YACH ET AL. REPOND

Abstract

We agree with Addo et al. that strong government leadership is needed for progress to be made in preventing micronutrient deficiencies in populations. However, the last 60 years has shown that without widespread and active collaboration with the food industry, government regulations and recommendations do not achieve their desired impact.1 For example, a recent review of factors leading to successful implementation of a salt iodization program in South Africa highlighted the importance of engaging all salt retailers and processed food manufacturers, of paying detailed attention to monitoring and quality control across the iodine supply chain, and to outcome assessment.2 In contrast to the success achieved in iodine deficiency, researchers highlight how, despite government regulations, equivalent progress has not been made in reducing iron deficiency through fortification of brown bread. Manufacturers were inadequately involved in the implementation process, which led to both the level and type of iron fortificant used being inappropriate.3 Closer interaction between food companies and government regulators is required to address the many practical aspects of fortification if the desired public health goals are to be met. In many developing countries, considerable challenges hamper rapid progress. Some issues could be addressed through stronger private–public alliances of the type recommended by the Global Alliance for Improved Nutrition, World Health Organization, and the Unitede Nations Standing Committee on Nutrition.4,5 These partnerships tend to mainly involve major multinationals despite the fact that in most developing countries the contribution of the informal sector to the total volume of food sold far exceeds that sold by multinational corporations and often exceeds sales generated by the total formal sector. The food industry in many countries is led by small-to-medium companies, such as the 1000 or more mid-sized food producers in Mexico,6 as well as small enterprises in India that dominate national food production, accounting for 75% of food output.7 The informal sector also accounts for 74% of Nigeria's food purchased, while mid-sized supermarkets account for 60% of Brazil's retail market. These sections of the food industry are clearly too significant to be ignored,8,9 especially because they reach the poorest communities most in need of micronutrients. Engaging them will require innovative national strategies supported by government and encouraged by the entire food sector.