Fortify to Increase Productivity

Fortifying wheat and maize flour and rice with essential vitamins and minerals provides extra health benefits through commonly eaten foods. Over time this leads to consumers with increased capacity for physical activity and productivity.


Anemia is defined as low hemoglobin and results in lethargy and decreased productivity. It also leads to complications in pregnancy as well as maternal deaths.

Anemia is estimated to contribute to:

  • 17% lower productivity in heavy manual labor
  • 5% lower productivity in other manual labor [1].

Studies throughout the years have confirmed the link between iron status and productivity. Three examples are:

  1. In the 1970s, the quantity of tea picked by workers in Sri Lanka was evaluated after one month of iron treatment. The overall increase in tea picked per day that could be attributed to iron treatment was 0.3 kilograms, which was significantly greater than the quantity of tea picked by those who received placebos [2].Sri Lanka

  2. In the early 1990s, the work productivity of 80 iron-deficient women was studied at a cotton mill in Beijing, China. Their work pace was determined by a machine and was constant throughout the study. Women who were treated with iron were able to perform their work with less cardiovascular stress and less exertion [3].

  3. A 2001 paper conducted a systematic review of research literature about the relationship between iron deficiency anemia and work capacity. The authors found that the effect of iron-deficiency anemia on work capacity justifies interventions to improve iron status [4].

In children, iron deficiency limits physical growth and mental development, and these losses are never recovered. Children who do not reach their full physical and academic potential will have limited future opportunities.

Brain and spine birth defects

Folic acid (vitamin B9) is included in fortification to help prevent brain and spine birth defects, also known as neural tube defects. Spina bifida is a common example. Spina bifida cannot be cured, and it leads to some level of paralysis and bowel and bladder control problems.

Adults who care for children with spina bifida spend time making medical appointments, taking children for treatment, and helping children with many daily activities such as toileting and mobility [5]. Adults with spina bifida are very often independent and productive, but they usually require ongoing and often intensive medical care [5].

A study of 88 people in Germany with spina bifida found that physiotherapy was the most used healthcare resource, and more than half the study participants used a wheelchair [6]. The authors concluded that their care givers "might have to either adjust their careers overall or adjust their working schedule, resulting in productivity losses" [6].


[1] Horton, S., and Ross, J, The Economics of Iron Deficiency. Food Policy. 2003, 28: 51-75. Also see corrigendum.

[2] Edgerton, V.R., et al., Iron-deficiency Anaemia and Its Effect on Worker Productivity and Activity Patterns. British Medical Journal. 1979.

[3] Li, Ruowei, et al., Functional Consequences of Iron Supplementation in Iron-deficient Female Cotton Mill Workers in Beijing, China. American Journal of Clinical Nutrition, 1994.

[4] Haas, Jere D., and Brownlie, Thomas IV., Iron Deficiency and Reduced Work Capacity: A Critical Review of the Research to Determine a Causal Relationship. American Society for Nutritional Sciences. 2001.

[5] Gross, Scott, et al., c., Impact of Spina Bifida on Parental Caregivers: Findings from a Survey of Arkansas Families. Journal of Child and Family Studies, 2009.

[6] Van Nooton, F.E., et al., Resource Utilization and Productivity Loss in Persons with Spina Bifida - An Observational Study of Patients in a Tertiary Urology Clinic in Germany. European Journal of Neurology, 2014.

The global estimate for 'Disability Adjusted Life Years' for iron deficiency: A loss of 25.9 million years.

- The World Health Report 2002. The Disability Adjusted Life Years (DALY) seeks to estimate the years of life lost to poor health and disabilities.


Nutritional Anemia

Deficiencies in several nutrients can affect anemia and lower productivity. Among the nutritional contributors to anemia are deficiencies in:

  • Folic acid
  • Iron
  • Riboflavin
  • Vitamin A
  • Vitamin B12
  • Zinc

Read more in the book Nutritional Anemia.

Wheat and maize flours and rice are regularly fortified with many of these nutrients. This can be part of a country's efforts to improve productivity because it reduces the risk of anemia from nutritional deficiencies.