#FFI20: Santosh Karmarkar
Pediatric Surgeon at the Lilavati Hospital and Research Centre
FFI: How did you become interested in nutrition?
Karmarkar: I am a pediatric surgeon and I deal with children and parents on a day-to-day basis. Children and nutrition almost go hand in hand. Apart from that, my interest in nutrition at the public health level was because of my interest in neural tube defects and their prevention through folic acid. I am connected to nutrition on a public health level because neural tube defects are the most common birth defects in India.
FFI: What inspired you to become involved with food fortification?
Karmarkar: We started the Spina Bifida Foundation way back in 2009. Over the years, the foundation and its work and scope have expanded. With this growth we realized that, with fortification, there is the potential to prevent 40,000-50,000 children from being born with neural tube defects in India each year. It is this fact and these overwhelming numbers that inspired me to get involved with fortification. Friends such as Dr. Godfrey Oakley and other associations such as FFI have been consistent sources of inspiration, we learn a lot from them.
FFI: How is your country prioritizing fortification?
Karmarkar: Unfortunately, India needs to do much more to prioritize fortification. At various levels, at the state and central government levels, fortification is known but it is not where it should be. There is a great need for development to create more public awareness about the benefits of fortification. We are doing our bit by lobbying with the government and giving fortification the level of attention it deserves.
FFI: What health outcomes do you expect fortification to improve in your country?
Karmarkar: I think there are two areas health-wise where fortification will play an important role in India. As mentioned, India has one of the world’s highest prevalence of neural tube defects. Fortification can lead to a large decrease in the number of children born with neural tube defects. Another major issue in India is nutritional anemia. Fortification would help in reducing that as well.
FFI: In your experience, what are the main components to a successful fortification program?
Karmarkar: I think the public needs to be more aware about the benefits of fortification. A campaign to make people aware about the benefits [of fortification] is one of the major components for success of a program because, if people are aware, it will put pressure on those making the decision to fortify food. The government also needs to set the right standards for fortification. Currently in India, the recommended standards have been diluted. Lastly, it is important that fortified food be accessible to the population.
FFI: What are the greatest challenges you have encountered in planning or implementing fortification programs? And how did you address those challenges?
Karmarkar: India is a very vast, diverse country. There exists a lot of inequality and various states have their own policies, so there are challenges in trying to implement a national program. The number one biggest challenge is that most Indians do not buy branded sacks of wheat or rice. People buy their own grain and get it milled in local mills. To overcome this, some state governments have been distributing flour through the public distribution system, PDS. Again, making people aware of the benefits is very important.
FFI: What can we do as a society to continue strengthening fortification efforts?
Karmarkar: As a society, there are so many social organizations and groups connected with health and nutrition related issues. They need to be involved more in talking about fortification and lobbying for fortification. There is a need to get all of the stakeholders together. I think it would be a nice idea to have a global task force, so to say, that look at issues of fortification. It should include FFI and the Spina Bifida Foundation as well as other international and federal organizations to discuss on a shared platform.
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.