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Don't medicalise micronutrient deficiency

In their article Nutrition key to cutting infection rates, Andrew Thorne-Lyman and Wafaie Fawzi call on donors and developing countries to improve nutrition by providing micronutrients to populations.

But while current ways of doing this — biofortifying food or giving out supplements — may reduce the short-term burden of malnutrition, they are doomed to fail in the long term because they frame micronutrient deficiency as purely a health issue, ignoring the food and agricultural aspects of the problem.

Strategies to introduce biofortified crops, for example, rarely consider issues such as the water and land needed to grow such crops.

Moreover, these strategies do not adequately address the poverty gap. They often rely on farmers continuously buying biofortified seeds, excluding poorer farmers and allowing only rich or commercial farmers to benefit from the farming of biofortified crops. Similarly, interventions based on supplements rely on a regular supply of pills or sachets without considering long-term sustainability.

The underlying problem is that supplementation and biofortification are carried out in much the same way that medical problems are treated: identify the problem — for example, iodine deficiency — find a 'cure', i.e. iodine, and give it to people either via crops or in supplements.

But malnutrition is a multi-faceted problem that depends on individual physiology, for example. Research shows that single solutions, such as supplementing food or fortifying crops with one or two micronutrients, do not solve malnutrition because micronutrients often increase or decrease the extent to which the body can absorb other micronutrients.

A strategy that frames malnutrition not only as a health problem but also a 'food problem' could have more success. Such a strategy must consider the full complexity of social and ethical issues associated with tackling micronutrient deficiency: ensuring sustainable and climate-neutral agriculture, protecting biodiversity, and understanding cultural food preferences and communities' perceptions of risk.

A key ingredient for success will lie in listening to poor communities. Instead of 'pushing' a technology such as biofortified seeds onto farmers, a strategy for tackling micronutrient malnutrition must start by examining indigenous knowledge and local practices, for example.

Farmers' social contexts must be considered, not only because farmers make up 75 per cent of people suffering malnutrition, but also because they provide the rest of the populationwith food.

Research strategies should also aim to create benchmarks for biofortification strategies. A central collection of case studies would allow researchers and governments to identify those strategies that work and those that don't, helping to establish good practice and set realistic targets for reducing micronutrient deficiencies.

See Letter to the editor.