Has it been four years already? Micronutrients Redux

There was an interesting article published by Slate late last week about a topic that I discuss in one of my first posts - the undeniably important role of micronutrients, particularly in developing countries, on global health. While there are many prominent issues that have a resounding impact on population health in many poor countries of the world, treatment deficiencies in micronutrients stands out due to it's relative economic feasibility.

The topic is in the spotlight once again as the meeting which shone the spotlight on micronutrients four years ago, the Copenhagen Conference, is set to take place again, and once again, an expert panel of world renowned economics will ho and hum as to which "solution" to global health is the most economically worthwhile - that is, which issue has the greatest payoff for the amount of money invested. 

The interesting thing this time around however, is that a different team is leading the charge for micronutrients. In 2008, it was Sue Horton et al's paper on vitamin A and zinc deficiency that garnered the top prize of the most economically worthwhile cause in global health. In their paper, they focused primarily on the importance of getting these two micronutrients in particular to populations, especially children, in developing countries. Strategies that have resulted thereafter have included an increased attention to supplements, as well as the fortification of foods with micronutrients. 

This time around, John Hoddinott, Mark Rosegrant, and Maximo Torero are the primary advocates of malnutrition. Rather than focusing on the supplementation of certain nutrients, it appears that they are instead targeting the issue of insufficient food production. As summarized in the Slate article, they posit by increasing product of certain key foods, this will drives food prices down, making them more affordable across the globe. The key to driving food production is to provide farmers in developing countries the necessary information they need to ensure high crop yield, in addition to a steady supply of fertilizer. 

Not a bad idea to be sure, but I am wary about how much bang per buck we can achieve using this strategy. The beauty about focusing on vitamin A and zinc was that strategies hoping to decrease deficiencies in these nutrients were relatively cheap to implement, and that they resulted in significant results in terms of decreased morbidity, if not mortality. The reason I worry about the strategy of increasing yield is that they do not specify which types of crops will be affected by the solutions. For instance, an increase in rice yields will certainly do a lot of good in areas of the world that are affected by famine. But, if you're not, then rice is itself does not contain many significant nutrients. When people don't get sufficient vitamin A, there are health consequences that follow. Unless you're in a famine, there is no disease that results from a lack of rice. 

In any case, I look forward to the full paper by Hoddinott et al on malnutrition etc., as well as the other cases of the Consensus. On a slight tangent, it would be particularly interesting if the Consensus decided to once again choose a malnutrition issue as its top solution. I suspect it is more likely that the institution will choose an issue in a different field, to diversify the attentions of the global health activists, and from a political standpoint, to avoid implying that not enough has been done in the area in the past four years.