The Poor, Malnutrition, Biofortification, and Biotechnology - The Oxford Topic of Food, Politics, and Society - page 155

Most of these studies build on the DALY framework previously described, and more
specifically on Stein et al. (2005), who adapted the methodology for the evaluation of
iron, zinc, and vitamin A deficiencies. In short, the procedure is the following: First the
burden of a deficiency in a given region is quantified and expressed in the number of
DALYs lost, then the consumption of a biofortified crop is simulated (which leads to
higher micronutrient intakes). Based on the new (higher) micronutrient intakes, the
new (lower) prevalence of the deficiency is derived and used to calculate its new (lower)
burden. The difference between the old and new burden, which is expressed in the num-
ber of DALYs that can be saved, represents the potential impact of the biofortified crop.
This step of the analyses demonstrates the potential effectiveness of the biofortified
crops, which is a necessary condition for a positive evaluation. However, in a world of
scarcity, costs also matter, so that superior cost-effectiveness is a sufficient condition.
As the World Bank (1993, 61) explains, “Because interventions can differ so much in
cost-effectiveness, making allocative decisions badly in either the public or the private
sector costs lives. . . . Insisting on value for money is not only fully consistent with com-
passion for the victims of disease, it is the only way to avert needless suffering.” Similarly,
the World Health Organization confirms that “making best use of resources is vital in
developing countries that are struggling to improve public health with limited funds”
(Evans et al. 2005, 1133).
To determine the cost-effectiveness of a biofortified crop, its potential impact (mea-
sured in DALYs) is divided by the costs that need to be incurred for its development,
dissemination, and use. Where appropriate, these costs are shared among several ben-
eficiary regions. The metric that is thus generated is “Dollars per DALY,” which indicates
how much it would cost to save one “healthy” life year (DALY) if the given bioforti-
fied crop was consumed by the target population. Obviously, the less it costs to save one
DALY, the more cost-effective the intervention, and with a given budget more DALYs
can be saved. Moreover, because DALYs are not only used for the evaluation of micro-
nutrient malnutrition but for a wide range of negative health outcomes (Figure 6.2), the
results for biofortification can be compared with those for other interventions—to rank
and prioritize different programs, for example.
An overview of the biofortification results from the different evaluations is given in
Table 6.1. What can be seen is that results can vary by an order of magnitude between
studies; across crops, micronutrients, and countries; and even between different sce-
narios within a study. One explanation is that these studies are ex ante analyses that rely
on different data and assumptions (Figure 6.3) and are carried out at different levels of
aggregation. In particular, the prevalence of the micronutrient deficiency, the size of the
target population, the importance of the crop in their diet, the success of biofortification
in terms of additional micronutrient content that can be bred into a crop, the expected
coverage of the crop, and the current intake gap of the micronutrient all determine the
ultimate success of biofortification. Consequently, the less that is known about these
parameters, the wider the range of possible results. Filling such knowledge gaps and
refining the parameters is part of the ongoing scientific and policy process. Moreover,
such diverging results are not limited to analyses of biofortification. In a review of the