Scaling the impact of food fortification
09 April 2026New evidence suggests stronger fortification programmes could deliver a 3.5-fold increased impact, but wider debates risk confusing consumers.
A new modelling study published in The Lancet Global Health last month provides the most comprehensive global assessment of what large-scale food fortification is achieving and what could be achieved in future with greater ambition. Led by Valerie Friesen and Christopher Free, with collaborators from Global Alliance for Improved Nutrition (GAIN), fortification programmes across 185 countries, representing 99.3% of the global population, were modelled across six scenarios from no fortification to improved compliance and expanded coverage.1
What’s already working: Large impact at low cost
The headline finding is striking current programmes prevent approximately 7 billion nutrient inadequacies every year at a cost of $0.18 (15 pence) per person. Salt iodisation accounts for nearly half of this benefit, preventing 3.3 billion iodine deficiencies annually and reducing global iodine deficiency by 87%. Iron fortification of flour delivers much of the remainder.
The economic case is similarly compelling: every $1 invested generates an estimated $27 in health and productivity gains, making fortification one of the most cost-effective public health interventions available.2
Improving compliance and coverage unlocks further benefits
The study’s most commercially significant finding is what happens when compliance and coverage improve.
Enforcing existing fortification standards to 90% compliance, without changing existing regulation, would prevent an additional 6.1 billion nutrient inadequacies* at an incremental cost of $0.05 per person per year.
Aligning national standards with WHO guidelines while improving compliance adds a further 10.3 billion.
The most comprehensive scenario, combining expanded coverage in high-need countries with aligned standards and improved compliance, would prevent 25 billion nutrient gaps annually: a 3.5-fold increase on current fortification at a cost of $1.15 per person per year.
Even in this best-case scenario, around 20.9 billion inadequacies remain unaddressed. Fortification is a powerful and proven tool, but it is not a silver bullet.
*A nutrient inadequacy is a person-nutrient combination, so one person can have multiple prevented inadequacies.
A UK lens on deprivation and achieving micronutrient adequacy
The global framing should not obscure domestic urgency; the UK is grappling with how affordability shapes health outcomes. The Food Foundation’s Broken Plate 2025 report estimates that the most deprived fifth of the UK population would need to spend 45% of their disposable income on food to afford the government recommended Eatwell Guide diet, rising to 70% for deprived households with children. The wealthiest fifth face an equivalent burden of 11%.
The consequences are stark. The most deprived groups spend an additional 11 years in poor health and die significantly earlier on average.3 The Health Foundation projects that 80% of the increase in working-age people living with major illness between 2019 and 2040 will be concentrated in the most deprived half of the country.4
Diet is a key mechanism underpinning this inequality. The National Diet and Nutrition Survey shows that 96% of the UK population does not meet fibre recommendations,5 with the most deprived fifth consuming 17% less fibre than the least deprived.6 Similarly in the most deprived quintile, 34% of adults are reported to have serum concentration levels of vitamin D below the deficiency threshold compared to 9-17% in the other 4 quintiles.5 In this context, fortified staple foods such as bread, milk and salt are crucial.
The UK’s mandatory fortification of wheat flour with iron, calcium, niacin and thiamine, has been in place for decades providing a safety net for the populations for whom a balanced diet is harder to reach financially. The 2024 legislation requiring folic acid fortification of non-wholemeal wheat flour, due to come into force on 13th December 2026, is estimated by the Department of Health and Social Care to prevent around 200 cases of neural tube defects per year, delivering NHS savings of approximately £20 million over ten years.7 The economic case for fortification at a national level mirrors the findings of Friesen et al. that there are significant public health benefits for a modest cost, particularly for more deprived populations.
Where science meets friction: The UPF debate and consumer confusion
Friesen et al. arrives against the backdrop of The Lancet ultra processed food (UPF) series, released in November 2025.8 Their publication has resurfaced the public and media discourse on UPFs. There is agreement with the UPF author group that government-mandated fortification of minimally processed staple foods is important. In fact, the UPF series authors have stated that they “take no position against food fortification more broadly, which is a public health solution used by many governments around the world, [such as] fortification of flour with folate or the addition of iodine to salt”.9
The friction emerges when fortification moves off staple foods and into ‘ultra processed foods’. The UPF series recommends “prohibiting nutrient and health claims on UPFs to avoid so-called health halo effects”.10
For manufacturers and retailers, this creates a credibility challenge: fortification can deliver genuine public health benefit, yet still risk being perceived by consumers as a marker of ultra-processing, and therefore something to avoid.
Health claims in the UK
The UK regulatory framework highlights how difficult it can be to communicate nutrition and health effectively.
Health claims in Great Britain operate under assimilated EU law: the Nutrition and Health Claims (England) Regulations 2007 as amended in 2024. An example is "Calcium is needed for the normal growth and development of bone in children". While scientifically robust, the authorised language is often highly technical and poorly aligned with how consumers understand health.
Fibre is another clear example. The authorised claim that oat grain fibre “contributes to an increase in faecal bulk” is compliant but lacks consumer resonance.11 Regulators permit some flexibility but are explicit that claims must not be made stronger than the authorised version.
Recently Marks & Spencer have been open about the regulatory friction this creates. In submissions to the House of Lords Food, Diet and Obesity Committee, M&S have called for “clearer labelling and flexibility on fibre health claims to support healthier choices”.12 The argument is consumer-intelligible language such as “good for gut health” is more likely to drive behaviour change than technically compliant but harder to understand alternatives, particularly when 96% of the population is already missing fibre recommendations.
There is a clear opportunity here to modernise the language used to communicate benefits, while standing firm on meaningful compositional thresholds. This pathway is achievable, and timely within the UK’s post-Brexit regulatory flexibility.
IGD opinion
The case for staple food fortification has never been stronger. The UK’s existing mandatory flour fortification and its upcoming folic acid extension reflect the global evidence base highlighted by Friesen et al. (2026) and should give policymakers confidence to go further.
Fortification provides a nutritional foundation for millions of people who cannot consistently access a balanced diet. Industry credibility is strongest where products are genuine staples, fortification is meaningful, and compliance is demonstrably high.
At the same time, the system for communicating health needs to evolve. The gap between scientifically valid claims and consumer understanding is now a barrier to behaviour change. Bridging that gap, without compromising rigour, should be a priority.
Finally, industry should continue to champion the evidence for fortification clearly and responsibly. In a landscape where debates around ultra-processing risk oversimplification, maintaining a strong, evidence-led narrative is essential to avoid unintended public health consequences.