We’re engaging in an exciting entrepreneurship experiment: can a new EA-aligned organization effectively reduce the burden of iron deficiency anemia and neural tube defects? The burden is so large that we hypothesize that there exist opportunities for impact beyond already excellent work being done by major organizations. We have begun to develop relevant expertise and curate potential strategies for intervention. We are now consulting with experts to deepen our expertise and build partnerships, as well as narrowing down potential locations in which to focus our work. We hope to develop a GiveWell-worthy charity that can exceptionally effectively put donations to work in improving the lives of vulnerable people. We believe that despite the challenges to achieving this ambitious goal, this initiative is worth our efforts. It provides great career capital and learning opportunities for us, and we believe this project will have valuable lessons for the effective altruism movement. We are grateful for the opportunity to work on this potentially high-impact and exciting project.
Anemia and neural tube defects are widespread, preventable health problems that primarily lead to the suffering of women and children. Poverty predisposes people to anemia and neural tube defects for a variety of reasons, including inadequate nutrition, weak health systems, infectious/parasitic disease, and limited access to fortified foods.
Iron deficiency anemia (IDA) occurs when the body does not have enough iron to produce hemoglobin and cannot carry sufficient levels of oxygen around the body. IDA is responsible for roughly half of the 2.36 billion cases of anemia globally, and accounts for four percent of all years lived with disability. Anemia can cause chronic tiredness/fatigue, impaired cognitive development in children, low moods and low productivity in adults, and even increase risk for depressive symptoms and heart disease.
Neural tube defects (NTDs) are developmental abnormalities affecting the spine, spinal cord, and brain, largely due to folic acid deficiency within the first month of pregnancy. NTDs account for over five million DALYs and over 40 thousand deaths annually.
Fortification of staple foods with iron and folic acid is an evidence based strategy to reduce the burden of these diseases. IDA and NTDs account for widespread illness and their prevention is evidence-based and cost-effective. An organization transparently and successfully facilitating fortification would align well with GiveWell’s criteria for exceptionally effective organizations, and we’ve set out to try to develop such an organization.
Charity Science is incubating this initiative. According to their rigorous evaluation, iron and folic acid fortification is among the top causes that could become a GiveWell top charity. Causes were evaluated in terms of cost-effectiveness, scalability, strength of evidence, ease of testing, flexibility, and logistical possibility. Experts in the field, including GiveWell, 80,000 Hours, and Charity Science think charity entrepreneurship is an effective way to make a difference in the world.
What we hope to learn
Is it possible or realistic for non-expert, effective altruism-aligned individuals to establish a GiveWell-worthy organization from scratch?
In the interest of setting up an organization that meets GiveWell’s criteria, we are eager to test the possibility of EAs founding effective charities. Our first steps have been to begin gaining expertise on iron and folic acid fortification, and we will be grateful to the experts willing to share their knowledge with non-experts entering the field.
Charity Science: Health, an EA-aligned organization that provides SMS reminders for vaccines, is a good example of an implementation organization that has been developed from scratch by non-experts. This is the only charity startup of its kind that we are aware of and we hope to employ a similar model in building a micronutrient fortification initiative.
Are there gaps in the current work focused on IDA and NTDs through staple food fortification that likely won’t be met by other institutions in the near future?
At present, one of our priorities is to understand the current global landscape in micronutrient fortification and the different stages involved in the fortification process. By extensive reading and expert consultation, we hope to pinpoint the most neglected areas in the fortification process and we are considering a range of potential strategies (discussed below). As we gain expertise and familiarity with the existing actors, we will prioritize potential locations and strategies.
Who are we?
Brendan Eappen, Co-Founder, most recently worked with Partners in Health (Socios en Salud) in Peru on the development of their mental health program. Brendan studied Cognitive Neuroscience & Evolutionary Psychology, and Global Health & Health Policy at Harvard College.
Nikita Patel, Co-Founder, most recently worked at Malaria Consortium in global health communications, and prior to this completed an internship at the Centre for Effective Altruism. Nikita studied French and German at University of Oxford.
Joey Savoie, Mentor and Funder, CEO and Co-Founder of Charity Science (an effective altruism organization based in Vancouver) is providing extensive mentorship and initial funding to fortify hEAlth. Joey directs Charity Science: Health, the first EA-aligned charity startup of its kind. Their project sends text message reminders for vaccinations in India, where only 65 percent of the 20 million children in India receive all recommended vaccinations by age two. Charity Science: Health has been awarded two GiveWell incubation grants.
If fortify hEAlth advances beyond its initial stage, we plan to hire industry experts with specific skills and experience relevant to the chosen strategy and location.
Progress so far
In brief, during our first month, we have:
- Curated a library of relevant literature available on micronutrient supplementation and fortification. We are continuing to review this and will publish a summary in a later blog post;
- Established operational systems;
- Fine-tuned communication and external relations strategy;
- Identified roles and gaps we could fill in the fortification landscape, with an aim to narrow these down upon speaking with experts in the field.
Our initial research suggests that, despite the attention of several organizations to iron deficiency anemia (IDA) and neural tube defects (NTDs), there may remain many gaps that prevent people from access to iron and folic acid. Several potential approaches may be employed to improve access to these key nutrients and therefore combat IDA and NTDs. Any strategy we implement would be pursued in coordination with local organizations, international organizations, academic experts, and others. We will rigorously evaluate the potential for EA-aligned action consistent with these and other strategies.
Here are some intervention approaches we have identified as possibilities:
- Facilitating mandatory fortification of staple foods. We would work with local health professionals, lobbyists, and governments to establish requirements for specific staples that are industrially processed (such as flour or rice) to be fortified with iron and folic acid, to evidence-based standards.
- Short of working towards the introduction of legislation where it does not already exist, we could work with the government to update technical standards for fortification to reflect the WHO and Cuernavaca guidelines. One analysis suggested that only nine out of the 78 countries countries with mandatory iron fortification of flour are doing so most effectively, yet the infrastructure and political will exists (existed) to take on this issue, it could be a particularly feasible opportunity for impact.
- Within countries that mandate fortification, there may be poor adherence to fortification policy. We could develop capacity for (and carry out) quality assurance (monitoring, and evaluation) of fortification practices, working with the government to improve the effectiveness of existing programs that might exist on paper without adequately serving the people they are meant to support.
The above strategies are particularly appealing because of the scale of the potential impact. However, if further investigation proves they are either too crowded or infeasible, our efforts may be most impactful in extending fortification initiatives to communities often outside their reach, such as by:
- Providing technical support and subsidize fortification at small-scale, local mills in communities outside the reach of fortification initiatives that tend to target large-industrial mills.
- Revisiting strategies beyond fortification to improve nutrition, such as supplementation.
If you would like to learn more, guide us, or join us, please email us. Especially if you have expertise in this domain, but in any case, we would love to hear from you. This article is also posted on our blog.