Food Fortification as Healthcare Policy: The Ethics of Removing Choice

Although social security removes choice from its participants, respondents are evidently willing to sacrifice present autonomy for the benefit of financial stability later on. The government would offer a similar bargain through a single plan, universal healthcare system. However, respondents vehemently opposed this trade. This is striking. The data suggest that Americans are more likely to favor government paternalism in their personal economics rather than their personal health decisions. This indicates that consumers would rather have the right to reject food fortification than have the policy thrust upon them. Despite this, food fortification is ubiquitous in our markets.

Because fortification does not significantly alter the taste or the price of goods, it can easily become the default choice for a consumer. For example, milk does not naturally contain Vitamin D [15, 16]. Milk contains calcium, the main component in bone construction, but it is fortified with additional bone strengthening Vitamin D to combat reduced sun exposure in American children [15, 16]. This addition, were it to be government mandated, would be seemingly incongruous with the fact that a majority of Americans would oppose similar government intervention in healthcare. Yet, many citizens still buy fortified products, suggesting that making the addition of Vitamin D in cow’s milk mandatory would not be entirely unpopular. Such a decision would make into policy an essential medical service that has forever altered the physical constitution of American citizens.

As made evident by their continued presence in stores, there is a market for fortified food products. Government standardization of food enrichment would ensure that citizens get more nutritional value from the same products they buy everyday. Rather than giving consumers the option to be nutritionally deficient, our healthcare policy should broaden the scope of federal food regulation, keeping companies accountable for a practice that has improved the quality of life for the entire population.

The role of food fortification in daily life is best exemplified through breakfast cereal. Cereal is incredibly popular in the United States, with a total market evaluation of nearly $44 billion [17]. Most brands are fortified with a litany of vitamins and minerals. Lucky Charms, for example, contains Vitamin A, Vitamin B6, Vitamin B12, Vitamin C, Vitamin D, Calcium, Iron, Thiamin, Riboflavin, Niacin, Phosphorus, Magnesium, and Zinc [18]. Rather than delegating the responsibility of managing a healthy daily intake of these minerals onto the average person, the fortification of cereal mitigates the taxing decision making necessary for daily survival. Instead, this mental space can be devoted to other endeavors, to everything that makes life worth living rather than to just what keeps us alive.

A daily bowl of breakfast cereal, with fortified milk, is a trivial routine of habit in most people’s lives, but it holds remarkable significance for the advancement of human progress. Not only is it medically ethical to mandate the enrichment of common food products, the government has a moral obligation to ensure that these mandated products are available and attractive for consumers. By removing choice from the average citizen, mandated food fortification both contributes to national dietary nutrition and allows the populace to spend less energy managing their intake of micronutrients.

Not only does food fortification impact dietary health, but so too does the privilege to be free from choice represents a remarkable method for combating poverty and medical inequality. The mental burden imposed by simply staying alive can be insurmountable. Removing this burden can be a key tool in the fight against global poverty. Food fortification, especially the iodization of salt, is an extremely cost effective way to combat medical inequality for those in extreme poverty (defined by the World Bank as living on less than $2.15 per day) [19].

By removing the need to manage Iodine intake, food fortification programs allow the extremely poor to think beyond immediate survival and towards social mobility [20]. The purification of tap water provides an excellent example of how government intervention can reduce menial mental load. Just as fortifying milk mitigates the need to manage Vitamin D intake, purifying tap water removes the need for the drinker to add a chemical, such as chlorine, with each use, reducing both waterborne disease and cognitive weight. The right to have chlorine added to tap water is as essential as access to the free tap water itself.

Food fortification serves the same purpose as free, clean water access. With government intervention in the field of nutritional fortification comes a guarantee to the consumer that adding cereal to their breakfast will add value drastically beyond simply the calories it supplies. Thus, food fortification is not only medically ethical, it is an essential provision that should serve a larger role in U.S healthcare policy. Government mandated food enrichment would raise standards for average nutrition and move the onus of nutritional management away from the individual, and towards the society. Without this responsibility the average citizen is liberated from the need to keep alive, and free to pursue the need to be alive.