JUNE 2014 Page 4 How Committed are F&B Companies to Improving ? Page 13 GMOs Will Not Feed the World Page 20 What’s Google Got to Do with it?

The private sector’s potential (and existing) fortification A impact on private-public partnerships A, iron, , iodine GMOs WORLD hidden hunger malnutrition private-sector engagement WITHOUT ready-to-use therapeutic food food insecurity closing the HIDDEN caloric gap hunger myths medical HUNGER? June 2014 naturalproductsinsider.com

#NatProdInsider CONTENTS

Health in Action: 3 Viewpoint 25 A Garden of Transforming Agents

Has Partnership Working Changed Private Sector Behavior in the Fighting Hidden Hunger with 4 Nutrition Space? 28 Fortified Foods

Achieving Through Gender Equality in The Buy-One-Give-One of 8 Developing Countries 31 Peanut Butter: Good Spread

How to Feed the World: 11 Debunking Myths About Hunger 34 A Complex Challenge

GMOs, Failing to Feed a Upwards: Vitamin Angels’ 13 Hungry World 38 Expands its Efforts Globally

How Companies and Nonprofits Are Collaborating to Tackle The Industrial Food Revolution: 17 Undernutrition 41 3D Food Printing

Food Fortification: Investment Opportunities in the 22 A Lasting Nutrition Solution 44 Medical Foods Market

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2 INSIDER A World Without Hidden Hunger June 2014 Viewpoint

Addressing a Global Concern

t is amazing to consider that while the and much of the developed world is struggling with an epidemic of overweight and obesity, at the same time, 842 million people do not have enough to eat, Imany of them in developing countries across Asia, India and Africa. Undernutrition is responsible for 3.5 million child deaths every year; those who survive often have severely compromised physical and mental health. This is certainly not a new problem; I bought my copies of “Do They Know It’s Christmas” and “We Are the World” back in the 1980s to fight in Africa. But the global scale, the increasing awareness of the dichotomy in food resources, and the As we look concerns around sustainability are bringing the topic to the front burner. And this means toward the looking at public-private partnerships and ways that governments and private industry can work together to develop innovative solutions. future, with In May, I had the opportunity to attend a two-day symposium on “Peanut Power,” a population sponsored by The Peanut Institute. One of the speakers was Dr. Mark Manary, who is burgeoning affiliated with Washington University but spends the majority of his year in the fields of Malawai and other African nations. He discussed the development of Ready-To-Use toward 9 billion Therapeutic Food (RUTF), an energy-dense peanut butter paste, and the unbelievable people, it will positive effects this home-based therapy has had on recovery from malnutrition and long-term health. On page 31, the founders of Good Spread have shared how this program fall on all of inspired them to develop a “buy-one-share-one” program for peanut butter. us to face the The contributions in this issue are designed to call out the innovative efforts being undertaken across the country and the world to meet these challenges. The information problems and from non-profit organizations should prove food for thought on what we can all do to help develop new address this situation. And as we look toward the future, with a population burgeoning ways to support toward 9 billion people, it will fall on all of us to face the problems and develop new ways to support health for all. health for all. Best regards,

Heather Granato VP Content, Health & Nutrition Network [email protected]

@heathergranato

3 INSIDER A World Without Hidden Hunger June 2014 Has Partnership Working Changed Private-Sector Behavior in the NUTRITION SPACE? BY MARC VAN AMERINGEN

ince the launch of the Millennium Development Goals (MDGs), Also at Davos, the U.N.’s Scaling Up Nutrition one of the defining features of the “development system” has (SUN) movement launched its Business Network been a shift to include—alongside governments and multilateral with 40 member companies collectively signing up to improve nutrition for 127 million people institutions—non-state actors such as the private sector, every year by 2020. Chaired by GAIN and the non-government organizations (NGOs), special interest groups, World Food Program (WFP), this is the first-ever philanthropic foundations and others. In the area of , single platform for private-sector engagement Smany of these structures were institutionalized and given mandates to galvanize on nutrition. actions in a range of areas neglected by existing institutional arrangements. Speaking at Davos, Justine Greening, the U.K. Development Minister, pointed out in the case of Indeed, the Global Alliance for Improved hunger and malnutrition, it will primarily be the Nutrition (GAIN) was created in 2002 for private sector that delivers the solutions. Indeed, this very reason—to unite an international it is in the marketplace that people access the alliance of governments, NGOs, the private majority of their food. The private sector also has sector and civil society around the vision unparalleled opportunities to influence through of a world without malnutrition. Twelve their supply chains and workforce, their ability to years on, GAIN supports multi-stakeholder influence consumer behavior and their access to projects in more than 40 countries, reaching cutting-edge research and expertise. If we are to It is true that partnerships an estimated 811 million people with reach the billions who are malnourished, and do involving the private nutritionally enhanced food products. The so in a few decades, it will require the technology expanding involvement of civil society and and marketing skills of business to be harnessed sector have not been the private sector creates more opportunities for the public good. for us to work with partners, helping us welcomed by all. Nor to move toward our target of providing Does the Private Sector ‘Get’ Nutrition? have all of them been sustainable sources of affordable, nutritious Criticisms of multi-stakeholder foods for one billion people by next year. partnerships usually target the private a success. The nutrition Similar multi-stakeholder partnerships sector, focusing on issues of transparency, have emerged in other sectors and today they accountability and conflicts of interest. It is agenda has not yet been are common features of the development true that partnerships involving the private fully embraced by the landscape. Has this created a step change sector have not been welcomed by all. Nor in private-sector behavior? There has been have all of them been a success. largest food and beverage progress, but there is still a long way to go. The nutrition agenda has not yet been fully companies—despite embraced by the largest food and beverage The Emergence of International companies—despite evidence of the positive evidence of the positive Frameworks impact that improved nutrition can have on This shift in thinking around development productivity and gross domestic product (GDP). impact that improved has been coupled with efforts to provide more Last year, the Gates Foundation, Welcome Trust formalized routes to private-sector involvement and GAIN co-published the Access to Nutrition nutrition can have on in tackling malnutrition. Earlier this year, the Index (see page 5) rating the top 25 global food productivity and gross World Economic Forum meeting in Davos saw and beverage manufacturers on their corporate business and political leaders signing up to strategy on nutrition; formulation and delivery domestic product. the U.N. Secretary General’s “Zero Hunger” of nutritious products; and positive influence on challenge to eliminate hunger in our lifetimes. consumer choice and behavior.

4 INSIDER A World Without Hidden Hunger June 2014 RANKINGS

Undernutrition ranking (maximum score = 10)*

1 Unilever 5.4

2 Danone 5.3

2 Nestlé 5.3

4 PepsiCo 4.1

5 Kraft Foods Inc. 3.1

6 Coca-Cola 2.9

7 Ajinomoto 2.1

8 Grupo Bimbo 1.8

9 Heinz 1.4

10 Kellogg 0.8

11 FrieslandCampina 0.7

12 General Mills 0.5

13 Mars 0.3

14 Barilla 0.0

14 Brasil Foods 0.0

14 Campbell 0.0

14 Lactalis 0.0

14 Lotte 0.0

14 Nichirei 0.0

14 Nissin 0.0

14 Sigma 0.0

14 Tingyi 0.0

0 1 2 3 4 5 6 7 8 9 10

BMS manufacturers Company did not provide information to ATNI’s research partner during the research phase

* Three companies (ConAgra, Ferrero and Hershey) are not ranked on undernutrition. Two are confectionary companies, and one did not sell products in lower-income countries at the time of research.

The sub-ranking for undernutrition re ects additional actions that companies can take to address undernutrition, including the fortication of products with otherwise decient in the .

ACCESS TO NUTRITION INDEX GLOBAL INDEX 2013

5 INSIDER A World Without Hidden Hunger June 2014 Successful partnerships involving the private sector do not happen by themselves. They need clear structures, transparent working arrangements, and an intellectual and policy structure to measure performance and direct them. Above all, they need effective management structures outside of the usual institutional fabric to provide coherence, independent measurement and continuous communication.

The Index found that even the top performers nutrition priorities. The roadmap proposes a The second model is one that unites can do more to improve access to nutritious two-track approach: improving the nutritional governments and the private sector around food options. Companies’ practices often do status of smallholder farmers and workers a common goal as exemplified by the not measure up to their nutrition commitments, employed in agricultural supply chains, and Amsterdam Initiative against Malnutrition particularly in areas such as formulating healthy in parallel exploring opportunities to scale-up (AIM), which brings together governments, products, making them more accessible to the production of more nutritious foods. civil society, and northern and southern consumers and marketing them appropriately. The roadmap was co-developed by GAIN and businesses to develop innovative, social The Index also found companies are often less the Southern Agricultural Growth Corridor of business models to tackle malnutrition in than transparent about their nutrition practices. Tanzania (SAGCOT) Centre and focuses initially Africa. This market-based approach has The lack of deep commitment by business on Tanzania. However, it provides a template several advantages. It is sustainable in the is reflected when we look at investments for bringing the agriculture and nutrition long-term and leads to product innovation, in nutrition compared to agriculture and communities closer together across the whole value-chain optimization and the use of food security. The World Economic Forum’s of the developing world. It also serves as a locally produced ingredients. New Vision for Agriculture has been hugely useful reminder that most of the opportunities to successful, mobilizing more than $5.7 billion engage the private sector in nutrition are at the Conclusion in new, mainly private-sector, commitments country level where markets are dominated by Reaching the U.N. Secretary General’s for agriculture and food security in just small, medium and some large food producers, goal of ending hunger and malnutrition in our four years. This compares with just tens of and where a significant portion of the food on lifetime is a realistic aim; however, the scale millions committed by the private sector to the market is loose and unpackaged. This is and level of complexity posed by malnutrition combat malnutrition. where the greatest potential sits to harness the means no one sector has the resources, This should not obscure the fact that many private sector. capacity and reach to single-handedly companies are already taking some action. achieve this goal. But there’s a long way to go. Tools like the Index Backbone Structures New platforms to engage the private sector promote a more objective public debate and Successful partnerships involving the in nutrition should be used to bring in more provide a useful tool or road map for companies private sector do not happen by themselves. global and national private-sector players. to use in improving their nutrition practices. They need clear structures, transparent But, we must couple this open-door approach working arrangements, and an intellectual with a demand that the private sector’s role is Incentivizing the Private Sector to Go and policy structure to measure performance meaningful and long-term. Farther and Faster on Nutrition and direct them. Above all, they need As we look to the post-2015 framework, Initiatives such as the New Alliance for effective management structures outside food and nutrition security should be an Food Security & Nutrition and Grow Africa of the usual institutional fabric to provide important priority, as should the need to show there is clear support from business coherence, independent measurement reinforce the role of multi-sector partnerships (both global and local) to engage and deliver and continuous communication. The and the backbone structures that make in food policy; however, despite the clear Stanford Social Innovation Review recently partnerships to tackle malnutrition a success. public policy demand to develop deeper recognized GAIN’s role in the delivery of links between investments in agriculture, nutrition programs as one such example of a health and nutrition, existing platforms “backbone” structure. Marc Van Ameringen is the executive director of the still largely do not deliver quantifiable and These are common features of the Global Alliance for Improved Nutrition (GAIN). Under traceable nutrition outcomes. partnerships that GAIN facilitates. One such his leadership GAIN has become a leading player Organizations like the SUN Business model is national fortification alliances, which globally in efforts to end hunger and malnutrition. Network are attempting to plug these bring the public and private sector together GAIN programs are today improving the lives of over gaps, engaging at the country level to to improve nutrition by fortifying staples 800 million people, more than half of which are support national governments in developing such as wheat and maize flour, edible oils women and children. In 2014, Marc was awarded programs and partnerships to guide and salt with micronutrients. In this model, the World Food Program’s ‘Hunger Hero Award’ and business engagement in nutrition. This the government sets the policies, standards in 2010 he received the Visionary Award from Helen work has culminated in a new Roadmap for and regulations; the private sector produces Keller International. Agriculture and Nutrition (see page 7), which fortified foods and makes them available and links business and agriculture with national affordable to the consumer.

6 INSIDER A World Without Hidden Hunger June 2014 AGRICULTURE AND NUTRITION ROADMAP 2014

Use policy tools to influence agricultural performance • R&D investments • Subsidies and taxes • Markets and trade • Land policy • Infrastructure investments

AGRICULTURE Agricultural growth rates, levels, and patterns all matter for the links with nutrition and health. The agricutural value chain extends from technologies, inputs, and production to processing, A healthy, well- distribution, marketing and consumption. nourished labor force contributes to increased Improve the other agricutural production. conditions that Maximize agricuture's benefits affect agriculture's for people's health and nutrition, links with nutrition and minimize its risks and health BENEFITS • Rural infrastructure • Production for farmers' own • Land distribution consumption • Healthcare services • Income and assets • and • Employment sanitation • Diet diversity and quality • Gender roles and • Revenues for targeted nutrition culture and health programs RISKS • Water and food-borne diseases Address factors • Zoonotic diseases that affect household Demand for nutritious • Obesity and chronic diseases capacity to generate and healthy foods • Occupational health hazards better nutrition provides opportunities • Heavy demand on women's time and health for smallholders to • Allocation of resources increase income. in the household • Education • Care practices Household well-being • Mother's health

NUTRITION HEALTH

Source: Co-developed by GAIN and the SAGCOT Centre at the request of the Government of Tanzania.

