Stein, A.J. (2006). Micronutrient malnutrition and the impact of modern plant breeding on public health in India: How cost-effective is biofortification?

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Millions of people worldwide suffer from micronutrient malnutrition or "hidden hunger"; and it is mostly women and children in poor households who suffer from a lack of essential minerals and vitamins in their daily diets. These deficiencies can have devastating consequences for the life, health and well-being of the affected individuals, but they may also perpetuate a vicious circle of undernutrition, low economic productivity and poverty. Hence, in many developing countries vitamin and mineral deficiencies are public health problems of primary concern.

Economic development and rising incomes can only address undernutrition in the long run, but conventional approaches also have weaknesses that limit the overall progress in controlling micronutrient deficiencies. Therefore, "biofortification" may be a promising complementary intervention. The idea is to breed food crops for higher micronutrient content, which can be done through cross-breeding or genetic engineering. Targeting staple crops that fortify themselves already on the farmers' fields has several advantages: the enriched crops simply follow the normal food chain and they are eaten by the poor in bigger quantities. Moreover, the underlying germplasm of micronutrient-rich crops only needs to be developed once and can then be used around the world - and farmers can grow and reproduce biofortified crops year on year and share the micronutrient-dense seeds. Therefore, the initial investments in research and development (R&D) of biofortification can be followed by a continuous stream of benefits that accumulates over time and space, which suggests that biofortification can be a very cost-effective intervention.

Apart from two more limited studies that focused on "Golden Rice", which has been genetically engineered to produce beta-carotene, a more rigorous and comprehensive assessment of biofortification is still outstanding. This book has been written to narrow this knowledge gap and to offer a sound basis for future research and policy decisions regarding biofortification - covering both, crops that are produced through conventional breeding and genetically modified organisms (GMOs). For this ex ante evaluation of biofortification, an impact assessment of five different crops (iron-rich rice, iron-rich wheat, zinc-rich rice, zinc-rich wheat and beta-carotene-rich Golden Rice) has been done for India to determine their effectiveness. A scenario approach and various sensitivity analyses were used to probe the robustness of the results and to increase their reliability.

The main contribution of this study lies in the development of a methodology that reproduces the whole sequence of effects between the cultivation of the micronutrient-rich crops and their ultimate health impacts, taking into account various micronutrient levels in the crops, different rates of adoption and acceptance, and the ensuing improvements in individual nutrition status. To this end - apart from consolidating the use of the "dose-response" function to relate vitamin A and zinc intakes to overall health status, and apart from developing a method to link individual iron intakes via their cumulative distribution function to population health status - in this book the disability-adjusted life years (DALYs) framework has been refined and applied to determine the disaggregate burden of disease of iron deficiency anaemia (IDA), zinc deficiency (ZnD) and vitamin A deficiency (VAD) in India.

The assessment of the potential impact of the biofortified crops has been complemented by an economic evaluation, because mere effectiveness is a poor guide to policy making when resources are limited. Therefore, a cost-effectiveness analysis (CEA) and a cost-benefit analysis (CBA) have been carried out for each of the crops to determine their efficiency and their overall social profitability. The attributable costs of the R&D for the crops as well as the costs for related dissemination and extension activities within India have been juxtaposed to the expected health benefits. (In this context the costs for general social marketing campaigns and for more particular information, education and communication (IEC) programmes to introduce Golden Rice were explicitly taken into account.) The resulting cost-effectiveness measure ($/DALY saved) has been compared to alternative micronutrient programmes and to benchmarks of international organisations for assessing public health interventions. By attaching a minimum value to each DALY saved, the benefits of biofortification were translated into monetary terms to calculate a lower bound of the social rates of return of the crops. These economic indicators could then be compared to those of other agricultural technologies.

While conventionally bred biofortified crops are less contentious, genetically modified crops (GM crops) and, thus, the transgenic Golden Rice are controversially discussed in the ongoing debate about plant biotechnology. Therefore, related issues are discussed in more depth in special sections of this book. Having new consumer traits, Golden Rice is classified as second generation crop of the "gene revolution"; the validity of common claims about Golden Rice are scrutinized in a comprehensible and verifiable way; and, hence, the book seeks to provide a basis for informed decision making also in this field.

The study concludes that biofortification has the potential to help control vitamin and mineral deficiencies in a lasting and sustainable way - even though the commitment and the support of key stakeholders may be necessary to achieve its full impact. The various economic analysis have also shown that biofortification promises to be a very cost-effective, efficient and socially profitable intervention, both if compared to alternative public health measures and if compared to other agricultural innovations. Nevertheless, to control micronutrient deficiencies, the importance of a more comprehensive strategy is underlined; in such a strategy other micronutrient interventions like targeted supplementation, fortification, dietary diversification, nutrition education and poverty reduction may all have a role to play.

(German keywords: Mikronährstoffmangel, Mineralstoffmangel, Vitaminmangel, Eisenmangel, Zinkmangel, Vitamin A-Mangel, Mangelernährung, konventionelle Pflanzenzüchtung, grüne Gentechnik, natürliche Anreicherung (Biofortifizierung), angereicherte Grundnahrungspflanzen, Goldener Reis, gesunde Lebensjahre (DALYs), Krankheitslast, Gesundheitsnutzen, Ex-ante-Bewertung, Kosten-Wirksamkeits-Analyse, Kosten-Nutzen-Analyse)

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Copyright © 2006-2013 Alexander Stein.