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Shifting the global narrative around food fortification
We need a paradigm shift around how we talk about, design and implement food fortification programs. Laura Rowe, Nutrition International’s Global Portfolio Director for Large Scale Food Fortification, shares why.
Posted on June 3, 2026
In Bangladesh, fortified rice is integrated into social protection programs to support families to receive the nutrients they need.
I’ve often had to stop myself and ask a simple question: if education is so central to breaking cycles of poverty, why do I work in nutrition and not education?
The answer reveals what’s at stake.
You can build the best education systems in the world, but if children are malnourished, it simply won’t work. The conditions that enable a child’s brain to develop start long before they step into a classroom. Learning is compromised if the nutritional framework isn’t in place. Potential is already constrained.
That realization is what pulled me into food fortification — and it’s why I still believe this work sits at the very foundation of development, whether we talk about health, education or economic opportunity.
The evidence around fortification’s public health impact and unparallelled cost-effectiveness is well documented, reinforced by a recent Lancet study. Can food fortification really have a greater economic return than vaccines, with returns of 27:1 for fortification compared to 16:1 for vaccines? Can tiny amounts of vitamins or minerals added to foods people already consume truly save lives?
The answer to both questions is yes.
But realizing fortification’s full potential requires us to shift how we think about and design programs to respond to the realities faced by politicians, food producers, public health professionals and nutrition programmers.
Fortification as a foundation, not an add-on
Food fortification is often described in technical terms: adding small amounts of essential vitamins and minerals like iron, folic acid or iodine to foods people already consume, such as flours, oils and salt.
That definition is accurate, but it doesn’t explain why fortification is so powerful.
Food fortification builds the nutrition foundation of a population. It enables other interventions like education or disease prevention to be more effective.
Addressing the health and wellbeing of a population is multifaceted and shaped by dozens of different entry points and influencing factors along the continuum of human development, capacity building and care. But for those efforts to succeed, there must be a strong foundation in place. That is what food fortification contributes to.
Contextual relevance needs to lead the design
It is our responsibility to use what we know works. That includes adapting recommendations and programming to ensure they are relevant to a country’s context and responsive to the interrelated health challenges our world faces today. We cannot operate in a vacuum.
The next generation of fortification programming must remain grounded in evidence, contextual need and proven program design while simultaneously incorporating a ‘do-no-harm approach.’ Fortification is a complement to the broader mix of interventions designed to address a country’s most pressing nutritional challenges. We need to take all of this into account.
Programs should only be introduced following a thorough assessment of nutritional needs, their underlying causes and whether fortification can meaningfully address identified dietary intake gaps.
Building resilience from individuals to food systems
Food fortification plays a unique role at the intersection between humanitarian and development needs by helping populations become more resilient to shocks.
In humanitarian settings, fortification increases resilience to be better prepared in the face of conflict, climate impacts, disease outbreaks, and other crises. For example, as climate changes affect the nutrient quality of crops and soils, the strategic addition of nutrients to staple foods becomes even more important. Fortification formulas can and should evolve to address changing nutrient gaps in locally grown foods.
But resilience extends beyond individuals.
Food fortification also helps to strengthen food systems by reinforcing supply chains, integrating food safety practices, and helping ensure nutrient-rich staple foods remain available during times of crisis.
This includes ensuring fortified foods align with national public health goals. Edible oils should be free from industrially processed trans fatty acids. Salt iodization programs should coordinate with salt reduction strategies. Food safety systems should address contaminants, such as aflatoxins in flour. And we should continue exploring opportunities to identify other staples, such as lentils and other pulses, that are naturally high in protein and fiber as alternatives where appropriate.
A public health intervention powered by the private sector
Food fortification is unique in that it’s a public health intervention that leverages the strengths and the acumen of the private sector. When designed appropriately, it can be folded into food safety checks so that it becomes completely owned and managed by food producers and governments, ultimately precluding the need for outside support.
By design, fortification relies on foods already locally produced or imported and consumed through existing marketing systems. This reduces the delivery burden on often overstretched health systems.
Understanding and addressing the needs of food producers — the very actors who make fortification possible — is vital. This includes identifying and designing effective incentive structures that are meaningful to businesses and their bottom lines. This not only ensures the participation of the most important players in fortification, but it also reinforces the production of quality products if, and when, enforcement wanes or legislation is stalled.
Designing for sustainability with a systems approach
Fortification programs need to take a systems integration approach, leveraging complementary delivery channels, such as schools, hospitals, health centres and social safety net programs to reach the most vulnerable in the most cost-effective ways.
When designed effectively, fortification programs can be managed and maintained in their entirety by local entities, from governments to producers to civil society organizations and even universities, where the use and analysis of consumption data can be used to inform fortification programming and modelling.
Fortification is meant to be owned, operated, and maintained nationally — the potential of realizing this is what continues to motivate me.
It is not enough to simply fortify foods. We must consider good program design, the need for safe foods first, and the broader public health context in which programs operate. By taking a truly holistic and needs-based approach to improving the health and wellbeing of individuals, strengthening food systems, and supporting the economic return of nations, our intervention-specific efforts have a real opportunity to reach their full potential, just like the individuals and nations these interventions are designed to serve.
Learn more about our work in food fortification.
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