sectoral partnerships. The private sector is needed to meet public health goals, and the public sector can provide the right frameworks and incentives for inclusive food systems that meet the nutritional needs of consumers. Cross-sectoral, complementary partnerships enable food manufacturers to be part of a systemic innovation that sustainably improves the nutrition of entire population groups.
Many thanks for the interview!
TO PERSON: Dr. Andreas Blüthner is Director of Nutrition at Bill & Melinda Gates Foundation. He is currently leading the revision of the foundation's nutrition strategy, which focuses on innovation, private sector involvement and large-scale food fortification. Blüthner previously worked as Director of Food Fortification & Partnerships for chemical company and micronutrient manufacturer BASF SE. The nutrition expert has also worked for the United Nations, the German government and the Global Alliance for Improved Nutrition GAIN.