May 9, 2002


Gates Fights Malnutrition With Cheese,

Ketchup and Other Fortified Food Items



Let them eat Cheez Whiz?

An international consortium led by Bill Gates's charitable foundation plans to address malnutrition around the world by offering economic incentives to Kraft, Procter & Gamble and other food companies to bring fortified processed foods and food commodities to impoverished nations.

The unusual program, funded mostly with $50 million from the Bill & Melinda Gates Foundation, has signed up Kraft Foods Inc., Procter & Gamble Co., H.J. Heinz and vitamin manufacturers Roche and BASF Corp. Participating companies would add nutrients, such as iron, folic acid and vitamin A, to food products they sell in poor countries and also provide governments and small food producers with technical assistance for fortifying food staples, such as rice, maize meal, wheat flour, oil, sugar, soy sauce and salt.

In exchange, the consortium, called the Global Alliance for Improved Nutrition, or GAIN, would offer companies assistance in lobbying for favorable tariffs and tax rates and speedier regulatory review of new products in targeted countries. The consortium also would give local governments money for initiatives to help create demand for fortified foods, including large-scale public relations campaigns or a governmental "seal of approval."

The effort, whose total funding is $70 million over five years, is set to be launched officially Thursday by Mr. Gates at the United Nations General Assembly Special Session on Children. The consortium includes U.N. agencies such as the World Bank, the World Health Organization and Unicef, the governments of the U.S., Japan, Germany and Canada, and global health and nutrition experts. Negotiations with some countries have already begun. The presidents of Sri Lanka and Zambia are expected to be at the announcement and are considering expanding current food-fortification programs under the new effort.


Facts about vitamin and micronutrient deficiencies in developing countries:

• Two billion people suffer from anemia (mostly iron deficiency anemia)

• One-fifth of maternal deaths are due to severe anemia

• An estimated 200 million children do not get enough vitamin A from their daily diet

• Without supplemental vitamin A, 250,000 would go blind each year

• Close to two billion people do not get enough iodine from their daily diet

• Iodine deficiency is the leading cause of preventable mental retardation in the world


Some experts are troubled by the idea of Bill Gates and multinational food companies teaming up to reach into underdeveloped countries' food systems. Critics dislike helping corporations peddle processed foods that, despite added nutrients, still aren't especially healthy because of their fat, sugar or sodium content. Many see the GAIN program as just a heavy-handed way to ease corporate access to poor markets -- and one that won't do much to counter malnutrition, to boot.

"This is a reductionist, single-nutrient techno-fix to a problem that is much more complex," says Marion Nestle, professor of nutrition and food studies at New York University, who is the author of "Food Politics: How the Food Industry Influences Nutrition and Health." "The main reason for the lack of decent nutritional status is poverty," she says. "Nobody's looking at ways to get people jobs or health care. Maybe that's too hard -- even for Bill Gates." Wouldn't it be better, she asks, to teach people to grow fruits and vegetables in adverse conditions?

"It's a good idea, but a lot of people will die from malnutrition before we eliminate poverty," replies Sally Stansfield, a Gates foundation official working on the GAIN project. "We are trying to maximize the health, cognitive power and productivity of people living right now."

Andrew Natsios, administrator of the U.S. Agency for International Development, which represents the U.S. in the consortium, dismisses doubts about working with big companies and processed foods. Critics "may make comments about the multinationals," he says, "but that's how people eat." He says the program intentionally involves fortifying both processed foods and staples in order to reach people of all income levels. "The only way this kind of effort works on a mass scale is by layering," Mr. Natsios says.

Horst Kramer, spokesman for Swiss drug company Roche, says even though Roche, as part of the program, might sell its vitamin-and-mineral "premix" packet, which users are supposed to add to flour or rice, the GAIN effort's overarching goal is to provide nutritional assistance to the poor. Indeed, he notes that GAIN will provide cash to governments and nonprofits that apply for it. "This is not a marketing tool," he says. "It's a philanthropic effort."

The folks at Kraft Foods see the project in a more pragmatic light. "We think this partnership can accelerate the process of bringing fortified products to market and build an accurate consumer awareness of the role these products can play in improving nutrition," says Stuart Wilson, director, strategic growth initiatives, for Kraft Foods International.

"Participating in GAIN complements our own focus on health and wellness as a key growth platform," says Roger Deromedi, co-chief executive of Kraft Foods and the chief of Kraft Foods International.

The GAIN project is modeled after the billion-dollar global vaccine program to inoculate poor children, also backed by the Gates foundation. The guiding principle is to bring public agencies and private industry together to address grossly inadequate basic health care for the poor resulting from failures of the marketplace. The foundation's approach is to fix problems using market mechanisms. "We're interested in any health intervention that can impact millions of lives, especially when the intervention is incredibly inexpensive," Mr. Gates says, in an interview. "Micronutrients fits that in a big way."

Details of the new program are still being worked out. But Kraft, majority-owned by Philip Morris Cos., says some of its biscuits, cheeses and beverages are already being fortified with nutrients and would make possible candidates for the GAIN project. For example, Cheez Whiz and Kraft Singles cheese slices are fortified with calcium, and Kool-Aid and Tang are fortified with vitamins A and C, Kraft says. It currently sells fortified Trakinas fruit-filled sandwich cookies in Brazil, fortified Pacific cookies in China and fortified O'Smile cookies in Taiwan.

Meanwhile, in Venezuela, Procter & Gamble is test-marketing a new powdered beverage mix called NutriStar, which contains iron, Vitamin A and iodine. Heinz sells fortified ketchup in the Philippines.

GAIN's goal is to work with individual governments to assess nutritional deficits and then, if appropriate, to help manufacturers bring fortified foods to easy-to-reach urban populations there, says the Gates foundation's Dr. Stansfield, who also works on the foundation's Infectious Disease and Vaccine global health program. At the same time, the program will try to reach desperately malnourished families in rural areas by supporting local millers, nonprofit food programs and even households: Mothers could add free or discounted packets of nutrients to their children's food.

Fortified foods, of course, aren't new. Iodine added to table salt has improved health world-wide by reducing occurrences of goiter, neck swelling, mental retardation and growth abnormalities. In the industrialized world, fortification is so ubiquitous it goes largely unnoticed: Milk is fortified with vitamin D, and every box of corn flakes has a list of added micronutrients in bold-face type. Still, GAIN's approach -- pulling together governments, the private sector and small nonprofits -- is unusual for its scope, makeup and funding.

GAIN officials say they hope to encourage national governments to provide regulatory concessions for fortified foods, thereby reducing the costs for industry. They also hope for better policing of nutrition claims. Kraft's Mr. Wilson says regulators often can't evaluate new products scientifically. "GAIN can help facilitate these approval processes with appropriate guidance from scientific authorities and public health experts," he says.

Indeed, inconsistent regulatory standards is "one of the key barriers to the private sector jumping into product fortification at the present time," says Keith Zook, a spokesman for Procter & Gamble's corporate sustainable development division.

Nevertheless, GAIN remains a tough sell. The Gates foundation's Dr. Stansfield says some European governments view such fortification programs as one step away from genetically modified food and oppose them. Some potential donors in Europe have been reluctant to meddle in the politics of food distribution in poor countries -- even though GAIN, she says, for just pennies could help children in northern Zaire with brain damage resulting from iron deficiencies. A single added nutrient could help two billion people world-wide with iron deficiencies or more than 800,000 world-wide with vitamin A deficiencies, which can cause blindness.

Write to Rachel Zimmerman at rachel.zimmerman@wsj.com1

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Updated May 9, 2002 12:31 a.m. EDT

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