The World Health Organization (WHO) recognizes food fortification as one of the most cost-effective and beneficial public health measures available. Mass fortification policies and regulations can reduce health disparities, including in high-income countries, by improving micronutrient intake among food-insecure or high-risk populations without changing their diet or behavior. While international health organizations have traditionally prioritized technical assistance and grants to medium and low-income countries, it is important to recognize that micronutrient deficiencies may also pose an important yet underappreciated public health problem in many high-income countries. Nevertheless, some high-income countries, including Israel, have been slow to adopt fortification, due to a variety of scientific, technological, regulatory, and political barriers. Overcoming these barriers requires an exchange of knowledge and expertise among the all stakeholders to achieve cooperation and broad public acceptance within countries. Similarly, sharing the experience of countries where the matter is in play may help inform efforts to advance fortification globally. Here we share a perspective on progress and barriers to achieve this goal in Israel, to inform efforts made to avoid the regrettable waste of unrealized human potential from prevalent yet preventable nutrient deficiency conditions, in Israel and beyond.
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Food fortification has been a safe and cost-effective method of preventing prevalent micronutrient deficiencies for over a century (, ). As of 2020, 143 countries around the world have adopted mandatory food fortification policies (). Along with vaccinations, the World Health Organization (WHO) recognizes food fortification as one of the most cost-effective and beneficial public health measures available, and as a safe, effective, and inexpensive public health measure to prevent the harms associated with pernicious micronutrient deficiencies (). Mass fortification can reduce health disparities including in high-income countries by improving micronutrient intake among food-insecure or high-risk populations without changing their diet or behavior (, –). Indeed, on January 31, 2023, the World Health Organization Executive Board decided to recommend that the World Health Assembly adopt a resolution calling to accelerate efforts for preventing micronutrient deficiencies and their consequences, including spina bifida and other neural tube defects, through safe and effective food fortification (). The Executive Board recommendation is supported by Australia, Brazil, Canada, Chile, Colombia, Ecuador, Malaysia, Paraguay, the European Union and its 27 Member States, and by Israel. Nevertheless, some high-income countries, including in Europe and Israel, have been slow to adopt fortification.
Copyright © 2023 Endevelt, Tulchinsky, Stahl, Mor, Davidovitch, Levine and Troen.
- NTD (neural tube defect)
- folate (folic acid)
- vitamin B12
- vitamin D