7 INSIDER A World Without Hidden Hunger June 2014 ACHIEVING

FOODThrough Gender EqualitySECURITY in Developing Countries

BY JUAN E. ANDRADE AND JULIO R. LOPEZ

hen people say “food security,” it sounds like having appropriate The Food and Agriculture Organization alarm systems for their pantries. In a certain way it is that, but (FAO) explains that food security can be better much more. This new buzzword is used among agricultural understood by its dimensions: availability, accessibility, utilization and stability. The first development programs, politicians and the common folk as a W dimension, availability, explains that people punch line to bring hunger awareness and to jump start programs, as an should have physical access to foods; for indicator of progress or as an outcome measurement. But what is food example, one cannot eat huevos rancheros security? The World Food Summit in 1996 defined food security as existing if there is a shortage of eggs in your local “when all people at all times have access to sufficient, safe, nutritious food market. The second dimension, access, links to maintain a healthy and active life”—a simple concept, but with complex the individual’s purchase power with this dimensions for its existence. food availability. Building on our example, it is possible that eggs are present in the region, but as an animal source of nutrients, these are more expensive than or tortillas, and thus out of our reach. The third dimension, Cycle of in Developing Countries utilization, links the previous two dimensions Figure 1 with nutrition and health. Indeed, this is the most misunderstood and, to my belief, underappreciated dimension of food security. Food insecurity, The utilization dimension encompasses hunger, undernutrition a plethora of biological, psychological, sociological and cultural sub-dimensions, which can either potentiate or lessen the impact of Poverty the previous two dimensions, and, certainly, the last one, stability. This last dimension understands food security as an outcome of how resilient a household or an individual is to shocks in any of the other dimensions due to, among other things, adverse weather conditions, political unrest or economic factors such as increases in food prices, market crashes and unemployment. My research group tends to gravitate around the third dimension Low and, in the next lines, this concept will be productivity explained in more depth from the perspective of an agricultural and market development program in Guatemala. Poor physical The utilization of foods is not a simple and cognitive dimension to explain. In this dimension, the development individual is placed at the center of decision- making in the household and is subjected to intrinsic (i.e., biological and psychological)

8 INSIDER A World Without Hidden Hunger June 2014 Adequate nutrition and health are critical to support the role of women in agriculture as engines of socio-economic development in low-income countries. Women stand at the center of development as they are responsible for three major roles, tangibly linked in households: production, nutrition and home/health care.

and extrinsic (i.e., cultural, sociological, standard, corrupt government. It is hard to women in the household are still lacking. environmental, economic) factors. These believe, but, according to the FAO, it is the More development programs are targeting make the individual more or less successful reality for more than 870 million people who women and support their roles to maximize in seeking, selecting, accessing and live in hunger, mostly in developing countries proposed impact. A case in point is the consuming foods and, thus, maximize its around the world. In these countries, Purchase for Progress initiative in Guatemala. return on investment in nutrition and health. individual income is quite low and household The Purchase for Progress (P4P) Initiative In the United States, for example, household decisions (i.e., income use) are heavily made is a five-year pilot program from the World purchasing decisions within a family could be by men, potentiating the vicious cycle of Food Program (WFP) that enables low-income very different if the net income is high or low, poverty (Figure 1, page 8). Nevertheless, there farmers from 21 countries to conduct more and constant or not. Yet, two families, with low is hope. In most countries (and in the United productive agricultural activities and links and high income, could easily find, buy and States, I might add) food-purchase decisions them with formal markets, including the WFP’s consume high-calorie, nutrient-poor foods, or are made by women. This represents both a operations and other stakeholders. In addition, what nutritionists and media refer to as “junk” limitation and an opportunity. the P4P invests in capacity building at country foods in local markets. Thus, a food secure Adequate nutrition and health are critical level in areas such as sustainable agricultural and insecure household can make poor food to support the role of women in agriculture practices, post-harvest handling and storage, consumption choices. According to the USDA as engines of socio-economic development and organizational management with the aim Economic Research Service, an estimated one in low-income countries. Women stand to boosting national food security over the in seven households was food insecure at least at the center of development as they long term. The P4P’s conceptual framework is some time in 2012. Still, obesity is rampant are responsible for three major roles, based on the premise that by developing the in the United States, particularly in some tangibly linked in households: production, capacity to sell to an institutional or private southern states, where the prevalence of food nutrition and home/health care. Despite buyer such as the WFP, smallholder farmers insecure households was above the average their role, women are the most neglected and their farmers’ organizations can gain (14.5 percent) in 2012. Currently, this is a and misunderstood agents of change knowledge, skills and confidence to better debated issue among the scientific community, in development programs. For example, engage with formal markets. The development the government, the industry and the public, women represent the largest malnourished logic of P4P states that increased smallholder and probably beyond the scope of this short and most health afflicted group in most income is a function of increased agricultural discourse. Yet, it exemplifies how vast and developing nations. Yet, they are less likely productivity, improved capacity for aggregation, complex the concept of food security could be. to access agricultural loans, property rights, market development and an enabling In any case, decision making is an important and health care and education services. environment that supports smallholder market aspect of food security, one that starts with the Nonetheless, they are responsible for a access (Figure 2, page 10). individual and her capacity to make informed great deal of production practices, rearing In Guatemala, the P4P Initiative links decisions in a changing environment. children, food collection, preparation and its smallholder-targeted demand with the Now, let’s move a few thousand miles storage, household dynamics and education capacity building activities of several actors in away from the United States and imagine of offspring; all of these items are associated order to create a more suitable environment a place where you are faced with more with the utilization dimension of food for smallholder farmers’ income-driven precarious conditions, where diarrheal security. Current evidence has shown when activities, resulting in increased food diseases, parasite and opportunistic women have the opportunity to earn and security. These actions lead to a virtuous infections, lack of potable water and poor control income, they are more likely to focus cycle that improves the quantity and quality sanitation are the norm; and where the other their spending on their children’s nutrition, of the commodities smallholder farmers dimensions of food security are hampered by education and health. Although this has been can offer not only to the P4P market but bouts of poverty, civil unrest, poor markets known for quite a while, efforts to tangibly also to new, more profitable markets in or and distribution channels, and a sub- link these development associated roles of outside Guatemala. As of January 2013,

9 INSIDER A World Without Hidden Hunger June 2014 P4P Guatemala Conceptual Framework Figure 2 P4P Guatemala

Improved capacity for aggregation Public Income Enabling enviroment Food security Partners Market development Increased agricultural International productivity Smallholder farms

P4P Guatemala supported 7,363 smallholder infancy and will require continuous support intensification of agriculture in low-income farmers (34 percent women) distributed from both the private and public sector. countries. Programs such as the P4P are among 64 farmers’ organizations located Public-private partnerships (PPPs) are a good examples that, although the road to throughout 10 states. More importantly, form of cooperation between government development is uneven and full of obstacles, the main targets of this initiative have been and business agents (e.g., food and investment in women farmers through women farmers, which the program states agricultural industries), which at times creative and supportive PPPs could level the hold the key for success. involve private voluntary organizations plain field faster toward long-lasting impact The initiative has boldly stipulated that and academic institutes, agreeing to work for the years to come. support will be given to farmer groups only if together toward a common goal or carry women are at the top of their organizations. out a specific task, while mutually sharing The program closely monitors female resources and assuming the responsibilities Juan E. Andrade, Ph.D., is assistant professor participation in training activities, as it is and risks present. Indeed, PPPs have the in the Department of and Human primordial for program implementation and potential to address complex food and Nutrition at the University of Illinois, Urbana- survival. Moreover, by promoting public- nutrition security challenges in developing Champaign. He works in food and nutrition issues, private partnerships, the initiative has countries. Some potential benefits include: especially those associated with diagnostic built a network of more than 40 partner increase awareness of food and nutrition technologies for deficiencies and the institutions in the financial, governmental, security issues among policy makers; adequate delivery of micronutrients to populations non-governmental and commercial sectors. facilitate a more systematic visualization of in developing countries. Partners participate in technical assistance food value chain, processes and delivery Julio R. Lopez, Ph.D., is currently a strategic marketing programs; provide field training, sales structures; support mobilization of funds analyst at Archer Daniels Midland. He is a former and financial services; and offer other for targeted activities and outcome-driven student of Juan Andrade and his dissertation work activities to P4P beneficiaries. Program research; streamline technology transfer was directed at evaluating the role of agriculture activities focus on increasing smallholders’ to persons of interest; and expand the development programs in promoting food security productivity and farmer organizations’ access to agricultural inputs, medications, and dietary diversity among rural farmers within the marketing and organizational capabilities vaccines, food and nutrition assistance Purchase for Progress Initiative in Guatemala. creating a more profitable access to broader during crises. These partnerships are critical markets. A focus on strengthening the direct in our development efforts and should be Disclaimer: The content of this article relationships between farmers, farmers’ synergistic, where the wealth and health of does not reflect the official opinion of the organizations, development partners the beneficiary should be in the best interest University of Illinois at Urbana-Champaign. (including government agencies) and of and should reinforce the relationship Responsibility for the information and views demand-side actors (processors, industry, between its members, and vice versa. expressed in the article lies entirely with traders, donors, government, institutions) Much work is still needed if we are to win the author(s). will enhance prospects for sustainability. this battle against poverty and malnutrition, This certainly could be the case as women and as the U.S. government’s Feed the Future participation continues to grow; however, Initiative contends, we cannot do it alone, but this development process is still in its we need to do it now through the sustainable

10 INSIDER A World Without Hidden Hunger June 2014 Debunking Myths About Hunger BY MICHAEL WILSON

orld hunger was a prominent issue in the 1980s with , people to feed themselves on $1.50 per flies and the “poverty porn” of malnourished crying African babies. day (the extreme poverty line) and raise In recent years, the aid and development industry has preferred to funds for poverty fighting organizations. Participants regularly report being shocked use more positive imagery and other focuses in its communications, W by how difficult it is to function on meals of but a number of misconceptions remain in the public mindset about world cheap , missing the hunger and how to tackle it. Let’s explore some of these misconceptions. and the body needs. So now we’ve partially debunked the notion The first myth is one that depicts the that hunger is a health issue. Being routinely hunger challenge as impossible: there just underfed is certainly not good for your health, isn’t enough food to feed all of the people in but the consequences of hunger permeate the world. It isn’t true. The world produces into much broader areas such as education 17 percent more food per person today than “There are more and the economy. A hungry child struggles it did 30 years ago, and it is indeed enough to focus, learn, ward off sickness or even to go around. The problem is one of effective pressing global attend school. Without education, it’s much distribution caused by bad governance, harder for them to grow up and contribute issues than lack of infrastructure and inequality. Around to the growth of the national economy. A 65 percent of the world’s hungry are located study in Guatemala found boys who received hunger.” in just seven countries (China, India, The fortified food before the age of 3 grew up to Democratic Republic of Congo, Bangladesh, have wages 46-percent higher than those in The reality is when Indonesia, Pakistan and Ethiopia). By a control group. When a country has millions populations are hungry, supporting small-scale farmers, ensuring food security is high on the global agenda and of hungry kids, the long-term consequences economies suffer, conflict opposing trade policies that exclude societies are magnified and limit the entire society. from fair access to food, the existing level Adequate food and nutrition can therefore occurs, farmers can’t grow of food production can vastly improve the be seen as a fundamental building block of their crops effectively and the situation of the world’s hungry. economic development. Following that is the idea that resolving This is the prism through which we can cycle of hunger continues. hunger means ensuring people have view the common statement of: “There are Economic innovation, enough to eat. That is indeed one of the more pressing global issues than hunger.” things hunger is, but there’s more to it than The reality is when populations are hungry, environmental sustainability, that. If someone is given three large bowls economies suffer, conflict occurs, farmers of rice a day, their stomachs will be full, can’t grow their crops effectively and conflict resolution and but will they be nourished? People need the cycle of hunger continues. Economic the other high-priority nutrients, vitamins and minerals in order innovation, environmental sustainability, to grow, think clearly, progress and reduce conflict resolution and the other high-priority global issues are far-better susceptibility to illness. Good nutrition global issues are far-better addressed by addressed by populations means having the right combination of populations with food security and adequate nutrients and calories needed for healthy nutrition. Without it, the conditions simply with food security and development; this is especially important can’t exist for progressive measured policies adequate nutrition. for infants, pregnant women and young to be implemented in other areas. children to ensure proper development. So, what causes hunger? A frequently The Global Poverty Project’s own “Live heard explanation is that hunger is caused Below the Line” campaign challenges by droughts and natural disasters. But nature

11 INSIDER A World Without Hidden Hunger June 2014 is only one factor that affects global hunger. predict and can’t be prepared for. In reality, It is true that weather and infestations can tools exist to monitor and predict trends in wreak havoc on crops and food-supply food production as well as food prices. For planning, but communities with the resources example, the Famine Early Warning System to build irrigation systems, storage facilities Network (FEWS NET) analyzes meteorological and efficient transport infrastructures and economic factors to alert the world A defeatist attitude are able to improve harvests and better to the possibility of hunger hotspots and safeguard their societies against climate famine. The improving quality of data and to the hunger issue volatility. But beyond droughts and natural analytics available today enable evolving is that hunger and disasters, the proportion of food crises trends in hunger and food security to be that are linked to human causes has more better anticipated, diagnosed and reacted to. famine are not easy to than doubled since 1992. Conflict is often Global transport networks enable food and at the heart of today’s worst food crises. resources to be efficiently sent to areas of predict and can’t be War tactics that destroy infrastructure and need, if only the policies and willpower exist farms has a lasting impact on societies’ food to respond adequately. prepared for. In reality, security. The inter-connectedness of the 21st The final area that needs to be looked at century global economy also means nations is the scale of the hunger problem and the tools exist to monitor and regions are increasingly reliant on the despair can be felt when contemplating it. cross-border trade of goods and services to With one in seven people in the world hungry, and predict trends in meet their own local needs. When dispute or most of them overseas, it’s easy to become conflict closes trade routes, food security can daunted and resolve to just “look after your food production as become a real issue. own” locally. At the Global Poverty Project, It’s not only during emergencies along with our community of Global Citizens, well as food prices. and disasters that people are hungry. we refuse to see it that way. The scale of the Emergencies only account for 8 percent of hunger problem is certainly large, but the food The improving quality the world’s hungry. There are close to one exists, the infrastructure can exist, the policies billion hungry people in the world who do can exist, if we collectively decide to have the of data and not make the headlines, and yet they go to willpower to stop human potential from being bed hungry every night. This is why long- wasted due to hunger. analytics available term efforts like school meals programs are As Global Citizens, we stand against so important. There is an untold amount of the greatest injustice of our time: extreme today enable evolving talent and innovation in the world that is poverty. We’re fighting because we know that trends in hunger and unable to be harnessed due to persistent a world that deprives 1.2 billion people of food and hunger problems that are not the their basic rights and opportunities is unjust food security to be product of wars. and unacceptable. We’re fighting because It is also important to address the we know that we must be the ones to do better anticipated, perception that the world’s hungry live in something about it. Africa. In 2014, that is just not true. Of the People living in extreme poverty are diagnosed and world’s nearly one billion hungry, more than working hard to break the cycle of poverty half live in Asia and the Pacific. Hunger is themselves, but that we need to learn, and reacted to. also a relevant issue in the United States, take action, to change the rules that trap them where 50 million Americans are food insecure. in broken global systems that have been in The African continent continues to have a place for far too long. The hunger myths and significant hunger problem in certain regions, misconceptions that have been explored in but inadequately fed and nourished people this piece are inextricably linked to the poverty live in middle-income countries and high- and a sense of justice, and in 2014, the fight income countries, too. Inequality in generally continues to extend dignity, health and hope to prosperous countries produces portions of the all of us, not just some of us. community who are unable to provide for their basic needs, and policy changes in this area can have a significant impact. Michael Wilson is the communications manager for A defeatist attitude to the hunger issue Global Citizen. is that hunger and famine are not easy to

12 INSIDER A World Without Hidden Hunger June 2014 FAILING TO FEED A HUNGRY WORLD GMOs BY KEVIN M. FOLTA ood biotechnology advocates frequently claim that GMOs will feed the from people that hate corporations more than world. It is an outright oversimplification and detracts from the technology’s they love people. It is a profound statement current applications, its limitations and, most of all, its fantastic potential. that integrates skepticism of technology and corporate mistrust with the fact those in need Most people, from scientists to the general public, understand there is no F are invisible to the majority of those in the one-size-fits-all answer to the complicated problem of world hunger. Nutrition industrialized world. deficits are due to unpredictable climate, crop disease or pests, or simply a The solutions that follow are not science lack of resources or mechanisms to get food to places where it is needed most. fiction—they are real, proven and on-the- It is a problem exacerbated by politics, religion, regional skirmishes, age-old edge-of-deployable technologies. These ethnic rivalries and many other factors that broaden this multifaceted inequity. transgenic (the scientific term for GMO) Biotechnology alone will not feed the world; it can’t. However, it will be part of an plants are literally dying daily in academic laboratories because there are no funds integrated plan that will bring welcome relief to many of those in critical need. to validate them for safety and efficacy in That is, when it is finally allowed to realize that potential. application, the next steps before moving them to productive use. Solutions are languishing Critics take pride in noting that the ranging in corporate greenhouses because there is no humanitarian promises of biotech agriculture profit to cover costs of deregulation and only have fallen far short of expectations. At vocal bad press via activist networks if they the same time, the same critics will claim are inched toward development. The following the technology is dangerous, untested and are examples from the actual scientific irresponsible. They’ll stoke efforts to limit its literature of plants alive and well today that Critics take pride in noting application, stop its study and taint public might soften the effects of food insecurity. that the ranging humanitarian perception with falsehoods. Projects with great opportunity for environmental or human promises of biotech benefit are vilified as ecological or personal Fifty percent of the world’s population agriculture have fallen far . Legitimate trials testing efficacy suffers the symptoms of , and safety are targeted for vandalism1 or installed from a diet lacking diversity and short of expectations. At the complete destruction under the guise of fresh food. There are biotechnology solutions. same time, the same critics “decontamination.”2 It is indeed ironic that Metabolic engineering is a discipline interested the same voices that vow to stop agricultural in changing specific chemical profiles in a will claim the technology is biotechnology also revel in its sluggish pace plant. In other words, it is manipulation of dangerous, untested and of deployment. biochemical pathways that can increase So what are the lost opportunities? (or decrease) the production of key irresponsible. They’ll stoke Solutions now exist that can provide lifesaving compounds. These may be vitamins and other efforts to limit its application, assistance to many throughout the world. Why phytonutrients of great benefit to the human have they not been deployed? The answer diet. In the industrialized world, staple foods stop its study and taint public to that question is, sadly, that a relentless are supplemented with everything from trace perception with falsehoods. misinformation campaign has erected a elements to vitamins and beneficial oils. Both barrier of fear that has blocked technology the developing and industrialized worlds could from reaching those that need it. It has been benefit from plant-based foods that simply said the opposition to biotechnology comes produced their own nutrient enrichment.

