Over the past several decades, micronutrients have never received the same media attention as other global health issues such as HIV/AIDs control or malaria. Yet despite their lack of fame, research in the field has proven repeatedly and consistently that micronutrients contain vital health benefits.
Relatively diverse diets in developing countries allow many individuals to take receiving micronutrients for granted. Yet they have vital implications for health, particularly Vitamin A and zinc. Vitamin A deficiencies can result in visual impairment or blindness, as well as a weakened immune system. Studies are also investigating the link between vitamin A and reduced mother-to-child transmission of HIV. In the past decade, studies on zinc have indicated that its absence is related to stunting, which is a widespread problem in many developing countries. Zinc could also play a role in pneumonia prevention, and is recommended by the WHO and UNICEF as recommended treatment for acute diarrhea. The importance of these benefits should not be underestimated: combined, diarrhea and pneumonia are the leading causes of mortality in children under five.
Estimates from the World Health Organization (WHO) and the World Food Programme surmise that approximately 2 billion people globally do not receive sufficient levels of micronutrients such as vitamin A and zinc. This is particularly true in resource-strapped regions. Nutrient-rich foods tend to be expensive and are not contained in the foods that poor people habitually purchase. In western India, researchers found that 40% of extra income was spent on wheat, rice and sugar – foods sorely lacking in micronutrients.
Supplementation initiatives for micronutrients, however, are extremely cost-effective. In terms of cost per person, vitamin A and zinc supplementation total approximately $1.20/child/year and $1.00/child/year, respectively. Benefit:cost ratios are estimated at approximately 17:1 for Vitamin A and 13.7:1 for zinc. These benefits consider generally improved health status, increased learning ability for children, better worker productivity, and decreased strain on healthcare systems.
Despite evidence of the cost-effectiveness and substantial benefits of micronutrients, the international community largely ignored this solution for decades, compared to the attention other global health initiatives received. It was not until the Copenhagen Consensus of 2008 that the issue of micronutrients was finally positioned as a priority for field workers and policymakers alike.
A sort of Olympics for the world’s leading economists, the Copenhagen Consensus occurs every four years and creates a list of ranked solutions for global development. In 2008, competition was fierce, with economists advocating for issues ranging from vaccines for children to improved education to the development of low-carbon energy. In the end, malnutrition issues accounted for five of the top ten solutions, and , micronutrients supplements of vitamin A and zinc for children took the top spot.
So what is being done about it? For starters, several global supplementation and food fortification programs are gaining momentum. Funded by the Gates Foundation, the Orange Sweet Potato initiative is one example. Already on the ground in Uganda and Mozambique, the project aims to convince farmers to replace the traditional white sweet potato, which is relatively nutrient deficient, with the orange-fleshed variety, which is packed full of vitamin A. Results so far are promising. A survey of over 24,000 households in rural Africa found that families that switched to the more colorful potato more than doubled their intake of vitamin A.
Globally, many clinics such as the Santa Cruz Health Centre in Guatemala have now trained their staff on the benefits of zinc supplementation, and distribute supplements along with oral rehydration salt to treat diarrhea. With the aid of local government and international NGOs such as the Ottawa-based Micronutrients Initiative (MI), communications materials are distributed, and public health professionals talk to patients about the benefits of zinc while they are waiting to see a doctor. Three years after zinc supplementation was introduced to the Santa Cruz clinic, MI has reported high rates of adherence to zinc supplements among clinic patients, and the initial pilot project is considered a success.
Both the sweet potato project and zinc supplementation at local health clinics demonstrate that small-scale, locale success is possible. In order to create a more significant and lasting impact across the developing world, however, scale-up of these projects is required.
The three greatest challenges facing effective program scale-up are sustainability, finding funding sources, and mobilizing local leadership. Providing one-time supplements to families is difficult to sustain, given that health workers have to repeatedly replenish this supply. The orange sweet potato project is particularly salient in this regard as it allows farmers to create their own micronutrients. Secondly, funding, as always, presents a significant obstacle. So far, financial contributions have come from foundations, NGOs, private industry and governments, yet it is not enough. Despite the demonstrated cost-effectiveness of micronutrient initiatives, Bangladesh is the only country to have successfully implemented a national scale-up of zinc supplementation. Finally, for these initiatives to be successful, there also needs to be local leadership that encourages long-term behavioral shifts towards foods that contain vital micronutrients.
As 2012 approaches, so does the next round of the Copenhagen Consensus, and along with it, a new batch of global health solutions eager to grab the spotlight. In an area such as global health, where there is abundance of initiatives but fluctuating media and political attention, there is significant risk of losing focus. The health benefits of micronutrients are known; the economic benefits have been shown; and the groundwork is in motion for national scale-up. Let’s not lose focus now.
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