What Does it Take to Change Your Mind?

By Marium Ibrahim

When evidence conflicts with strongly held beliefs, how easy is it for us to change our minds?

There may be many motivations behind why we hold certain beliefs, but what are these motivations, and in the event that evidence shows otherwise, how easy is it to change our point of view?

Let’s talk about…wheat flour fortification

By Haris Gazdar

Wheat flour chakki in Pakistan
Photo credits: Wikimedia Commons

1. What is food fortification?
Food fortification is the addition, usually at an industrial scale, of essential micronutrients to commonly consumed foods, to overcome nutritional deficiencies in vulnerable populations. It is a response to ‘hidden’ hunger – or the persistence of deficient diets in populations where hunger, as such, may not be obvious. Common examples of deficiencies are minerals (iron, zinc, iodine) and vitamins. Common examples of food fortification are salt iodisation, fortification of milk, condiments, cooking oils and staple foods with various micronutrients.

2. Why is it in the news?
Major stakeholders in the world of nutrition are supporting or taking part in fortification initiatives currently being launched. These are donor-supported programmes in various provinces to fortify wheat flour with iron and folic acid, salt with iodine, and cooking oil with Vitamin A. Mandatory regulation has been put in place in some provinces.

3. Why is food fortification so popular among stakeholders?
It seems like a low-cost response that can reach large numbers of those in need relatively easily through existing government and market systems. It does not require major economic uplift or poverty reduction – in fact it is best suited to addressing micronutrient deficiencies precisely in those populations which no long face extreme hunger and poverty.

4. So, does it really work?
Yes, no, maybe.

Salt iodisation has a good record globally and in Pakistan. Staple food fortification with folic acid has worked in many countries to address a foetal condition known as NTD. But there is little evidence that staple food fortification with iron reduces anaemia.

And in Pakistan the fortification of wheat flour with iron and folic acid has been tried several times without any publicly available evidence of success.

5. What is the hitch with wheat flour fortification?
There may be several, some technical others practical.

Technically, there is no clinching evidence that adding iron to staple food is an effective way of reducing anaemia. There are questions about quantities and absorption.

Practically, for fortification to be even considered, it should be applied to a food that is consumed by much of the target group through the year. In Pakistan there is no precise information on:

• What proportion of wheat flour that is consumed is milled industrially? Estimates range from 30 to 50 per cent. 
• What proportion of the population consumes milled flour all-year round, and what proportion of the population most vulnerable to anaemia consumes it? 
• Why do most rural households and many urban ones prefer chakki flour, and those that do use milled flour often opt for ‘fine’ varieties rather than regulated flour? 

6. Anything else?
Yes.

Around half of Pakistan’s population suffers from inadequate energy intake. One in three households say that they are vulnerable to hunger. So, Pakistan needs to urgently deal with actual hunger and not just hidden hunger.

7. What does that have to do with wheat fortification?
We need a serious reform of food security policies to ensure that no person is vulnerable to hunger. Current policies which aim to address food security are based on government wheat procurement and its subsidised supply to private sector mills who are then supposed to provide subsided flour to the population. This clearly does not work. The system has created adverse incentives and rent-seeking for capturing subsidies. Regulatory weaknesses in the sector arise from these rent-seeking opportunities.

Wheat fortification projects, by focusing on a technical solution around the same inefficient sector, are in danger of doing two things:

• Detracting from the need to address actual hunger, and not just ‘hidden’ hunger 
• Ignoring numerous sector analyses which call for a reform of the wheat system 

8. What needs to be done?
Policy and public debate must focus on ‘hidden’ hunger as part of a broader agenda of food security and combatting hunger – rather than imagining that stand-alone technocratic solutions are possible. And existing fortification programmes might avoid disappointment if they recognised some of the problems highlighted here, revised some of their expectations, and took on board existing critiques of the wheat subsidy system. 

This blog is a part of a new “Let’s talk about…” series that distils key research findings aiming to start a public conversation on emerging issues.