13 INSIDER A World Without Hidden Hunger June 2014 There are many examples where this has to diets, as well as profitability to farms. Yet been done in the laboratory—only to never be these proven technologies remain only as deployed to the people that need it. testimonials to biotechnological innovation The best referenced example is Golden confined to the pages of journals with no Rice, developed to be given away to immediate hope for application. subsistence farmers. The goal was to Simple biofortification alleviate deficiency, a disorder Meeting Challenges of Pathogens affecting 125 million children, with as many and Pests may have profound as 500,000 going blind annually. Golden Addition of the Bt gene to corn and cotton Rice was developed to help this problem by has substantially decreased insecticide use effects on third- installing genes required for the synthesis of in the industrialized world. This single compounds that are converted to vitamin A.3 blocks digestion and survival of targeted world human health Activists have firmly stood in the way of its insects, and is harmless to other animals. The and, in many cases, deployment.4 The lack of adoption of this same technology has had undeniable benefits vitamin-rich rice is estimated to have cost for some farmers in the developing world.12 may even extend 1.4 million human-life years5, a startling Other technologies show effects of transgenes number that illuminates the harm of non- against fungi in crops like potato.13 A plant benefits to livestock, action. The same technology has been gene called NPR1 has shown great promise integrated and demonstrated in other crops in combatting broad-spectrum diseases in adding more depth including wheat and . Cassava feeds a host of diverse backgrounds, including and richness to 250 million sub-Saharan Africans, yet it lacks staples such as rice.14 These solutions could nutrient density and key nutrients. Genetic allow growth of pest and pathogen-resistant diets, as well as engineering has developed plant products with crops throughout the world, leading to greater enhanced vitamin A, iron and levels.6 availability as well as less environmental profitability to farms. There are many examples of vitamin impact from insecticides, fungicides and the Yet these proven enrichment via biotechnology. Vitamin E, fuels needed to deploy them. an outstanding dietary antioxidant, has been technologies remain increased six-fold in corn through expression Growing in Marginal Areas of a single barley gene.7 Folate, required for Changing climates present new challenges only as testimonials normal fetal development, can be increased to traditional ways, and plants have been greatly in a diversity of crops, such as rice8 engineered with new genes to adapt to new to biotechnological or even tomato.9 Strawberry fruits have extremes. Many genes have been engineered innovation confined been modified with a strawberry gene to into plants to increase adaptability and deal increase the amount of vitamin C.10 One line with heat stress. Evidence of success comes to the pages of of transgenic corn has been developed that from a diversity of crops such as maize, bears three transgenes that fortify the kernels wheat, cotton, alfalfa and cassava.15 Flooding journals with no with more than 150 times the beta-carotene causes massive losses in rice, yet a transgene immediate hope for (a vitamin A precursor), six fold as much solution shows promise.16 Salt and aluminum vitamin C, and twice the folate.11 These are tolerance, drought tolerance, and the ability application. just a few examples that demonstrate science to grow through cold and freezes are all can create these products. possibilities based on laboratory evidence. Essential fatty acids (EFAs) have important roles in inflammatory response and Other Applications cardiovascular health, among others. Their In the industrialized world, 50 percent of synthesis is well-understood, and food goes to waste, while in the developing have been engineered into crops like soybeans world 50 percent is lost to spoilage. Genes and brassicas to change dietary levels in controlling the breakdown of plant materials, resulting oils. known as transgenics, will inevitably assist Simple biofortification may have profound in this process as well.17 Other “throw-away” effects on third-world human health and, in plant products may be made appropriate many cases, may even extend benefits to for human benefit. For every 1 kg of cotton livestock, adding more depth and richness fiber produced there is 1.65 kg of cotton

14 INSIDER A World Without Hidden Hunger June 2014 50% of food goes to seed produced, yet this protein-rich product is high in toxic compounds. It’s been shown that the can be genetically engineered WASTE out of the seed, leading to a new way to get protein to millions of people.18 These are just a few examples out of many examples of how transgenic plants have demonstrated abilities to solve problems. Now the question is developing the desire to move them to the places that need them the most.

IN THE INDUSTRIALIZED WORLD Conclusion I’ve never pushed the promise of “feeding the world,” mostly because one’s world to feed is a question of perspective. To those opposed to biotechnology, their world suffers from CASSAVA overnutrition, and offers the convenience of year-round produce and luxury choices from specialty markets. In that privileged world, it is easy to levy complaints against technology FEEDS that seemingly only enables farmers to produce agronomic crops destined for convenience foods, cattle feed, fuel and fiber. 250 But what about the world of a single mother in Zambia’s Western Province, where her million drive is seeking education for her children and enough day-to-day nutrition to elude sub-Saharan Africans inevitable deficiencies? What about the world of the 61-year-old subsistence farmer in rural yet it lacks nutrient density China that sees his annual yields crashing and key nutrients. because his summers have become hotter and drier? What about the world of the fifth- generation citrus farmer in Florida that is considering going out of business because of an unstoppable disease? Maybe biotechnology can’t feed the world, 50% but it can feed a world. And if that world is your world, your family’s world—it is an extremely of the world’s population valuable technology. Biotechnology solutions suffers symptoms of will never solve the problem of world hunger by themselves, but they will be part of integrated VITAMIN DEFICIENCY solutions. That is, if we have the courage, vision and compassion to implement them. due to a diet lacking diversity & FRESH Kevin M. Folta is the associate professor and chairman of the Horticultural Sciences Department at University of FOOD Florida, Gainesville.

15 INSIDER A World Without Hidden Hunger June 2014 References:

1. Tolentino V. Visit to vandalized Golden Rice 12. Kathage J. & Qaim M. “Economic field trial, 2013. impacts and impact dynamics of Bt (Bacillus thuringiensis) cotton in India.” Proceed Nationa 2. Shukman D. BBC News, http://www.bbc.com/ Acad Sci. 2012;109:11652-56 news/science-environment-18224637, 2012 13. Song J. et al. “Gene RB cloned from 3. Schaub P., Al-Babili S., Drake, et al. “Why Is Solanum bulbocastanum confers broad Golden Rice Golden (Yellow) Instead of Red?” spectrum resistance to potato late blight” Plant Physiolo. 2005;138:441-450 Proceed Nationa Acad Sci. 2003;100:9128-33

4. Potrykus I. “Nutritionally Enhanced Rice to 14. Sadumpati V., Kalambur M., Vudem Combat Malnutrition Disorders of the Poor” D. R., et al. “Transgenic indica rice lines, Nutri Rev. 2003;61:S101-04 expressing Brassica juncea Nonexpressor of pathogenesis-related genes 1 (BjNPR1), exhibit 5. Wesseler J., Zilberman D. “The economic enhanced resistance to major pathogens” J power of the Golden Rice opposition” Enviro Biotech. 2013;166:114-21 Developm Eco FirstView, 2014;5(1469- 4395):1-19 15. Ahuja I., de Vos R. C. H., Bones A. M., et al. “Plant molecular stress responses 6. Mayer J. E., Pfeiffer W. H., Beyer P. face climate change” Trends Plant Sci. “Biofortified crops to alleviate micronutrient 2010;15:664-74 malnutrition” Curr Opin Plant Bio. 2008;11:166-170 16. Xu K. et al. “Sub1A is an ethylene- response-factor-like gene that confers 7. Cahoon E. B. et al. “Metabolic redesign of submergence tolerance to rice” Nature. vitamin E biosynthesis in plants for tocotrienol 2006;442:705-08 production and increased antioxidant content” Nat Biotech. 2003;21:1082-87 17. Nambeesan S. et al. “Overexpression of yeast spermidine synthase impacts ripening, 8. Storozhenko S. et al. “Folate fortification of senescence and decay symptoms in tomato” rice by metabolic engineering” Nat Biotech. Plant J. 2010;63:836-47 2007;25:1277-79 18. Sunilkumar G., Campbell L. M., Puckhaber 9. Diaz de la Garza R. I., Gregory J. F., L., et al. “Engineering cottonseed for use in Hanson A. D. “Folate biofortification of tomato by tissue-specific reduction fruit” PNAS. 2007;104(10):4218-22 of toxic goss-ypol” Proceed Nationa Acad Sci. 10. Agius F. et al. “Engineering increased 2006;103:18054-59 vitamin C levels in plants by overexpression of a D-galacturonic acid reductase” Nature Biotech. 2003;21:177-81

11. Naqvi S. et al. “Transgenic corn through biofortification of endosperm with three vitamins representing three distinct metabolic path-ways” Proceed Nationa Acad Sci. 2009;106:7762-67

16 INSIDER A World Without Hidden Hunger June 2014 An Appetite for Change: How Companies and Nonprofits Are Collaborating to Tackle Undernutrition BY JAMES L. PHELAN

Undernutrition as Deadly Wasting (technically called severe acute malnutrition heir daughter was starving to death. Little Mariam was severely [SAM]) is deadly if left untreated—even malnourished at 18 months old when her parents brought her to an though it is largely predictable, absolutely Action Against Hunger-supported health center in the West African preventable and treatable with 90 to 95-percent success rates. T nation of Mauritania. Frail and listless from severe “wasting,” she At any given time, an estimated 52 million arrived weighing less than 10 pounds—half of what she should weigh—as her children suffer from acute malnutrition body’s vitals continue to weaken under the stress of severe acute malnutrition. worldwide—both moderate and severe— resulting in more than a million young lives Conjuring up negative images of Without the micro- or macronutrients lost each year, and devastating physiological spoilage or untapped potential, the term their bodies require, severely malnourished setbacks for the millions who survive. wasting is technical yet poignantly apt in children like Mariam can succumb to a type Luckily, little Mariam’s survival and recovery the field of emergency nutrition, referring of physiological reversal as their tiny bodies is becoming more and more possible for to the harrowing loss of body mass that begin to dismantle healthy tissue to keep millions of other severely malnourished boys young children can experience, often as a vital organs functioning. and girls. result of vanishing food sources (although An extreme form of undernutrition, the causes can vary). wasting that little Mariam experienced Global Burden & Underlying Causes Acute malnutrition has a number of causes and can often hide in plain sight. It affects large swaths of Sub-Saharan Africa, crops up in Central and Southeast Asia and is highly prevalent in South Asia. India, Pakistan, Indonesia, Nigeria and Bangladesh alone account for nearly 70 percent of acute malnutrition’s global burden. So we know where and when we can find this deadly condition, but what causes it in the first place? Acute malnutrition has a number of direct and indirect causes, including a seasonal dimension, which affects communities whose livelihoods are tied to the agricultural cycle and susceptible to cyclical disruptions (e.g., droughts and floods). When harvests fail or food prices spike, families are often forced to sell off assets, stretch meager reserves and skip meals—and this belt tightening can set off a debilitating cycle of illness and malnutrition for children under five years of age. And while economic shocks, political upheavals and natural disasters grab the headlines—and can certainly exacerbate a population’s nutritional well-being—the

Source: Calculation by Authors based on UNICEF-WHO-World Bank Joint Dataset

17 INSIDER A World Without Hidden Hunger June 2014 A mother feeds her child Plumpy'nut, the first ready-to-use- therapeutic food.

persistence of acute malnutrition depends Thanks to these new developments, it caretakers in delivering lifesaving care; on a host of more mundane factors (see was suddenly possible to rescue 90 to and treatment at home held the promise of infographic on page 19). 95 percent of all at-risk children in just four reaching millions of children who could never Luckily, proven methods exist to help to six weeks. To ensure these practices access treatment before. governments assess and respond to at-risk were as widely available as possible, Action Action Against Hunger carried out early communities—a package of nutritional Against Hunger left these products and field tests in 1997 to help develop protocols surveys, community outreach and protocols unpatented, and the U.N.’s World for the use of Plumpy’nut, and over the next therapeutic treatment programs. Integrated Health Organization (WHO) later adopted this decade RUTFs like Plumpy’nut have become into existing health systems, this package treatment package as the industry standard essential in expanding access to lifesaving can more systematically detect, track and for emergency nutrition. nutritional care (and have proven just as treat children for SAM. effective as inpatient care). The Ready-to-Use Revolution With the advent of revolutionary new tools A Therapeutic Breakthrough While these lifesaving products and like Plumpy’nut—and the scalable outpatient This package of proven approaches to protocols were effective in treating SAM, models they make possible—we can now preventing and treating acute malnutrition is they had their drawbacks. Treatment could reach the millions of children in need of a fairly recent development. only safely be administered in hospitals with lifesaving treatment each year. For years, treatment options were poorly access to clean water and round-the-clock Glimpsing a rare moment of historic adapted to severely malnourished children’s medical oversight, and the lengthy stays importance, the global community is now fragile bodies (whose and other imposed economic hardships on families poised to eradicate hunger-related deaths vital systems cease functioning) and an forced to leave livelihoods and other children for the first time in human history. appalling 25 percent of all children simply behind to travel for treatment. Despite being died during treatment. By 1994, however, effective, the cost of treatment was high and Nutrition’s ROI: Investing in Action Against Hunger’s Scientific Committee only some 3 percent of the children in need Scalable Solutions developed and tested two therapeutic had access. More than a decade later, these formulas with game-changing results. A second revolution took place in 1997 revolutionary advances in nutritional With the advent of Action Against when Action Against Hunger’s F-100 care began to gain support in the policy Hunger’s specialized F-75 and F-100 milk milk formula was repackaged as a more realm, with a growing recognition among formulas (named for their caloric contents), stable peanut butter-based product called international actors and governments the humanitarian community found its Plumpy’nut, the first ready-to-use-therapeutic that investments in nutrition hold first effective treatment against this global food (RUTF). This ground-breaking particular promise. scourge. Capable of reversing the ravishes formulation solved a number of problems: A range of economists and public-policy of severe acute malnutrition, this treatment Plumpy’nut required no refrigeration or experts now agree that global investments dropped mortality rates for severely mixing with water; it had a long shelf life in childhood nutrition offer the biggest malnourished children by 75 percent during and could be stored anywhere; it opened returns when compared to all other social treatment, down to just 5 percent from an the door to treating children at home instead expenditures. A group of the world’s top unacceptably high 25-percent rate of loss. of in hospitals, empowering parents and economists, known as the Copenhagen

18 INSIDER A World Without Hidden Hunger June 2014 Action Against Hunger uses the Conceptual Framework for Nutrition to identify the factors needed to ensure a child’s good nutrition. The factors in a child’s immediate environment are reliant on underlying factors in households and communities. THE PATHwAy TO These, in turn, depend on the effective functioning of elements at the national level GOOD NuTriTiON – the basic factors. If any of the basic or underlying factors are missing, it is likely that the immediate factors will not be present and the child will be at increased risk of undernutrition.

