#FFI20: Rajesh Mehta
Former Regional Advisor, of the Child and Adolescent Health, South-East Asia Regional Office at the World Health Organization
FFI: How did you become interested in nutrition?
Mehta: I am a pediatrician by training and was in a clinical profession before I moved into public health. Nutrition has been embedded in my work with maternal, newborn, and adolescent health right from the beginning of my professional career, as it is an important determinant of health. When I joined the Regional Office of the World Health Organization (WHO), there was a 2010 World Health Assembly Resolution in which concerns regarding birth defects were raised. The Resolution called on Member States to undertake actions for birth defect surveillance prevention and care. It has been well known that neural tube defects are preventable by appropriate intake of folic acid and vitamin B12, so the nutrition of women of reproductive age is very important.
FFI: What inspired you to become involved with food fortification?
Mehta: As part of my work for newborn and child survival and health, we needed to pay attention to micronutrient deficiencies like iron, vitamin A, iodine, and vitamins, including those leading to neural tube defects. Anemia has also been quite rampant in children, women, and adolescents in our part of the world. We can prevent common types of anemia through food fortification with micronutrients that also prevent neural tube defects like iron, folic acid, and vitamin B12; food fortification is an important public health strategy for countries in Southeast Asia.
FFI: How is your organization prioritizing fortification?
Mehta: The South-East Asia Regional Office of WHO supports 11 countries in the region, which is home to about 25% of the world’s population. There is a disproportionately high burden of disease and morbidity in this population, so we advocated for strategies like supplementation and food fortification to take care of micronutrient deficiencies within these Member States, including a focus on prevention of neural tube defects and anemia.
FFI: What health outcomes do you expect fortification to improve in your region?
Mehta: While countries in the region have a long experience in food fortification with iodine (salt) and vitamins A and D (milk and edible oil), our recent focus has been on fortification of foods with folic acid, vitamin B12, and iron. This would help us reduce the prevalence of nutritional anemia, which, in our region, is largely caused by iron deficiency. Our priority has been to prevent neural tube defects that need a higher level of fortification to address the folic acid insufficiency as per the global standards along with other ways of increasing intake.
FFI: In your experience, what are the main components to a successful fortification program?
Mehta: The primary driver and challenge is how to convince people to understand the evidence and benefit [of fortification]. A lot of advocacy is required to improve the demand side of food fortification programs, involving multiple stakeholders like policymakers, influential decision makers, and opinion leaders. The legal and policy framework is clearly important. We have seen that mandatory food fortification programs work much better than voluntary participation programs; therefore, we need regulatory and legal mechanisms for fortification to be successful.
FFI: What are the greatest challenges you have encountered in planning or implementing fortification programs? And how did you address those challenges?
Mehta: There has been a lack of understanding of the science, the evidence related to the benefits and absence of harms of micronutrient fortification programs. The understanding [in the region] is divided, some are convinced some are not. Therefore, there is always a voice from the other side, which can be a big challenge in terms of making policy decisions related to food fortification. Dissemination of evidence and technical support can help prepare for national plans and implementation mechanisms. Afterwards, it’s important to support fortification programs with quality control and mechanisms for surveillance of neural tube defects and other birth defects. Another challenge is that wheat and rice processing for consumption frequently happens at a small scale, like village level grinding of wheat and milling of rice. Flour fortification at this level is much more challenging compared to industrial milling. However, the distribution and consumption of industrial food products has been gradually expanding over the last few years.
FFI: What can we do as a society to continue strengthening fortification efforts?
Mehta: I believe that it will help if we support countries to create local evidence related to safety and effectiveness food fortification programs. Some local strategies for food fortification would have to evolve, whether it is at the point of consumption, or at small grinding units level or large scale milling.
FFI: Is there anything else you would like to share?
Mehta: I am an optimist and have reasonable patience that comes from my experience working with developing countries within this part of the world [the Southeast Asia region]. I have observed that there is always a learning curve for public health programs. We have to convince people that food fortification is a good public health strategy for which we should continue to be tenacious in our advocacy, and we should also be prepared to sustain support for countries to build and implement good quality food fortification programs and address the implementation challenges.
This interview is part of the #FFI20 Champions campaign, a celebration of fortification heroes who have helped build a smarter, stronger, and healthier world by strengthening fortification programs over the past 20 years. To read interviews with other champions, visit the #FFI20 Champions campaign homepage.