Combating malnutrition: the best global investment – Copenhagen Consensus 2008

Publiceret Januar 2009

A panel of distinguished economists that met to ponder global challenges at the 2008 Copenhagen Consensus was asked, hypothetically:  if you had 75 billion dollars to improve the world, how would you best spend it?1 The panel ranked biofortification, the improvment of micronutrient content of crops through agricultural technology, fifth on a list of the “most promising solutions to ten of the most pressing challenges facing the world today.” Providing supplements and food fortification were also in the top five. This clearly indicates that reducing hunger, especially micronutrient malnutrition, should be among the top priorities for today’s policymakers. The panel recognized the enormous potential of a relatively small dollar investment to improve the nutrition for millions of people through biofortification. As food prices continue to rise, and people are forced to reduce their consumption of more nutritious foods, micronutrient malnutrition will undoubtedly increase. Biofortification will therefore become more important as a strategy to improve nutrition, well-being, and ultimately productivity, for millions of people2.

The Copenhagen Consensus1

The Copenhagen Consensus is a global project founded in 2002 by a Danish adjunct professor at the  Copenhagen Business School, Bjørn Lomborg, and the Danish Environmental Assessment Institute. The goal of this project is to establish priorities for improving the welfare globally using methods that are based on a theory of welfare economics. To achieve this goal, prominent economists have been working since 2002 to find the best solutions to ten of the biggest challenges to humanity.

The world’s biggest challenges are1:

  • Air pollution
  • Conflicts
  • Diseases
  • Education
  • Global warming
  • Malnutrition and hunger
  • Sanitation and water
  • Subsidies and trade barriers
  • Terrorism
  • Women and development

Suggested solutions to improve global welfare

In May 2008 a panel of 8 top-economists, including 5 Nobel Laureates, spent a week in Copenhagen and agreed on a prioritized list highlighting the potential of 30 specific solutions to combat some of the biggest challenges facing the world. The panel considered economic costs and benefits to order the proposals.

The top 10 suggested solutions, listed after priority, are shown below1. The malnutrition related propositions are indicated in bold.

  1. Micronutrient supplements for children (vitamin A and zinc)
  2. The Doha development agenda
  3. Micronutrient fortification (iron and salt iodization)
  4. Expanded immunization coverage for children
  5. Biofortification
  6. Deworming and other nutrition programs at school
  7. Lowering the price of schooling
  8. Increase and improve girls’ schooling
  9. Community-based nutrition promotion
  10. Provide support for women’s reproductive role

It is remarkable that five of the first ten priorities addressed malnutrition.

Why is addressing malnutrition such a high priority from an economic point of view?

Undernutrition; deficiencies of vitamin A, zinc, iron, and iodine; together with suboptimum breastfeeding are estimated to be responsible for 11% of the total global disease burden and 35% of child deaths3. The increase in diseases and mortality leads to losses in economic output and higher health care costs. Poor nutrition causes reduced productivity and learning. Furthermore, there exist cost-effective interventions to combat malnutrition4. Primarily, micronutrient interventions were found to have some of the most favorable cost-benefit ratios of any development intervention. Among these, providing vitamin A and zinc to small children, the universal iodization of salt, and the fortification of staples with iron and folate are the top priorities.

Biofortification is listed as a promising solution, but this approach has not yet been broadly applied (see additional articles in this issue).

What is the cost efficiency of combating malnutrition?

As an example, it was estimated that providing vitamin A and zinc to 80% of the children who lack this micronutrients will cost $60 million per year and will be responsible for a benefit of more than $1 billion5. This means, that each dollar spent in this program will result in benefits (for example reduced mortality, less diseases, and increased productivity) that are worth more than 17 dollars.

Improving iron nutrition will help combat anemia and will have a strong positive impact on productivity4. Different approaches can be taken to improve iron nutrition, including supplementation, fortification, and biofortification. For example, the benefit-cost ratio of using the supplement product called “Sprinkles” which contains iron and other micronutrients was estimated to be 37:1. This estimation assumed that a four months intervention in children 6-12 months of age protects the child against anemia throughout childhood.

For iron fortification the benefit-cost ratio was calculated to be on average 8.7:1, while the actual value depends on the fortificant and the food target being used.

A difficulty of using these approaches to improve nutrition among the poor is to reach undernourished groups living in resource-poor, isolated areas. Biofortification can reach isolated areas, as the “biofortified crops” can be grown by the individual families and isolated farmers. The initial cost and the time for developing biofortified crops is relatively high, but once new cultivars with increased nutrition have been produced, they can be distributed and grown using established practices and thereby replace the less nutrititious cultivars. In that way, biofortification can provide a sustainable alternative to supplementation and fortification, without the need of high annual recurrent costs.


Thank you to Yassir Islam of HarvestPlus and to Jens Stougaard of University of Aarhus for their contributions to this paper.


  3. Black, R. E. et al. Maternal and child undernutrition: global and regional exposures and health consequences. The Lancet 371, 243-260.
  4. Sue Horton, Harold Alderman, and Juan A. Rivera. Copenhagen Consensus 2008 Challenge Paper
  5. Press Release. Copenhagen Consensus 2008 - RESULTS. The world’s best investment: Vitamins for undernourished children, according to top economists, including 5 Nobel Laureates.