ImmEDIATE FACTORS

Adequate dietary intake Disease-free, preventive and curative environment

UNDERLyING FACTORS

Health services and Food security Optimal care practices healthy environment and livelihoods • Optimal breastfeeding • Physical, social and economic • Adequate and appropriate complementary access to adequate health services • Access to affordable and nutritious food feeding of infants and children • Adequate sanitary facilities and at all times • Development of the parent-child bond and the clean water • Adequate food production child’s social skills and cognitive stimulation • Safe environment at home • Year-round employment opportunities • Positive hygiene and health practices (limiting the • Predictable and manageable • Ownership of / access to land impact of harmful cultural practices) natural environment

bASIC FACTORS

Political Economy Society • Democratic governance systems • Economic growth and • Environmental protection and • Absence of conflict and sustainable development recycling of resources instability • Stable, predictable food prices • Gender equality (including • Absence of discrimination • Transparent companies which women’s education and protection of girls from • Transparent, corruption-free pay the tax that is due underage marriages) government • Equitable distribution of incomes • Respect for and promotion of human rights • Adequate land rights $

SOmE OF THE ROOT CAUSES OF UNDERNUTRITION confLict food prices gender eQUaLitY A COUNTRy LOSES AN AvERAGE OF 30 yEARS IN 2008 A 6.8% RISE IN FOOD pRICES wORLDwIDE wOmEN pRODUCE bETwEEN 60 AND 80 pERCENT OF ECONOmIC GROwTH TO CIvIL wAR AND ITS INCREASED THE NUmbER OF mALNOURISHED OF THE FOOD IN mOST DEvELOpING COUNTRIES INTERNATIONAL TRADE TAkES ON AvERAGE 20 yEARS pEOpLE by AN ESTImATED 44 mILLION yET THEy OwN LESS THAN TwO pERCENT OF TO RECOvER (THE STATE OF THE wORLD ATLAS, 2013). (FAO FOOD pRICE INDEx 2013) THE LAND (OxFAm 2013)

Land rights tax revenUe cLimate change LAND ACQUIRED THROUGH LARGE-SCALE LOw-INCOmE COUNTRIES COLLECT AN by THE END OF THIS CENTURy CLImATE CHANGE LAND ACQUISITIONS IN THE LAST DECADE AvERAGE OF 13% OF THEIR GROSS DOmESTIC pRODUCT IS LIkELy TO DOUbLE THE FREQUENCy OF ExTREmE IS ENOUGH TO FEED A bILLION pEOpLE THROUGH TAx REvENUES COmpARED TO 35% IN DROUGHTS AND INCREASE THEIR DURATION by (OxFAm 2012) HIGH-INCOmE COUNTRIES (bRITISH INTERNATIONAL SIx TImES (STERN REvIEw 2006) DEvELOpmENT COmmITTEE 2012)

19 INSIDER A World Without Hidden Hunger June 2014 Consensus, were asked where they would espionage as employees lunched off-campus, start if they had $75 billion to invest in they quickly began to see good nutrition worthwhile causes. Their number one answer as an end in itself, as an essential building was investing in nutrition to fight hunger, given block for productive employees and healthy the estimated returns from basic interventions corporate communities—the fuel that gives like micronutrient supplementation and their workforce collective lift and propels the fortification in transforming lives and improving company forward. the health of entire communities. Google’s Global Food Service team— “Google’s vision These recommendations echo the which sources, prepares and serves more evidence-based findings on maternal and than 60,000 meals each day to employees for its food infant undernutrition published last year in The around the globe—has begun to formalize the Lancet. Listing a number of nutrition-specific company’s vision for leadership in the food, program is to investments with proven returns, these public- nutrition and sustainability space, broadening health experts offer up a range of simple its scope and forging Google into an agent of inspire the world interventions—improved access to therapeutic change and inspiration. care, targeted micronutrient supplementation As part of this new strategic direction, to use food and better care practices (e.g., breastfeeding, Google envisions inspiring the world—and its handwashing, etc.)—that have the biggest own employees—by using food experiences experiences and payoff for maternal, newborn and infant to foster more sustainable lifestyles and health, and that ultimately underwrite the long- choices; leveraging its market leadership, choices to develop term health and development of vulnerable brand visibility, corporate assets, and communities worldwide. purchasing power to improve local access more sustainable And while policy recommendations have to sustainable food options and nutrition never been more aligned with the tools at our education; and working with strategic cause lifestyles and disposal, we still lack the requisite political partners to enhance the impact of its nutrition commitments and financial wherewithal to programs—Action Against Hunger, for its communities.” reach the millions of children in need. global focus on undernutrition, and the Jamie Luckily, there is growing interest and Oliver Food Foundation, for its domestic focus – Michiel Bakker, involvement from the private sector in helping on overnutrition. to lay the groundwork for greater investments Ultimately, Google’s partnership with Action director of global in nutrition worldwide. Against Hunger and the Jamie Oliver Food Foundation aims to create global recognition food services, Partnering for Nutritional Impact: around the role that food and nutrition can Google’s Leadership play in driving vital social change. Google Inc. Corporate social responsibility (CSR) has evolved from simple check writing to more Employee Engagement for strategic involvement in causes aligned Lifesaving Nutrition with a company’s core business offerings. Although this partnership is still in its Collaborating with cause organizations fosters infancy, much was achieved during the first deeper commitment, greater openness and year of collaboration. strategic sharing on the realities of achieving Through a series of employee engagement social impact. activities, Google and its workforce raised Google Inc. has emerged as a socially more than $1.2 million for Action Against responsible corporate leader with a strategic Hunger’s lifesaving programs in 2013. interest in food, nutrition and sustainability. Building on Google’s unique organizational Google’s association with food can be culture, Action Against Hunger participated misperceived as beginning and ending with in employee-led initiatives (e.g., a Ramadan- the gourmet meals its workforce enjoys free of inspired fast-a-thon); the annual company- charge, but this is just the starting point. wide World Food Day Campaign; teamed While Google’s corporate food program up with Google’s gCorps volunteers for certainly began as a way to shape its technology support; and collaborated with unique culture, entice and retain employees, talented individuals through the company’s maximize productivity and guard against famed 20-percent opportunities (i.e.,

20 INSIDER A World Without Hidden Hunger June 2014 employees can dedicate 20 percent of their child with lifesaving therapeutic care. To produced ingredients and products, and time to projects of their choosing). encourage giving, Google committed to inspiring employees to take broader Google’s year-end World Food Day match each employee’s donation, thereby responsibility for what is consumed, wasted Campaign is a powerful example of the doubling their impact. and available for others. private sector laying the groundwork for Each office, department and project team Purchasing Power for Local Access: greater investments in global nutrition— were challenged to meet specific fundraising Corporate food programs can play a broader and of a global company can integrate such targets, with the aim to help Action Against role in bettering community access to efforts into existing organizational cultures Hunger save an additional 30,000 young lives nutritious and sustainable food sources. while harnessing employee pride, talent and in the final months of 2013. The campaign Harness your company’s purchasing power, enthusiasm. Google has infused working raised an extraordinary $846,000 in a work directly with vendor, and liaise with toward positive social change into month and a half, which enabled lifesaving local institutions like public schools to find its corporate DNA. treatment for more than 17,000 children, common ground for making nutritious foods The World Food Day campaign was a handful of whom were profiled in a post- more locally available and appealing. designed as an internal marketing effort and campaign Impact Report. Adopt a Nutrition-Sensitive Global rolled out across all of Google’s campuses The campaign’s end results—an infusion Program: Action Against Hunger helps and offices worldwide. With the central call of funding and a broadening of support— communities enhance their long-term to action embodied in the campaign’s “Save have enhanced Action Against Hunger’s nutritional well-being—bolstering Gilbert” messaging—a child Action Against ability to address global malnutrition, agricultural programs, jump-starting local Hunger treated in 2013—each Google ensuring that a greater number of the markets and supporting income-generating employee was challenged to contribute $50, 52 million children who suffer from acute opportunities—by ensuring local access which can provide a severely malnourished malnutrition can access the support they to a diversity of nutritious foods. We help need to survive and thrive. millions of people each year, but we could do much more with the right partners. We How Food & Beverage Leaders invite leading food and beverage companies Can Help and employees to adopt a program to help Google’s strategic interest in the food, others help themselves. nutrition and sustainability space serves Join FoodLove: Action Against Hunger’s as a solid example for other companies— innovative cause-marketing initiative, especially those in the food and beverage FoodLove offers food and beverage leaders industries—looking to deepen their own unique ways to support lifesaving nutrition. involvement in vital causes with clear returns Uniting food enthusiasts and brands in on investment. the food, beverage and hospitality sectors, As this partnership evolves, Action FoodLove connects those who celebrate Against Hunger and Google hope to inspire food and care about hunger, harnessing other individuals and brands to join in food’s inherent ability to build community, building awareness and securing the private transform lives and help the hungry. Join us resources needed to expand the ready-to- in celebrating food and community as we use revolution—because no child should provide lifesaving nutrition. die of hunger in the 21st Century, and this preventable scourge can be eradicated in our lifetime. So get involved! James L. Phelan is deputy director of external relations Harness Your Food Program for Good: for Action Against Hunger, the global humanitarian Using its corporate food program to inspire organization focused on child malnutrition. sustainable lifestyles and communities, Google’s pioneering model offers lessons for companies offering employee meals. Find out how your company’s food service options can be a force for good, offering health-enhancing meal options, engaging vendors to improve access to sustainably

21 INSIDER A World Without Hidden Hunger June 2014 Food Fortification: A Lasting Nutrition Solution

BY SAMY JANDALI

hen our intake of protein, or carbohydrates is inadequate, we The Challenge of Global Malnutrition feel hungry; however, when our intake of equally vital vitamins Although people in many developing and minerals is inadequate, we do not. Micronutrient deficiencies regions have access to staple foods such as flour or rice, these often contain are therefore also known as hidden hunger. It is estimated that W only small amounts of micronutrients. one-third of the world´s population suffers from hidden hunger. and Foods rich in vitamins and minerals, micronutrient deficiencies have severe consequences on health, and can such as vegetables, fruits, meat, milk result in weakened immune systems and higher mortality rates, especially in and eggs are either not available or too children, and pregnant and lactating women. Children often carry the burden expensive for poor populations. Lack of of early malnutrition into adulthood. essential nutrients pulls people into a vicious circle, as micronutrient deficiencies lower school and work performance and The private sector is helping to eradicate with iron or zinc are widely consumed. But in productivity, which can lead to poverty and malnutrition by fortifying foods with essential parts of the world where and ultimately poor health. micronutrients, thereby improving health consumer education are not as developed and worldwide. In industrialized countries, milk a majority of the population lives in poverty, fortified with or omega-3s, edible malnutrition remains a challenge—and fats with added vitamin A, and fortified fortification an opportunity.

Micronutrient deficiency Low deficiency Medium deficiency

Medium/High deficiency High deficiency Source: BASF and Maplecroft™

22 INSIDER A World Without Hidden Hunger June 2014 Food Fortification as a Solution: facilitate and support fortification programs. Small Amounts of Vitamins = BASF’s alliance partners include UNICEF, Global Huge Impact on Society Helen Keller International, GIZ1 and the Global Food fortification is the practice of Alliance for Improved Nutrition (GAIN). These Prevalence of deliberately increasing the content of fortification alliances raise awareness and micronutrients in a food to improve its facilitate dialogues between the Micronutrient nutritional quality. Fortified foods are often, and government to help create a favorable but not limited to, staples including edible oil, environment for fortification. The public sector Deficiency , flour, , salt, milk, and condiments collects and analyzes national malnutrition such as bouillon cubes and soy sauce. Staples data and defines need-based fortification are the cheapest among foods, and the most levels to meet dietary habits across widely consumed by people living in poverty. population groups. Based on this information, 33.3% of children and Innovative and affordable packaged foods development partners provide policy advice and beverages have been developed and to local authorities on setting food fortification 15.3% successfully introduced to relevant markets standards. Furthermore, they help organize by multi-domestic and local food companies campaigns for fortified foods in collaboration of pregnant alike. Innovators are rethinking ways to with food producers, and introduce supportive, women are produce affordable yet nutritionally valuable informative logos offering a competitive deficient in products such as cookies, snack bars, yogurts advantage in attracting and educating and milk drinks, and seasonings for low- customers about the added health value. All vitamin A income consumers. these contributions result in an economic Among the most essential micronutrients and political framework that helps fortified are vitamin A, iron, zinc, iodine, vitamin D products serve underserved consumer groups. of people do and omega-3. Deciding what micronutrients Complementary to such public sector 17.3% to use in which foods should be guided by activities, BASF supports interested food not take in adequate the specific population’s nutritional needs, companies in producing safe and cost- its local eating habits and its financial means effective fortified foods. As a producer of amounts of zinc micronutrients, BASF developed stable and necessary to most effectively realize a public robust products that are easy to apply and health benefit. economically viable. These products are Food fortification is truly affordable: adding especially suited for markets with difficult vitamin A to edible oils increases 18.1% conditions, such as warm temperatures, the price per bottle by only 0.2 percent— humid climates and challenging storage of children just a fraction of a penny. The bottom line: conditions. Local and international food fortified foods are meeting local consumers’ and producers are provided with onsite technical essential needs and empower people 19.2% of in developing countries to escape from pregnant poverty’s vicious circle. Vicious Circle of Micronutrient Deficiencies with Disease and Poverty women suffer from Technical Trainings iron deficiency anemia Food fortification programs require a favorable market environment including Sickness relevant governmental standards, labels indicating which foods are fortified, publicly Micronutrient 28.5% of people supported procurement and distribution, and malnutrition Low performance even social marketing campaigns advocating are iodine deficient the benefits of food fortification. These activities support businesses in reaching new Low productivity Source: The Lancet – Maternal and Child markets with food fortification—namely those Poverty Nutrition Series 2013 most in need: the base of the income pyramid. In many counties, strategic alliances, Low income including with governments and international organizations, have been established to Source: UNICEF, Helen Keller International and BASF Partnership Leaflet 2014

23 INSIDER A World Without Hidden Hunger June 2014 Social and analytical assistance in fortifying What’s in it for the U.S. Food Business? their food products. BASF helps in U.S. food companies supply to numerous Case defining the correct fortification level, countries facing micronutrient deficiencies. selecting and installing the right Nutritional needs can be addressed by equipment, as well as supporting and fortifying affordable exported foods using training staff in production, marketing quality nutrients and using an operational and laboratory work. shared-value business model. International Food Shared Through its product solutions, organizations, governments, foundations Fortification technical assistance, scientific capacities Projects and civil society stand ready to support U.S. Value and partnerships with academic and companies in such efforts by promoting social public-interest organizations, BASF is marketing initiatives and labeling programs. engaged in programs in more than The Bill & Melinda Gates Foundation, one of 30 developing countries that assist the largest private foundations in the world, food producers and the public sector is just one example of a supporter of public- in reducing micronutrient deficiency. private partnerships. Business BASF developed an innovative, multi- BASF asks interested food companies to step analytical process to determine join in exploring the opportunity to address Case vitamin A levels in a variety of different a humanitarian challenge in an economically foods with portable and easy-to-apply field sustainable fashion. Through our technical test kits. With little training, the test kits can and partnership support, we stand ready be used by local food industries, governmental to help food companies make combatting authorities and academia to determine the hidden hunger in developing countries a part levels of micronutrients in fortified foods. of their business. The test kits are easy to use and the most cost-effective tool for quick-spot analysis of micronutrient contents, with one test costing Samy Jandali is the vice president of BASF Nutrition only 1 cents to 5 cents. BASF distributes these & Health, North America. Visit food-fortification.com test kits free of charge to customers and food- for more information or contact BASF at fortification partners. [email protected].

