Mandatory policy: Most successful way to maximize fortification's effect on vitamin and mineral deficiency

Background: Damaging effects of vitamin and mineral deficiencies contribute to health and development problems throughout the world. Food fortification has substantially improved nutrition-related health conditions in many countries, but opportunities for fortification are not fully utilized. Where food fortification is considered, leaders have to determine whether fortification should be mandatory or voluntary. Objective: This article explores experiences with mandatory wheat flour fortification as compared to voluntary fortification to offer insight for policies related to any type of food fortification. Mandatory fortification means the country requires the addition of specific nutrients at predetermined levels to specified foods or food products. Voluntary policies allow food manufacturers to enrich their products but do not require them to do so. Results: Mandatory fortification is more likely than voluntary fortification to reach a high proportion of the population and hence achieve the desired health impact. Mandatory fortification does not require consumers to change food purchasing preferences, it distributes the health benefits more equitably than voluntary fortification across a population, it establishes safe levels of included nutrients, and it is not subject to the food manufacturers’ marketing investments or discretion. Conclusion: The health benefits of mandatory fortification are most likely to be achieved and sustained if national, multi-sector leaders develop a cooperative approach for appropriate food fortification policies that can be feasibly implemented and effectively monitored. Mandatory fortification, however, requires high-level commitment through the political process. Policy makers must contend with possible criticism that it interferes with personal choices or may cause unintended health problems.