Meeting on Regulatory Monitoring of Salt and Flour Fortification Programmes in Asia
Dr Shin Young-soo
World Health Organization Regional Director for the Western Pacific
Distinguished participants, colleagues, ladies and gentlemen.
It is a pleasure to host this meeting on Regulatory Monitoring of Salt and Flour Fortification Programmes in Asia.
I am especially pleased by our strong partnerships with the organizations whose collaboration, hard work and support have made this meeting possible.
In particular, I would like to thank UNICEF, the Flour Fortification Initiative, the Global Alliance for Improved Nutrition — or GAIN, the Micronutrient Initiative and the World Bank for helping plan and fund this meeting.
I am honoured to make these opening remarks on behalf of all our partners.
Today marks the second major event focused on Nutrition this year, in South-East Asia and the Western Pacific, following the Biregional Meeting on Scaling-up Nutrition held in Sri Lanka in August.
As you all know, fortification of staple foods is a highly effective way of improving nutritional status and public health because it does not require people to change their eating habits.
By adding micronutrients to staple foods¸ we can help to achieve United Nations Millennium Development Goals — in particular MDGs 1 through 6.
Micronutrients make a macro impact on development.
More than being effective, micronutrient supplementation and fortification have proven to be among the most cost-effective ways to reduce malnutrition and the resulting health and development issues it creates.
The Copenhagen Consensus is a group of leading economists, including five Nobel laureates, who analysed solutions to global problems on a cost versus benefit basis.
The group concluded in 2008 that two of the three most cost-effective solutions to global problems involved adding micronutrients to food.
Micronutrient supplementation for children — specifically Vitamin A and zinc — was rated Number 1, while iron and salt iodization was judged the third-most cost-effective way to attack malnutrition.
The conclusions of these top economists serve to provide further support to work that WHO and UNICEF have supported for decades and that was started as far back as 100 years ago.
The success of salt iodization programmes is perhaps the best example of the great strides possible when the food industry works with government to improve public health.
In 1990 the United Nations World Summit for Children set the goal of virtual elimination of iodine deficiency disorders — or IDD.
At that time, IDD affected more than 2 billion people all over the world.
IDD hurts children's ability to learn and negatively affects workers' productivity.
Indeed, IDD can retard development in a country.
Thanks to a worldwide effort, the proportion of people consuming iodized salt increased from about 20% in 1990 to about 70% by 2000.
This represents an increase of 350% over 10 years.
But even in many countries where salt is iodized, often not enough iodine is used to erase the threat of iodine deficiency for consumers.
These are important concerns to address now, as more than 120 countries are putting salt iodization programmes into effect.
Another 34 countries have already eliminated iodine deficiency with such programmes.
The key has been strong partnerships.
Former United Nations Secretary-General Kofi Annan singled out the universal salt iodization and iodine deficiency disorders work as a model public-private partnership for development.
Two regions in particular — Latin America and the Caribbean, and East Asia and the Pacific — are now close to achieving the goal of 90% of households consuming adequately iodized salt.
This achievement is one of many to celebrate in the Western Pacific Region, even as success has been more elusive in South Asia.
We face similar challenges with iron fortification programmes in the Region. About 2 billion people globally suffer from iron deficiency.
More than half of them live in South Asia.
Experts from WHO, the World Bank and Harvard University concur that iron deficiency costs countries more than any other disease, except tuberculosis.
Anaemia and even mild to moderate iron deficiency can hamper the work performance of people of all ages.
The condition can cripple children's ability to learn and grow, as well as their ability to fight off infections and other illnesses.
While rice is the main staple food in Asia, wheat has proven easier to use in large-scale fortification programmes because most countries, including the Philippines, have large modern wheat mills that can supply entire markets with high-quality fortified flour.
Iron fortification is especially important for pregnant women, nearly half of whom globally suffer from anaemia, considered responsible for 20% of maternal mortality.
In fact, adding multiple vitamins and minerals — including folic acid and iron — to the more than 400 million tons of wheat consumed globally each year would substantially improve health and nutrition overall, and help reduce birth defects.
But for these programmes to continue to steadily contribute to achieving the health-related MDGs, we must have strong and efficient regulatory systems in place to make certain that fortified foods meet nutritional, quality and safety standards.
The WHO and FAO Guidelines on Food Fortification with Micronutrients provide a model for monitoring and evaluating fortification programmes.
Even with clear guidelines, however, weaknesses in the regulatory monitoring systems can threaten to undermine the successes in the Region.
Specifically, health officials in some countries hesitate to start mandatory wheat flour fortification programmes because of concerns about their capacity to implement and monitor them.
Another concern with salt fortification programmes is overall salt consumption.
Iodized salt does not mean increasing total salt consumption.
High intake of salt is a major risk factor for high blood pressure and related noncommunicable diseases, such as stroke and cardiovascular diseases.
Estimates of salt consumption in the Western Pacific Region show it is much higher than the recommended limits and is increasing in some countries.
WHO encourages closely coordinating salt reduction strategies with salt fortification programmes to ensure good iodine levels while reducing the risk of hypertension and related diseases.
Precisely to help countries work through issues to build such programmes is the reason that so many partners — WHO, UNICEF, FFI, GAIN, the Micronutrient Initiative and the World Bank — have come together to organize this Meeting on Regulatory Monitoring of Salt and Flour Fortification Programmes in Asia.
In addition, we have invited representatives from various government sectors, as well as the salt and wheat flour industries, to bring together all the points of view and experience necessary to conduct successful national fortification programmes.
This mix of partners from all sides of the issue — from the public and private sectors, governments, scientific institutions, national and international nongovernmental organizations, millers and more —is our greatest strength:
a good partnership is much more than the sum of its parts,
a good partnership produces real and workable solutions.
With that spirit and conviction, I welcome you to Manila and wish you success in your deliberations.
I look forward to reviewing your conclusions and recommendations.
But most of all, I look forward to hearing your solutions.