The BASF Food Fortification Initiative: Combining Business Interests and References: Development Goals 1. Deutsche Gesellschaft für Internationale BASF works with private-sector partners Zusammenarbeit, comparable to the U.S. and public-interest organizations such as Agency for International Development the U.N., governments, academia and non- government organizations (NGOs) to ensure the success of its food- fortification projects. BASF pursues a shared-value approach, meaning that it combines development goals and business interests. With this approach, BASF’s engagement goes beyond “usual” business activities. It’s not only about profits nor is it charity; it is a financially self- sufficient approach to advancing essential nutrition and development.

24 INSIDER A World Without Hidden Hunger June 2014 Health in Action: A Garden of Transforming Agents BY FABIO ACERBI

razil is the largest country in Latin America and, by most accounts, workers and communities’ members. All the a prosperous nation. On the other hand, according to the U.N. efforts had been dedicated to: Food and Agriculture Organization (FAO), 8.5 percent of Brazil’s • Providing a more nutritious diet for 200,000 children by increasing the availability population still lives in extreme poverty. The lack of healthy habits B of fresh produce through school and home and good nutrition may lead to several negative consequences, including, gardens, supplemented by nutrition and but not limited to, worm diseases and iron-deficiency anemia that can have healthy lifestyles education for teachers, devastating consequences on children’s physical and cognitive development, students, cafeteria workers and families of permanently stunting their growth and intellectual potential. school-age children. • Enhancing nutrition knowledge and Background increasing food security for these children In 2009, the Mondelēz International and their families and neighbors by training Foundation focused on investing in a and actively involving parents and other family community program about healthy eating members in the program. in Brazil, and looked for a trained and • Improving children’s overall health experienced local partner on the subject. and nutritional status by treating them as INMED Partnerships for Children, INMED needed for intestinal parasitic infections that 8.5 percent of Brazil’s Brasil and the Foundation partnered rob them of vital nutrients, identifying and together to create Health in Action, a correcting micronutrient deficiencies that population still lives in program dedicated to improve the nutritional compromise their physical and cognitive health of children in communities where development, and providing biomedical extreme poverty. The Mondelēz Brasil has operations: Bauru (SP), (weight and height), parasitological (feces) Piracicaba (SP), Curitiba (PR) and six cities and hemoglobin (blood) tests. lack of healthy habits in Pernambuco (where the Vitória de Santo The first three years had five specific goals: and good nutrition may Antão’s plant was about to be inaugurated). a. improve nutritional intake; The USD$2.25 million grant for this program b. improve body mass index; lead to several negative represents the largest social investment ever c. decrease anemia; made by the Foundation in Latin America. d. decrease intestinal parasitic consequences that infection; and can have devastating Health in Action’s Mission e. increase nutrition and improve Since 2010, Mondelēz International behaviors. consequences on Foundation and Mondelēz Brasil, together with All project sites have standardized lunch INMED, led the Health in Action in nine cities in menus issued by the local departments of children’s physical and three states in Brazil. The project began with a education, most of which include vegetables three-year proposal that was extended for one as a regular component. To improve cognitive development, more year (2010-2013). nutritional intake, Health in Action planted This public school-based program has 109 full gardens in more than 100 schools. permanently stunting educated children and their families on good Cafeteria workers had a more reliable supply their growth and nutrition, healthy lifestyles practices, and of fresh produce and were able to adjust preventive health, hygiene and sanitation their daily menus to accommodate the intellectual potential. measures. Considering local needs where it vegetables available for harvest. At the same was implemented, the program is focused time, children were much more willing to eat on school-age children, teachers, cafeteria vegetables, once they had grown them with

25 INSIDER A World Without Hidden Hunger June 2014 Children harvesting vegetables in one of the full gardens built by the program

their own hands. Their understanding of the borderline hemoglobin levels. Following iron treatment has made a difference, and importance of a healthy diet improved, and supplementation combined with the provision ongoing preventive health, hygiene and the cafeteria workers were trained on how of iron-rich vegetables through school sanitation education through the Health in to prepare and present fresh produce in gardens and nutrition education to promote Action program will help sustain those gains. appealing ways. healthier eating at home, fewer than one in Lastly, the goal to increase knowledge At the end of year four, 58 percent of 10 children, on average, are anemic, and just and improve behaviors was focused on schools with gardens produced enough to more than one-fourth remain at risk by the having more children washing their hands, supply the school meals at least three times a end of the program period. brushing and flossing their teeth, and week. Additionally, eight community gardens Another issue mentioned was poor drinking filtered water (rather than tap water, were established. More than 800 families sanitation infrastructure and lack of access which is often contaminated), in addition to had built their own home vegetable gardens, to clean water, combined with limited eating a healthier diet—all essential building improving their nutrition, saving money on knowledge of preventive health and hygiene blocks for a healthy lifestyle. household food expenditures and contributing practices, resulting in endemic infection with In the fourth year, the key strategy was to to a sustainable future. intestinal parasites. These infections can help the program become more sustainable On improving body mass index (BMI), our compromise children’s physical and cognitive by giving more guidance to schools that objective was 75 percent of children outside development at the most crucial time in their needed more help, and preparing them to normal BMI range at baseline would show lives, sapping vital nutrients, energy and become more autonomous. This was the way improvement in their BMI. This objective was appetite, and ultimately stunting infected to secure Health in Action program’s long-term based on a three-year period of participation children’s growth and learning potential. sustainability and highlight the program as a and we saw truly significant improvements in At baseline in Pernambuco state, between model of multi-sector collaboration with a real the children who had been actively involved in 4 and 14 percent of children were infected impact on the health and lives of children, their the program. with intestinal worms. São Paulo and schools, families and communities. Meanwhile, the work to decrease anemia Paraná states have better infrastructure and The resources had to be adequate to was focused at baseline in Pernambuco therefore minimal infection rates. Although continue the program. Therefore, local state, where clinical anemia was identified these levels were not high in the context governments provided contributions for staff, as a significant concern; its of global prevalence, they nevertheless equipment and supplies to support ongoing affliction rates ranged from more than one represent hundreds of children whose health development of school gardens. Parents in five children to more than one in three was at imminent risk. Following semiannual and community volunteers took an active children with anemia. Furthermore, one in deworming treatment, infection rates were role in maintaining the gardens and the three children were at risk for anemia, with reduced by as much as 85 percent. Clearly, schools integrated the program into school

26 INSIDER A World Without Hidden Hunger June 2014 Students of one of the public schools assisted by Health in Action

curriculum. All of these efforts were made so cities in three states, reaching more than the community could take ownership of the 200,000 children and 1,716 cafeteria whole project. workers, in 430 schools, as well as 364 family health teams and more than 4,500 Results community health agents. By the end of the fourth year, we conducted comparative assessments in The Future three areas: BMI, feces examinations of As we look to the future of the Health in intestinal parasitic infection and hemoglobin Action program, we plan to expand not only tests to determine the incidence of anemia. the number of schools and communities In Pernambuco, the statistics confirm the involved, but also the scope of work. Mondelēz significant positive outcomes: the percentage International Foundation had identified a new of underweight children decreased in all but and complementary focus to the program: one town, while overweight children were increasing physical activity for school-age reduced in every site. children by training physical education In Pombos (Pernambuco’ state), following teachers. This component will be delivered two courses of iron supplementation for by a new partner: IEE (Instituto Esporte & children whose hemoglobin levels indicated Educação), founded in 2001 by Ana Moser, iron-deficiency anemia or risk of anemia, the a Brazilian ex-volleyball player, which is percentage of children with anemia decreased known for its principle of using sports as an by 15 percent and the percentage at risk educational tool. decreased by 44 percent. This new phase meshes INMED’s and IEE’s The incidence of intestinal helminth (worm) expertise and goals with those of Mondelēz infection, already very low at baseline, was International Foundation to implement a more eliminated. The prevalence of protozoan holistic school-based program that uses infection —commonly transmitted through nutrition education and active play as enablers contaminated water — decreased by 82 for children well-being and helps educate, percent, reflecting the likely impact of the but also transform behavior and practices of Health in Action program’s hygiene and institutions and families around healthy living. sanitation education component. Mondelēz International Foundation, Mondelēz Brasil and INMED are proud of Fabio Acerbi is the corporate affairs director at the results Health in Action achieved: nine Mondelēz Brasil.

27 INSIDER A World Without Hidden Hunger June 2014 FIGHTING HIDDEN HUNGER with Fortified Foods BY APARNA PARIKH

The Challenge of Hidden Hunger and intellectual development, blindness, e doesn’t look hungry; he eats two meals a day. But Michael, age 3, a little and, ultimately, the death of many children boy from a community in Tanzania, is representative of the one in three and mothers. Over time, hidden hunger can have people around the world who suffers from hidden hunger—the chronic a devastating impact on the social and H lack of vitamins and minerals essential for children to survive and thrive. economic development of a country by compromising the health and productivity of its population. There is compelling evidence that improving nutrition in developing countries is fundamental to breaking the cycle of poverty. The solution costs as little as $0.40 per person per year, but implementing this solution takes more than money. Food fortification offers an inexpensive and universal solution. Fortification of staple foods means adding essential micronutrients (vitamins and minerals that can only be obtained from the diet) to foods such as rice, flour and sugar that are widely consumed by a given population. However, to achieve sustainable improvements in a population’s nutritional health through fortification, a country must establish national food and nutrition policies, and strict standards for quality assurance, monitoring and evaluation. Moreover, its food industry must develop the Michael, age 3, is a Tanzanian toddler technological expertise to add nutrients to foods safely and consistently. suffering from hidden hunger. In 2013 two organizations—DSM and World Vision—forged a partnership to fight hidden hunger. The long-term goal of the Michael primarily eats one thing: maize. partnership is to create sustainable programs It fills his belly, but it does not fully nourish that will reduce the number of children under his body. He is losing his hair and he is very age 5 who are stunted in growth due to small for his age. His baby brother, half malnutrition, which is currently estimated at his age and still breastfeeding, is already 165 million. almost as big as Michael. Hidden hunger The scientific and technical expertise of disproportionately affects women and DSM and the community-based “boots-on- children in the poorest parts of the world. the-ground” community development expertise It leads to nutritional anemia, depressed of World Vision provide the perfect blend of immunity, stunted growth, impaired mental strengths to tackle the roots of hidden hunger.

28 INSIDER A World Without Hidden Hunger June 2014 ‘Millers Pride’ Encourages Fortification with essential micronutrients, which in turn in Tanzania will contribute to improved nutrition along the The first project, Millers Pride (Lishe Bora), coastal regions of Tanzania. was launched in June 2013 in the Dar es During its initial phase of approximately Salaam region of Tanzania. According to 18 months, the Millers Pride project is Elifation E. Towo, Ph.D., principal food scientist developing working relationships with up at the Tanzania Food and Nutrition Center, to 150 medium-scale processors to fortify About 22 million lack of essential vitamins and minerals is a approximately 150,000 metric tons of Tanzanians are served major nutritional problem among children and maize flour. Project personnel are also women in the region, especially women of working to develop the policies, institutional by medium-scale reproductive age. capacity and consumer awareness that will Nutritional anemias, caused by inadequate drive sustainability. millers who produce intake of the nutrients needed for the After the first feasibility trials, there have synthesis of hemoglobin—iron, folate and already been positive signs of consumer approximately 70 among others—can lead not acceptance, which is an important factor for percent of the maize only to growth stunting in children, but also the milling industry. Chaoga Tonge of Kimvuli maternal mortality, spontaneous abortions, Grain Mills, where the trials were conducted, flour consumed in the premature births and low birth weight. said people who tested fortified maize flour Deficiency of vitamin A depresses immunity gave positive feedback and were looking country. The DSM/ and can cause serious vision problems, forward to using it in the future. Some— including blindness. mostly mothers—were asking to buy fortified World Vision Millers At a recent press conference, Towo maize flour immediately, but it will not be Pride project is teaching cited statistics from the 2010 Tanzania widely available until the project reaches a Demographic and Health Survey showing stage where millers can start fortification. and empowering these 33 percent of children under age 5 and The Millers Pride program is also working 37 percent of women are lacking vitamin A; to establish a Millers Academy linked to a millers to fortify their 59 percent of younger children and 41 percent local academic institution that will provide of pregnant women are low in iron; and iodine training in all aspects of the milling industry flour with essential is inadequate in 7 percent of all Tanzanians. and award certification from the Millers micronutrients, which In the Dar es Salaam region, approximately Association to graduates. Ultimately, the 42 percent of children under age 5 are academy will offer a distance education in turn will contribute to stunted and 16 percent are underweight. option that allows working millers to attend A major contributing factor in the region courses during weekends and evenings. improved nutrition along is a diet based primarily on processed and refined maize flour, eaten as stiff porridge the coastal regions of known as ugali. In Tanzania, like many other Tanzania. developing countries, there has been an urban migration as increasing numbers of people abandon their rural farming lifestyle and move to the towns and cities. Now they purchase their flour from shops instead of milling their own maize. “The only way to combat the problem of widespread malnutrition here is to introduce the technology for incorporating the required vitamin and minerals into staple foods such as maize flour,” Towo said. About 22 million Tanzanians are served by medium-scale millers who produce approximately 70 percent of the maize flour consumed in the country. The DSM/World Vision Millers Pride project is teaching and empowering these millers to fortify their flour Chaoga Tonge, a Tanzanian miller who is participating in Millers Pride.

