Purpose of Initiative: Worldwide, inadequate folic acid intake among women of childbearing age contributes to an estimated 200,000  crippling birth defects each year, roughly equivalent to the number of crippling polio cases that occurred before the start of the global polio campaign.  The World Health Organization lists iron deficiency among the top 10 conditions that contribute to unnecessary illness and premature death.  Iron deficiency can result in deaths among pregnant women; diminished growth and development, and learning ability in children; and low productivity in working adults.

To help improve nutrition around the world, especially in countries where flour is a major food source, the Flour Fortification Initiative (FFI) was established in 2002 to build an alliance between governments and international agencies, wheat and flour industries and consumer and civic organizations to promote flour fortification.  FFI's mission is to stimulate interaction and partnership between the public sector and the grain and flour industries globally and in individual countries, and to inform, mobilize, and enable the industry to make micronutrient fortification of flour a normal part of large roller mill flour production.  The initiative supports fortification of flour with essential vitamins and minerals, especially folic acid and iron, as one important way to help improve nutrition around the world.  FFI is initially focused on wheat flour fortification.  Currently, only 21% of wheat milled into flour each year is fortified with either folic acid (34 countries) or iron (49 countries) 

Partners
Private Sector organizations that have collaborated to date include: the AWB, Ltd.; Canadian Wheat Board; Canadian International Grains Institute; U.S. Wheat Associates; International Association of Operative Millers; American Institute of Baking; Indian Millers Association; Seaboard Corporation; Archer Daniels Midland Company; Northern Crops Institute; Wheat Foods Council; Fleishman-Hillard, Inc.; International Grains Program; Interstate Brands Corporation; Bogasari Milling Company; and American Ingredients Company.  Academic Institutions include: Kansas State University and Emory University.  International agencies include: UNICEF; Micronutrient Initiative; Global Alliance for Improved Nutrition; International Nutrition Foundation; World Food Program; and World Health Organization.  Governments: The United States of America (Department of Health and Human Services/Centers for Disease Control and Prevention, Agency for International Development, and the Department of Agriculture); and Australia (The Western Sydney Area Health Service, a Unit of NSW Department of Health)
 
Partnership Targets
The partnership has five goals:

• Collecting and evaluating country-level data related to iron deficiency, wheat consumption patterns, wheat milling infrastructure, wheat fortification practices, regulatory and statutory policies, and cost-benefit analysis.
• Establishing a FFI Multimedia Clearinghouse to compile and share information on FFI activities for all audiences.  
• Creating a strategic alliance development plan to recruit public and private sector partners. 
• Conducting training and technical support for flour millers and others around the world in the design, promotion and implementation of fortification efforts.
• Fostering industry and consumer communications to encourage the world's flour industries to adopt fortification practices and to persuade the public to consume fortified wheat products.

Progress Toward Targets
Collecting and evaluating country-level data: FFI researchers have developed databases of national fortification practices in 188 countries.  The databases include country-specific information on the amount of different micronutrients added to flour, the legislative status of national fortification programs, and national milling infrastructure, including number, types and capacity of mills.  In-depth individual country briefs have been prepared on selected national flour fortification efforts. As FFI-affiliated partners have opportunities to talk with country leaders, this information provides a helpful overview of the need and efficacy of fortification.  Recent country briefs include Australia, Kenya, New Zealand, Sudan, and Ukraine.
 
Establishing a FFI Multimedia Clearinghouse: FFI has developed a messaging framework for flour fortification with a particular focus on its need and benefits for health and economic development of nations.  In addition, the FFI Web site has a number of available resources with information about fortification, such as PowerPoint presentations, testimonials, latest updates and developments, white papers, meeting reports, articles, and links to other sites and resources.  FFI regularly provides specific and targeted materials and information for members of the network to use as opportunities within their industry or organization arise, such as presentations on flour fortification in various industry conferences and meetings.
 
Creating a strategic alliance development plan: FFI is planning a June 2004 Leadership Forum in London to bring together the top leaders in industry and public health to discuss best practices, lessons learned and next steps to increase wheat flour fortification in the developing world over the next one to three years (2007).
 
Conducting training and technical support: An FFI training and technical support-working group has been established under the auspices of the International Association of Operative Millers (IAOM) and with assistance of the U.S. Centers for Disease Control and Prevention (CDC) as well as the Micronutrient Initiative (MI).  This working group is charged with developing a training curriculum on flour fortification to be distributed to milling schools around the world and providing, as needed, technical support on an ongoing basis to millers who fortify their flour.
 
Fostering industry and consumer communications: An FFI communication working group has been established with a principle role to act as a dissemination point for spreading information about FFI activities, such as the Leadership Forum in June, through trade and industry media outlets. This working group endorsed a new messaging framework established for FFI in March 2004 and will begin to work on trade communication in April and May. It is also acting as an advisory group to consider how best to engage consumer messaging and will help determine what kind of campaign is feasible and in how many countries. 

Next Steps
The following are immediate planned activities for 2004:

• Carry out an international millers' survey with an initial focus on SE Asia.
• Evaluate and improve the graphic identity of FFI to better represent the nature of the network and provide a foundation for a consistent and persuasive image in ongoing communications with key constituencies. 
• Evaluate and improve the FFI Web site to serve as a hub for information on flour fortification activities and to improve ongoing communication between partners in support of flour fortification efforts around the world.
• Work through the FFI communication group to outline potential consumer outreach programs and initiatives.

Resources
Since the development of FFI in 2002, the partnership's public sector partners have contributed approximately $400,000 and FFI private sector partners have contributed an estimated $1.5 million of in-kind support.
 
U.S. Government Primary Points of Contact
Centers for Disease Control and Prevention: Ibrahim Parvanta (Telephone: 770-488-5865; E-mail: Iparvanta@cdc.gov).

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