29 INSIDER A World Without Hidden Hunger June 2014 The DSM/World Vision partnership also window of opportunity—from conception until a supports like-minded institutions including child reaches 2 years of age—has a dramatic the Tanzania National Fortification Alliance impact on the child’s physical and cognitive and the Partnership for Nutrition in Tanzania development and substantially improves his by attending meetings, engaging in public prospects in adulthood. High-quality nutrition relations activities and participating in donor in this phase lays the foundation for a future in forums. It complements Tanzania’s National which children grow up capable of leading the Fortification Program, which mandates struggle for progress in their own communities fortification of wheat flour, maize flour and and countries. cooking oil through large scale industrial food “We are very encouraged at this one- fortification, as well as a rural fortification year mark in the project,” said Emmanuel program that is currently in its pilot phase. Kibala, project coordinator in Tanzania. The second phase of the Miller’s Pride “To date we’ve been able to network with (Left to right) Klaus Kraemer, project extending through 2016 will target 88 maize mill owners and 94 maize flour director of DSM’s humanitarian small-scale processors, who are widely traders who are processing their maize nutrition think-tank Sight and dispersed across the country and pose a in Manzese and Tandale, raising their logistical challenge in terms of product supply awareness on the nutritional and business Life; Kevin Jenkins, president of and technical support. The approach is to advantages of fortifying maize and gaining World Vision International; and apply lessons learned in phase one with their commitment to begin production. The Phillip Mpango, Ph.D., executive medium-scale millers to the small-scale first 20 mill owners and 10 maize flour millers and consumers in outlying areas, along traders anticipate receiving final certification secretary of the Planning with experience gained from a previous rural and starting production of fortified flour in Commission in the Office of the fortification project implemented by World September 2014.” Tanzanian President cement Vision from 1996 to 2005. Fortification of staple foods in Tanzania was officially launched by the country’s their partnership during an event Anticipated Project Impact president, Jakaya Kikwete, in May 2013. at the U.N. General Assembly This approach addresses two root issues of “Our goal is to scale up production of fortified in New York. Photo courtesy of chronic poverty simultaneously—malnutrition foods countrywide over the next several and economic development—and the impact years,” said Phillip Mpango, Ph.D., executive Sight and Life. will radiate throughout the community and secretary of the Planning Commission in the the country. The lives of children like Michael Office of President Kikwete. “We are deeply and millers like Tonga will be transformed by appreciative of the commitment DSM and Miller’s Pride. World Vision have made to help us solve our Children like Michael will still eat their country’s nutritional problems and create a porridge twice a day, but because of food brighter future for our children.” fortification, they will receive more of the essential nutrients they need. They will begin to grow and develop more normally. Their Aparna Parikh is the head of communications, human bodies will be stronger to play, and they will nutrition & health, North American, at DSM, a global be better able to concentrate and learn in Life Sciences and Materials Sciences Company school. Millers like Tonga will benefit from specializing in the production of vitamins and other improved processing technology, leading nutrients used as ingredients. DSM supports global to better products, broader markets and efforts to improve diets by fortifying staple foods and improved revenue. In turn, they will be able making vitamin and mineral supplements affordable to hire more employees and help reduce to the poor. poverty in their communities. World Vision is a global Christian relief, development Pregnant and lactating women will be able and advocacy organization that works in nearly 100 to bear and raise stronger infants. Optimizing countries with a specific focus on improving the well- the quality of nutrition for pregnant women being of children. and their infants during a critical 1,000-day

30 INSIDER A World Without Hidden Hunger June 2014 The Buy-One-Give-One of Peanut Butter:

BY MARK SLAGLE

hen I hear alarming stats such as, “Every six seconds a child windows of their development. I am far from dies from issues related to malnutrition,” sometimes it is having kids of my own, but I know that milk difficult to put them into context. They seem so dramatic, makes my bones grow (and my Oreos soggy). Children who are dying (daily) from the most so alarming that my brain would rather move on to the rest W advanced form of malnutrition used to have to of my Facebook feed. I’m 25 years old; give me more highlights of the rely on powdered milk or an IV from a doctor NBA playoffs, more YouTube pranks and movie reviews, more Instagram for these nutrients, because their mothers selfies. I don’t want to be a part of such a devastating narrative around were so malnourished. No milk at that age malnourishment, especially when it’s so often told with such little hope. turns into no brain development, no muscle My friend Alex and I lived that in that bubble for years until we stepped growth and a weak immune system. The old into the cockpit of a 1971 Winnebago and the conversation about global ways of powdered milk and hospital visits had many hurdles—from a need for more space in malnutrition was flipped upside down by a missionary turned entrepreneur hospitals to a lack of clean water to mix with named Mark Moore and a packet of peanut butter. the powdered milk. Still, the love of a mother for her child is strong. Mothers would walk Mark Moore is the founder of a non- the state of children suffering from severe days to get to a refugee clinic to seek care profit company called Mana Nutrition, acute malnutrition. I’m not a nutritionist or for their children. When some French food which makes a product called Ready-To-Use a food scientist, but the concept of Mana scientists got together and were commissioned Therapeutic Food (RUTF). RUTF is a blend and RUTF is easy enough to understand. by UNICEF to develop a solution to this issue, of peanut butter, milk and in In short, children need their mom’s milk they came up with RUTF, using peanut butter as a packet, and it’s dramatically changing in order to grow during the most crucial a medium for this powdered milk, creating an easily transportable, digestible and affordable solution. The children can be assessed and then sent home with packets of RUTF and a specific treatment plan, giving the power back to the mothers to feed their children and nurse them back to life. After all, there is nothing more powerful than a mom’s love for her child. After hearing a UNICEF representative explain this simple process, Mark Moore and the team at Mana immediately set out to produce and distribute as much RUTF to as many children in the world as possible, and they went straight to peanut butter paradise, Fitzgerald, Georgia. My friend Alex Cox and I had recently graduated college and had worked with a number of “causes” that were all trying to help people. From peace in obscure corners of the world to lobbying for child slavery, we were craving to be a part of something that paid us in meaning, not cash (our parents were concerned). When we first met Mark Moore, he put a packet of peanut butter in our hands

31 INSIDER A World Without Hidden Hunger June 2014 Co-founder Alex Cox with founder Mark Slagle

Photo by Michelle Marie Photography and for the first time, we could tangibly and once they realized how simple it was, also knew this business model could exploit see (and taste) a way to help our neighbor they would immediately ask how they could the best things about capitalism to grow a in need—with peanut butter. It was so help. It costs about $0.30 to make a packet company that viewed malnourished children refreshing and simple: this peanut butter of RUTF, so it was an easy ask. Everything as our shareholders—that their needs are can be delivered directly to children in need, was going really well until one fateful night our highest priority. and within four to six weeks dramatic results in Malibu, Calif., after we had made our way We called our peanut butter Good can be seen. This was simple enough for across the entire country. Our dearly beloved Spread, because our mission and purpose us to understand, so we joined the team Winnebago caught on fire and blew up! as a company is to help good spread. (We and did the most practical thing we could As we watched the ashes of the great beast also wanted a mission statement that we imagine; we bought a 1971 Winnebago. float out over the Pacific Ocean, we were wouldn’t forget!) Good Spread was born UNICEF has a budget for RUTF they distraught but determined to continue this out of the desire to provide more RUTF to distribute every year, but it comes up journey. After all, we still had peanut butter more kids, and the idea became a reality embarrassingly short in comparison to all in our backpacks! through the incredible partners that jumped of the kids that are in need. We wanted to Realizing the overwhelming response on board. The first was World Vision, drive all around the country and tell college from the public to Mana, and understanding a non-profit organization that already students, churches and communities about that the Winnebago tour would’ve ended delivers RUTF to children all over the world the good work that Mana Nutrition was doing eventually one way or another, we put through its incredible medical outreach. and how they could get involved. Finally, a our heads together to figure out how to It is a trusted organization that saw the good news story about malnutrition! We took exponentially grow support for Mana and potential in our vision to connect the to the streets to drum up the power of the the production of RUTF. Our only available American consumer with a real need in the people to help address all of the children in resource was a ton of peanut butter, and developing world. When we sell a packet or the world who weren’t being met by UNICEF’s that’s where we started. We decided to sell jar of our peanut butter, we shave off some budget. Great organizations like World Vision regular all-natural peanut butter in packets of our profits to donate packets of RUTF were sending RUTF to children in need to our friends and family, and use the profits through Mana, and then World Vision picks through donations from regular people, and we made to send packets of RUTF to children them up in Georgia and distributes them all we wanted to play our part in the story. Alex in need. It was a simple social enterprise around the world. Last November, we sent and I would pull up on a college campus in model, inspired by the likes of TOMS shoes. approximately 33,000 packets of RUTF to our 1971 Winnebago, complete with shag We loved the idea that a hungry consumer the country of Chad in Africa. As a young carpet and an 8-track player, and teach in need of a healthy snack here in the United company celebrating our first birthday, we students about Mana, malnutrition and how States could be sharing their meal with a were ecstatic. they could help. Everyone wanted to taste malnourished child in Guatemala through The growth of social entrepreneurship is the Mana packets, knead them in their hands the conscious purchase of our product. We exciting. There is no way Alex and I could

32 INSIDER A World Without Hidden Hunger June 2014 When we sell a packet or jar of our peanut butter, we shave off some of our profits to donate packets of RUTF through Mana, and then World Vision picks them up in Georgia and distributes them all around the world. Last November, we sent approximately 33,000 packets of RUTF to the country of Chad in Africa. As a young company celebrating our first birthday, we were ecstatic.

have successfully started a company like this by ourselves, and we’ll be the first to admit that we’re not the best businessmen in the world. What we are fiercely proud of, however, is the good that comes when a mother in Chad is able to feed her child with packets of life-saving RUTF because someone in Nashville bought some packets of Good Spread. A business with a mission that’s simple and effective is what drives us to grow and continue to spread good for years to come. Social enterprises like our own are not perfect by any means, and we’re often asked on the phrase “social enterprise” if we focus more on the social or more on the enterprise. We have started to respond with “Why not both?” You have to build a sustainable business that grows and makes a profit, but our main value proposition is that the sales of our product help feed malnourished children around the world. It sounds like a win-win to me. Good Spread is a young company, full of hope, fun and a lot of peanut butter. We know that an old market like peanut butter is full of some heavy hitters, but we believe anyone can help good spread. Alex and I grew up in a world that is growing smaller and smaller, and we’re more connected to people all around the world than ever before. We want our children to grow up in an even more connected world, where the choices we make every day, like what snack to buy at the grocery store, change our world for the better.

Mark Slagle is the founder of Good Spread. Good Spread peanut butter can be purchased online at helpgoodspread.com or in local markets around the southeast.

33 INSIDER A World Without Hidden Hunger Digital Issue June 2014 How to Feed the World: A Complex Challenge

BY K. SCOTT PORTNOY

ccording to the Food and Agricultural Organization (FAO) of the the extreme poverty that prevents access to United Nations, there are 842 million chronically undernourished food is in decline. Since 1990, the number of people in the world today—about one in eight people, many of people living in extreme poverty has declined by 700 million, according to World Bank data. them children. While food insecurity exists everywhere, including A In the year 2000, the U.N. established goals here in the United States, the greatest numbers of food insecure people for improving livelihoods worldwide by 2015. are in southern and eastern Asia and in sub-Saharan Africa. Known as the Millennium Development Goals, they included reducing the number of people Food insecurity could continue to grow. suffering from chronic hunger by half. Thanks The world will add another 2 billion people by to the collaborative efforts of governments, mid-century, most in the developing world, in non-governmental organizations (NGOs) and urban environments and in climates that are the private sector, that goal is within reach and less conducive to food production. The mere 38 countries have already achieved it. increase in numbers will create more demand for food. But the world is also becoming more Imperatives for Progress prosperous. As people’s incomes improve, The progress toward improved food diets change to include more animal protein, security is encouraging. But sustaining that sweeteners and oils. This shift has significant progress is a complex challenge that will implications for agricultural demand. require collaboration and an appreciation for second- and third-order consequences in an Reasons for Optimism interdependent, interconnected global food Despite the daunting numbers, at Cargill we system. Among the imperatives for further are optimistic about the ability to feed all the progress are: world’s people. In fact, with current technology • Honoring the economic principle of it is quite possible to produce all the calories comparative advantage, needed to provide sufficient nutrition to • Embracing open trade and 9 billion people (see infographic on page 35). • Supporting the world’s smallholder farmers. This optimism is rooted in what the world’s farmers have achieved. Production of 16 key Honoring Comparative Advantage crops that are the building blocks of the global Across our planet, natural resources are not food system—including wheat, corn, rice distributed evenly. Nature has endowed certain and major oilseeds—has more than doubled geographies with the climate and soil needed since 1975. This increase in production to produce a surplus of calories, whether in has been achieved largely without bringing the form of wheat from the plains of North significant new acres into production. Instead, America, rice from Thailand or soybeans from the gains in agricultural output have come Brazil. If all farmers plant the crops best suited from intensification: increasing yields per for their growing conditions—then trade the acre through improvements in seed genetics, surpluses with others—food will be produced fertilizers, crop protection technologies and in the most economically sensible and agronomic practices. environmentally sustainable way. Countries This optimism is also rooted in the progress help improve the food security of their own the world is making in reducing hunger. citizens—and the world—when they focus on Poverty is the principal cause of hunger. But producing foods where they have comparative

34 INSIDER A World Without Hidden Hunger June 2014 Most of the world has APPROXIMATELY PEOPLE ARE only recently escaped caloric insufficiency. Daily Caloric Consumption Per Capita OF THE WORLD’S 1,000 7 BILLION PEOPLE 1,100 ARE LIVING ON

BERT 1,300 LI Y

1,400 Q U R FOR AT LEAST PART OF EVERY YEAR A LA A DAY OR LESS R L TER DO

1,600

1,700

1,900

2,000

2,200

Range for healthy, active 2,400 adult 2,500

THE WORLD’S FARMERS PRODUCE ENOUGH 2,800 CALORIES TO FEED ALL THE PEOPLE ON EARTH 2,900 50% 3,000 21% 1981 2010

Tons of grain, rice and Approximate number oilseeds produced of tons of whole grains and consumed globally, required to fill the annually. caloric gap faced by the world’s undernourished.

have met the UN Millennium Development Goal to HALVE THE PERCENTAGE OF HUNGRY PEOPLE

PRODUCTION AND CONSUMPTION YIELD IMPROVEMENTS ARE THE PRIMARY OF GRAIN, RICE AND MAJOR OILSEEDS DRIVERS OF INCREASED PRODUCTION. IS ABOVE HISTORICAL TRENDS. (1975=100) (BIL MT) 190 3.0

180 2.8

170 2.6 YIELD 160 +86% 2.4 150 2.2

140 2.0

130 1.8 AREA 120 +11% 1.6 PRODUCTION 110 1.4 CONSUMPTION 100 1.2 1975 1980 1985 1990 1995 2000 2005 2010 1975 1980 1985 1990 1995 2000 2005 2010

• Honor comparative advantage • Collaborate creatively

• Let markets work • Invest in agriculture

• Let food move • Have Africa realize its food production potential • Help farmers prosper • Grow the economies of the • Source food responsibly poorest countries

Sources: The World Bank, UN Food and Agriculture Organization, Cargill internal data

35 INSIDER A World Without Hidden Hunger June 2014 advantage and import products from others in • The emergence of biofuels has been a net those areas where they do not. good for food security, providing incentives for farmers to produce more and encouraging Embracing Open Trade needed investment in agriculture. But Demographic and consumption trends we have to balance food and fuel needs. make open trade essential to improving food Mandated use of biofuels creates inelastic security. Today, only about 15 percent of all demand and increased volatility in the food Further investments the food in the world crosses international system. Government biofuels policies should borders. But with population growing most include provisions to lift mandates in times in agricultural rapidly in areas of the world where it is of supply stress so market forces can direct difficult to produce food, this percentage will short crops to those sectors where they are technology, increase. A prerequisite for a food-secure needed most. world is sound trade policy—policy that lets • Finally, Africa must be part of the global infrastructure, food move from those areas of the world that food-security solution. Africa represents innovation and have comparative advantage in producing about 60 percent of the available rain-fed it to those areas where demand for food is cropland in the world, but African agricultural training will give growing (see infographic on page 37). Without productivity has long lagged that of the rest the ability to move food from areas of surplus of the world. With the right policy structures, farmers the tools to areas of deficit, we will inadvertently and public and private investment, Africa can encourage unsound practices, such as putting become a net-food exporter and help feed they need to meet environmentally sensitive or water-stressed the world. areas into agricultural production. tomorrow’s food Working Together to Improve Supporting Smallholder Farmers Food Security needs. In the Smallholder farmers need support to fulfill Further investments in agricultural their expanding role in feeding the hungry. technology, infrastructure, innovation and developing world in But smallholders are often forced to sell at training will give farmers the tools they need to harvest when they are cash-flow destitute, and meet tomorrow’s food needs. In the developing particular, investing selling at depressed prices discourages further world in particular, investing in agriculture has production in future years. That’s why farmers proven to be among the most effective means in agriculture has need reliable markets to sell their crops each to reduce poverty and hunger and promote season, and an adequate price to compensate sustainability. At Cargill, we believe the public proven to be among them for their efforts and provide incentive and private sectors must work together to to continue production the following year. meet the challenge of feeding the world. We the most effective In addition, smallholders also need training look forward to continuing our work to nourish in agricultural best practices and access to people globally. means to reduce inputs, credit, storage and technology that poverty and hunger will help them increase productivity in a sustainable way. Scott Portnoy is a corporate vice president of Cargill. and promote For nearly 150 years, Cargill has been in the business Other Food Security Enablers of nourishing people. It works every day with farmers, sustainability. Other factors can further accelerate our ranchers, and food and beverage companies all over progress along the path to a food-secure world: the world. This work provides it with distinctive insights • Food production has benefited from the into what it takes to ensure all people everywhere have introduction of genetically engineered crops access to safe, affordable and nutritious food. that can be cultivated with less water, fewer crop protection chemicals, less fertilizer and less tillage. To produce enough food to feed the world while using natural resources responsibly and preserving land with high- conservation value, farmers must be able to embrace safe and proven technologies for increasing productivity.

36 INSIDER A World Without Hidden Hunger June 2014 Food Must Move Certain geographies are endowed by nature with fertile soil, plentiful rain and ample to Feed a Hungry World sunshine needed to produce food surpluses

accounts for

Rice 20% of the global diet, but only RUSSIA moves across At any one time, international 5% borders Cargill operates UKRAINE

FROM NORTH NORTH AMERICA 400 SOUTH AMERICA KOREA JAPAN TUNISIA CHINA vessels IRAQ IRAN across all the MOROCCO ALGERIA LIBYA world’s oceans EGYPT SAUDI ARABIA

NIGERIA Every year, Cargill transports an average million INDONESIA of the metric 16% food BRAZIL produced in the world 70 tons crosses of food internationally international borders for our customers AUSTRALIA SOUTH AFRICA

ARGENTINA

Wheat Corn Soy and Soy Products World Food Flows grains, rice, oilseeds, meals, oils, feed equivalent of meat—net interregional in millions of metric tons

1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2012

150 Natural 100 importers more people 50 than land

0

-50 Natural exporters -100 more land than people

-150 NORTH SOUTH EASTERN EUROPE/ CENTRAL SUB-SAHARAN WESTERN MIDDLE EAST/ AMERICA AMERICA FORMER SOVIET UNION AUSTRALIA AMERICA AFRICA EUROPE NORTH AFRICA ASIA

In 2050 In 2050 Most population growth between now 70% and 2050 will be in developing countries. of the population will be urban

MORE FOOD MUST MOVE FROM AREAS OF SURPLUS TO AREAS OF DEFICIT TO FEED A MORE AFFLUENT, MORE URBAN GLOBAL POPULATION.

When Food Flows Freely:

The impact of Farmers have Scarce natural local crop more market access, resources are shortfalls can improve used more on local food their incomes and sparingly for availability is are motivated to agricultural moderated produce more production

CONSUMERS BUY THEIR FOOD FOR LESS

growing a Note: Trade flows depicted are representative of key food flows important to food security and are not inclusive of all flows from origination to destination markets. FOOD-SECURE Sources: UN FAO, USDA, Population Reference Bureau, Global Trade Information Services Inc. (GTIS) Global Trade Atlas, Cargill internal data WORLD

37 INSIDER A World Without Hidden Hunger June 2014 Upwards: Vitamin Angels Expands its Efforts Globally BY NATALIE HERNANDEZ AND KIM SAAM

itamin A is a micronutrient essential for proper immune function and The transformational power of vitamins is maintenance of structural integrity of cells, both of which are vital for something that Vitamin Angels encounters reducing the effects of infectious diseases. The effects of vitamin A often. On a recent trip to Guatemala, Vitamin Angels staff met Monika, a mother deficiency (VAD), particularly for children under the age of 5, can be V of four whose youngest children are devastating. VAD leads to permanent blindness for about 350,000 children receiving vitamin A from Vitamin Angels. a year, increases morbidity, and results in approximately 157,000 deaths Monika lives in the small village of El annually from a range of illnesses including measles and diarrhea, which Barranco and, like many mothers in the children succumb to due to poor immune function. Vitamin A supplementation developing world, she wants the best for (VAS) is a simple, cost-effective solution that can reduce the risk of early signs her children but has limited means to provide it. The Vitamin Angels team learned of blindness caused by VAD by 68 percent, minimize instances of illness, and Monika had seen a marked difference in decrease mortality rates among children 6 to 59 months of age by 24 percent. the health and vitality of her two younger children since they began receiving vitamin Since vitamin A is not produced by the A. Compared to her older children who did body, it must be consumed in food (including not receive vitamin A, her two youngest foodstuffs that are fortified) or supplement daughters—Brittany, 1.5, and Michelle, form. Most often, children in developing 4.5—are much healthier. The girls still countries lack access to vitamin A-rich foods occasionally suffer from the common cold, either because their environments don’t but since they have been receiving vitamin support the cultivation of such foods or their A their recovery times are much faster families cannot afford to purchase sufficient than her two older children, Jacob, 10, and amounts of foods. Vitamin Angels focuses its Katherine, 9—who did not receive vitamin A efforts on distributing vitamin A to children as young children (Vitamin Angels’ project in this community began only two years ago). 6 to 59 months of age who are without easy Jacob and Katherine get sick more often access to government-sponsored facilities and have less energy than their younger or community-based health services and siblings. Of her four children, Monika had living in countries designated by the World seen an especially dramatic difference Health Organization (WHO) as experiencing in her daughter Michelle, who was more moderate-to-severe . The energetic and less shy than she used to be organization distributes vitamin A through a before taking vitamins. Monika shared that network of more than 300 international and Michelle loved to sing and dance and draw, local non-government organizations (NGOs) and used to get sick a lot but now was that have a local presence and intimate hardly ever ill. understanding of the community being served, Vitamin Angels encounters story after allowing every project to be tailored to the story from mothers like Monika whose individual needs of the population while using young children are thriving, sometimes in proven interventions delivered consistent with stark contrast to their older siblings, thanks accepted best practices. to their programs. The impact that vitamin Monika, mother of four whose youngest children are receiving vitamin A from Vitamin Angels, lives in the small village of El Barranco.

38 INSIDER A World Without Hidden Hunger June 2014 A distributions have made on communities worms, allowing for improved absorption and includes members such as the World such as the one Monika lives in Guatemala of vitamin A. With support from the Food Program (WFP) and the World Bank, serve as concrete examples of how international aid community, up-scaling is intended to address the critical gaps in essential Vitamin Angels’ work is. Through co-administration is now viewed as an STH prevention and treatment by providing distributions in Latin America, Africa and important opportunity to improve nutritional additional funding, approximately $120 Asia, it is apparent that high-dose vitamin outcomes among children receiving vitamin million, as well as resources meant to A is making a difference in the lives of A supplementation. As a result, Vitamin catalyze demand for treatment and to children who would otherwise not have Angels has embraced an ambitious goal of develop new tools and strategies for access to this essential nutrient. reaching 100 percent of all of its eligible interrupting the transmission of STHs. The success of vitamin A as an beneficiaries (children 12 to 59 months) Vitamin Angels is eager to continue intervention for young children can be with albendazole within the next two years. expanding its programming. “By giving pre- compounded by pairing its administration To that end, in April 2014, Vitamin school aged children albendazole alongside with albendazole, a deworming agent that Angels announced its participation in a vitamin A we are not only reducing the rids the body of intestinal worms, also new initiative introduced by the Bill and burden of intestinal worms, but also known as Soil Transmitted Helminthes Melinda Gates Foundation to fill critical improving absorption of this essential (STHs). Globally, approximately gaps in combatting STHs. Following Vitamin nutrient,” said Vitamin Angels’ founder and 266.4 million preschool-aged children Angels’ participation at the Uniting to president, Howard Schiffer. “Vitamin Angels are at risk of infection with intestinal Combat Neglected Tropical Diseases (NTD) has been pairing these interventions for worms, leading to impaired growth and Conference at the Institut Pasteur in Paris, years. We couldn’t be more pleased to join nutrition, decreased cognitive function the organization committed to scaling up co- this esteemed community and increase and anemia. An indirect consequence administration of albendazole with vitamin our efforts to bring these critically needed of the presence of STH infection is its A to all eligible pre-school age children interventions to young children.” contribution to poor absorption of vitamin not reached by government programs— Initial anecdotal evidence suggests A by the body. This is due to the fact an investment valued at $4.5 million. that not only does pairing vitamin A with worms like to feed on vitamin A, reducing In addition, Vitamin Angels will ramp up albendazole improve a child’s overall the efficacy of the supplementation. technical assistance support to its network health and nutritional status, but the By pairing albendazole with vitamin A of field partners. The joint initiative, which direct, tangible impact of deworming (the administration, a child’s body can be rid of consists of a consortium of aid organizations passing of worms in a child’s stool) inclines

39 INSIDER A World Without Hidden Hunger June 2014 caregivers to place more trust in the less- Natalie Rogers Hernandez is the event coordinator visible benefits of vitamin A supplementation. for Vitamin Angels. She holds a Bachelor of Arts in While undernutrition is an issue that is Spanish from Azusa Pacific University and a Master prevalent in developing countries, many of Arts in Latin American and Iberian studies from While undernutrition people do not know it’s also present in the University of California, Santa Barbara. United States. While high-dose vitamin A Kim Saam is the marketing-communications manager is an issue that is administration is not practiced in the United for Vitamin Angels. She graduated Phi Beta Kappa from States because most foods are fortified with prevalent in developing University of California, Santa Barbara with a Bachelor vitamins and minerals, Vitamin Angels does of Arts in global and international studies. countries, many people participate in the distribution of prenatals and children multivitamins to populations Since 1994, Vitamin Angels, a non-profit based in do not know it’s also at need across the United States. Vitamin Santa Barbara, California, has been distributing Angels’ domestic program will reach vitamin A and multivitamins to at-risk populations present in the United approximately 200,000 pregnant women, in need—specifically children 6 to 59 months of States. While high-dose new mothers and children younger than age and pregnant or new mothers—in the United 5 in 36 states this year. States and more than 40 countries. This year, vitamin A administration Vitamin Angels’ programs are made in addition to celebrating its 20th anniversary, possible largely through the generous the organization aims to reach approximately is not practiced in the support of companies in the natural products 40 million children and mothers globally with United States because and dietary supplements industry, as well lifesaving and life changing micronutrients. as retailers and increasingly, maternal most foods are fortified and childcare-oriented brands. In fact, References: with vitamins and the organization generates upwards of 90 percent of its funding through 1. “Investing in the Future. A United Call to minerals, Vitamin cause-marketing partnerships, which is Action on Vitamin and Mineral Deficiencies” advantageous for both its beneficiaries and Global Report 2009 p.7 Angels does participate the brands whose names are tied to the 2. RE Black, CG Victora et al. “Maternal and cause. Having received Charity Navigator’s child undernutrition and overweight in low- in the distribution of four-star rating seven years running, as income and middle-income countries” Lancet. well as two rankings on its list of “Top prenatals and children 2013;382(9890):427-51 10 Charities Relying Solely on Private multivitamins to Contributions,” companies and individuals 3. Imdad A, Herzer K, Mayo-Wilson E, et al. alike can feel confident their donations “Vitamin A supplementation for preventing populations at need are being put to good use. Vitamin Angels morbidity and mortality in children from 6 across the United States. welcomes the opportunity to partner with months to 5 years of age” Cochrane Database companies interested in supporting its cause Syst Rev. 2010;(12):CD008524. and will work together to create a mutually 4. WHO. “Weekly epidemiological record” rewarding arrangement that works for both 2014;13(89):133–40. Vitamin Angels and the interested company.

40 INSIDER A World Without Hidden Hunger June 2014 The Industrial Revolution of Food: 3D Food Printing BY ALISSA MARRAPODI

n 1989, the “future” Mrs. McFly (in Back to the Future Part II) pops a bite- as Holman points out, what’s happening in size frozen pizza into the hydrator, speaks a command and within three manufacturing as a whole is a shift toward seconds the pizza comes out full-sized, hot and sizzling. In 1989, we were more programmable factories; “What wowed by this Hollywood technology. Pizza in three seconds? Sign me up. that means is if we have general-purpose I robots—robots that don’t care what they’re Fast forward to 2014 where NASA funds Pablos Holman, senior inventor at making—then they can be programmed to a six-month $125,000 study on 3D food Intellectual Ventures Laboratory, is working make spaghetti and frozen burritos; the same printing. The food printer will fill moisture- on just that. When you’re talking about global robot can be used for making both.” free cartridges with nutrient-dense powders nutrition and malnutrition, there are what Here’s where 3D food printers come in. to create (print) numerous different foods. Holman calls compounding macro trends. The general-purpose robot most According to NASA, its current food system “On the problem side of things we have consumers are familiar with is the printer. “wouldn’t meet the nutritional needs and five- population growth—we have a lot more “You don’t need to get a different printer to print novels versus printing the ledger year shelf life required for a mission to Mars people to feed; we all know that,” he said. for your accounting because it’s been or other long duration missions.” Basically, “The second is most of those people don’t programmed accordingly. Therefore, a 3D NASA is developing the reverse technology get much variety in their diet. If you look printer is a general purpose robot that of that Hollywood hydrator—an advanced globally at their diets, they get almost no transfuses plastic.” Holman explains that, dehydration system that captures the meat. So what we need to figure out now is just as a toner cartridge is filled with ink, maximum amount of nutrients and eliminates how to take those two compounding trends these cartridges can be filled with plastic (or, waste. Nifty, eh? The implications of this type and feed more people with higher amounts of more recently, metal and other materials). of technology are incredible. Think about it: nutrients and do it efficiently. “The toner puts down a pixel of plastic What effects could food printing have on “Any one of those problems we could have food production, storage and distribution, instead of a pixel of ink until its printed an maybe handled with the way we’re doing entire layer of plastic until the object is built and, beyond that, how could 3D food printers things (e.g., how to grow more food efficiently). impact global malnutrition? (one layer at a time),” he said. “What’s great But how do we try and imagine a world where about this is the device is programmable we can solve all these problems at once? If “In architecture, 3D printers so it can print a coffee mug or a pair of we figure out how to get 10 percent more glasses, functioning the same way an will eventually use a giant yield out of a crop that will help a little bit, but ink printer does. 3D printers have been that really won’t solve our problem.” So, what advancing but they are nowhere near the printer to print the building. Holman is looking at is, with or without food, capacity of existing factories. Moreover, 3D Now take that same logic and how do we improve manufacturing? printers are expensive and have been mainly “Right now, we use what you can think accessible to architecture firms that need to apply it to food—developing of as special-purpose robots, i.e., factory make a lot of models. What we imagine for technology so it’s able to print automation tools,” Holman explained. “For the future is making printers more versatile, example, if you go to a factory to make , larger and cheaper, and start using them a meal for you—a pixel of what you see is a giant machine that takes for manufacturing. So in architecture, they wheat in on one side of the factory and puts will eventually use a giant printer to print food versus a pixel of plastic.” out spaghetti on the other side.” However, you the building. Now take that same logic and – Pablos Holman, wouldn’t make frozen burritos in this factory apply it to food—developing technology so because they are two radically different it’s able to print a meal for you—a pixel of senior inventor, Intellectual things, so with this type of manufacturing food versus a pixel of plastic.” Ventures Laboratory paradigm, spaghetti is made in one factory So let’s go to the marketplace and see and frozen burritos in a separate factory. But, what’s happening ….

41 INSIDER A World Without Hidden Hunger June 2014 Foodini Slated to become available later this year, Foodini, a 3D food printer by Natural Machines, is described as “a new- generation food appliance that combines technology, food, art and design.” It uses fresh and/or homemade ingredients to create sweet (think chocolate, cupcakes and cookies) and savory (think pasta, burgers and chicken nuggets) concoctions and turns them into an assembled meal. Here’s how it works: Let’s say you want to make raviolis. Since Foodini is a connective device, the cook need only select the ravioli recipe it wants to print (quantity, shape, etc.) from the device’s touchscreen, or a tablet or laptop. Next, load fresh/homemade ingredients, in this case pasta dough and filling, into Foodini’s open-capsule model, which then automates the assembly process by laying down the first layer of dough, pouring the filling and laying down the top layer of dough. Its purpose? To get consumers to eat less pre-processed food that’s fresher and less time-consuming.

ChefJet™ 3D Printer 3D Systems is creating amazing edible confectionery sculptures with a 3D printer. The company is working with Hershey to develop a 3D printer for “edible foods, including confectionery treats,” both chocolate and non-chocolate. In January, the company introduced the ChefJet™ 3D Printer Series, a “kitchen-ready 3D printer category for edibles”— one in monochrome and the other in full color. Its target audience is pastry chefs, restaurateurs and event planners.

Cornell Creative Machines Lab Cornell Creative Machines Lab created a 3D food printer that creates mini space shuttle-shaped scallop nuggets, and baked goods like cakes that, when sliced, reveal someone’s initials or a buried message. It is also printing a new style of corn chip made out of corn masa dough in the shape of a flower (albeit it looks more like a ramen chip than a corn chip). Its 3D food printer is not just about creativity with shapes, but creativity with ingredients.

Momentum Machines A different approach but relevant nonetheless is Momentum Machines’ food technology for quick-service restaurants (QSRs). Dubbed the next-generation of fast food, Momentum Machines plans to revolutionize food access with restaurant robots by taking the stigma out of fast food, i.e., serving gourmet burgers at quick-service prices using an alpha machine that eliminates the hamburger line cook. “Our technology will democratize access to high-quality food making it available to the masses.” The technology will be able to do everything from slice tomatoes to (in the very near future) customize meat grinds (e.g., 1/3 beef, 2/3 bison). By saving on labor costs, restaurants can serve premium ingredients at economic prices.

42 INSIDER A World Without Hidden Hunger June 2014 Now, these machines are scaled neither for industrial production nor as a means of tackling global nutrition and malnutrition, but rather a way for middle- to upper-class consumers to streamline their cooking, promote healthier eating, have a fancy new kitchen gadget or create culinary concoctions they otherwise couldn’t have made. But isn’t this how it starts? “The manufacturer’s website National Geographic’s new food segment, which explores “our complex relationship with claims that Foodini is ‘getting what we eat and where our food comes from,” delved into 3D food printers and the impact people to eat less pre-processed they will have on the average American’s diet. Author Mary Beth Albright commented: “The food,’ floating the much sought- manufacturer’s website claims that Foodini is ‘getting people to eat less pre-processed after health halo and making the food,’ floating the much sought-after health halo and making the ironic argument that 3D ironic argument that 3D printers printers will get people back in touch with food. While eating well is an issue across the will get people back in touch socioeconomic spectrum, it’s unclear that someone with $1,300, an Internet connection with food. While eating well is an and fresh pasta dough needs a Foodini to steer clear of processed food.” issue across the socioeconomic The Foodini is, however, only an example of how 3D food printing can impact an individuals’ spectrum, it’s unclear that life. But fast forward to 10 or 20 years down the road and zoom out to a global view of 3D food printing and the impact it could have on a someone with $1,300, an global scale. Can we feed 9 billion people with 3D food printers? Internet connection and fresh Holman provided a global perspective in that many technologies can “leapfrog different pasta dough needs a Foodini to developmental stages.” He said: “The classic one right now is Africa can use cellular steer clear of processed food. “ phones but it never even used landlines; they skipped landlines and went straight to mobile – Mary Beth Albright phones. That works because mobile phones turned out to be a much more scalable type of infrastructure than a wired infrastructure was. We’re trying to accomplish the same types of things with a way of feeding that is more scalable, that will make sense to bring it to the whole world. Right now, we haven’t even tried. The way we eat now doesn’t consider the efficiency or scalability of it. If we solve that, if we come up with a way that’s more efficient, it will make sense for the rest of the world to adopt that and benefit from it as well.” Back to the future indeed.

Alissa Marrapodi is a managing editor in the Informa Health & Nutrition Network.

43 INSIDER A World Without Hidden Hunger June 2014 Investment Opportunities in the Medical Foods Market

BY SANDY BIGELOW

edical foods are intentionally designed to target the nutritional condition possessing a distinctive nutritional aspects of disease conditions, thus augmenting the requirement established by medical evaluation. effectiveness of other interventions and improving the patient’s Medical foods were first introduced in 1957, condition. Medical food-drug combinations work well together in which Mead Johnson introduced the first M medical food, Lofenalac®, for the nutritional as interventions to ameliorate disease conditions, just like many drug- support of persons with phenylketonuria, a device combinations historically used by health care professionals. rare inborn error of in which the catalysis and clearance of the amino acid, Specialty nutritionals including medical phenylalanine, is impaired. FDA reclassified foods historically provide a 30-percent medical foods from drugs to foods in 1972 operating margin, thus representing mergers because of their intended use to sustain and acquisition (M&A) opportunities for adequate nutritional state of the patient. pharmaceutical and large supplement Medical foods are regulated with the same companies. The medical food market alone requirements for manufacturing and labeling generates $12 billion annually in United controls as those for conventional foods. Since States, and Medicare reimbursements yield an ‘88 1972, medical foods have been developed to effective return for medical food providers as a address the nutritional needs in patients with a result of their customers realizing diminished variety of medical conditions: costs. Darin J. Shaw, managing director and Largely defined in 1. gastrointestinal diseases and disorders; head of nutrition & healthy living investment 2. kidney diseases and disorders; 1988, medical foods banking for D.A. Davis & Co., said M&A 3. liver and biliary system diseases activity in the nutrition space lulled in 2013, and disorders; are specially processed yet are now offset but better valuations.1 4. pancreatic diseases and disorders; foods used under the Companies remain strong and more attractive as the cost of acquisition improves. Global 5. inborn (inherited) errors of supervision of a health population demographics support the prospect metabolism; and for growth during the current cycle at a 6. miscellaneous conditions (including care practitioner for minimum until 2040. Clearly based on the burn and trauma patients). the specific dietary use of supplementation to address nutritional The distinguishing aspect of medical adequacy of pre-disease states, Frost & foods is how to define the term distinctive management of a disease Sullivan estimated at least $47 billion savings nutritional requirements, which can be on annual health care costs now to 2020.2 defined as a physiological state of a disease or condition possessing Add to these savings the use of medical foods that exhibits an altered metabolic need for a distinctive nutritional to nutritionally target disease states in patients nutrients and other dietary substances, that in shortening their hospital stay, strong driving when the metabolic needs are met, results requirement established forces compel examination for increase in the ability to maintain sustenance for a marketing of supplementation for prevention patient, be the disease arising from inborn by medical evaluation. and medical foods that augment disease errors of metabolism, congenital defects or the interventions in the aging U.S. population. progression of pathophysiological condition(s), Largely defined in 1988, medical foods of which these requirements are based on are specially processed foods used under the recognized scientific principles as established supervision of a health care practitioner for the by medical evaluation. Examples of such specific dietary management of a disease or requirements include:

44 INSIDER A World Without Hidden Hunger June 2014 • Chromium and biotin work in concert to For strategic marketing purposes for 3. FDA Draft Guidance for Industry: potentiate the action of insulin receptors in substantiating claims, more than 80 percent Frequently Asked Questions About Medical ameliorating diabetes (a medical condition of food and supplement companies, and Foods; Second Edition, revised August 2013, with an annual health care cost of $30 billion) their suppliers, are conducting some form of p 13 clinical research to drive sales via stronger • Medical foods have been developed to 4. Bass, I.S. “Legal overview of the status provide nutritional support to normalize T4:T8 product claims. As advised by their staff, of medical foods in the United States” Food ratios in HIV patients (a $4 billion annual cost) most (70 percent) executives are concerned Drug Cosmet Law J. 44:467-477. • Methylfolate use has been clinically shown that the appropriate clinical endpoint be to overcome CNS folate receptor block/ used in the study.11 Companies are now 5. Ibd. FDA Draft Guidance for Industry: inactivation by autoantibodies generated by inclined to conduct their clinical studies Frequently Asked Questions About Medical certain patients with depression ($20 billion outside of the United States, resulting from Foods; Second Edition, revised August annual cost) FDA’s new broad investigational new drug 2013, p 13 • B vitamins have been shown to correct (IND) requirements, in which the agency 6. “Nutrition Recommendations endothelial cell dysfunction commonly found in is unable or unwilling to approve clinical and Interventions for Diabetes. A the progression of diabetes. studies for food components without a position statement of the American Altered nutritional disposition distinctive to substantial upfront investment.12 Ultimately, Diabetes Association.” Diabet Care. specific disease states supported by clinical U.S. research institutions will suffer from 2007;30(1):S48-S65 decreased demand for clinical studies. findings have been shown to reduce health care 7. “Nutrition Recommendations and Medical foods represent a manifestation costs and patient morbidity and hospitalization. Interventions for Diabetes. A position in advancing nutrition science rather than FDA unilaterally restricted the indications statement of the American Diabetes relegating medical foods to the purgatory for the use of medical foods primarily for Association” 2008:18 individuals with inborn errors of metabolism of limited use thus denying patient care 8. “Standards of Medical Care in Diabetes” (e.g., phenylketonuria).3 The legislative history and increasing health care costs, as well as Diabet Care .2010;33(1):S11-S61 of medical foods does not clearly restrict their diminishing investment and industry growth. use to inborn errors of metabolism.4 It is not Patients should win rather than to maintain an 9. Academy of Nutrition and Dietetics. unreasonable to anticipate that distinctive arbitrary regulation compliance gap between “Medical Nutrition Therapy Services” 2012:1 medical foods and drugs. Industry investment nutritional requirements can arise in disease 10. Ibd. FDA Draft Guidance for Industry: states other than those of inherited etiology, and future growth should not be stymied at a cost of arbitrary regulatory distinctions. Clinical Frequently Asked Questions About Medical such as those of congenital etiology, especially findings for medical food use can be used Foods; Second Edition, revised August for those diseases that are idiosyncratic to develop appropriate marketing claims for 2013, p 13 in nature. Regarding medical food use, it dietary supplements and conventional foods. 11. Granato, H. “Assessing the factors would unnecessarily confine the medical driving nutrition industry firms to support community to provide patient care by limiting scientific trials” Nat Produc Insider 2012; the scope of physiological state(s) based on a Sandy Bigelow is the principal at Vanguard Global March: 3-8 particular disease etiology, many of which can Associates LLC in Tucson, Ariz. manifest distinctive nutritional requirements 12. “Guidelines Clinical Investigators, Sponsors, and IRBs. Investigational New in later ontological time frames. FDA has References: rejected the notion that medical foods can Drug (IND) Applications – Determining be used for diseases such as diabetes, even 1. Shaw, D.J. “M&A activity slows. Acquirers Whether Human Research Studies Can though the scientific, medical, and clinical remain patient as business owners focus on Be Conducted Without an IND: FDA Sept. nutrition community say otherwise.5,6,7,8,9 growth” Nat Produc Insider 2014;20(2):13 2013:23 FDA’s repeated attempts to disentangle the 2. Shanahan, C., de Lorimier, R. “Smart wide spectrum of products it regulates into Prevention – Health Care Cost Savings discrete regulatory categories have fallen Resulting from the Targeted Use of Dietary short, as history has shown their difficulties Supplements. An economic case for promoting in regulating combination products separately increased intake of key dietary supplements as drugs or foods. FDA has now restricted as a means to combat unsustainable health the scope of indicated use(s) of medical care cost growth in the United States” Frost & foods more than that for orphan drugs and Sullivan 2013:136. Sponsored by the Council “humanitarian” medical devices.10 for Responsible Nutrition, Washington

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