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Welcome to GiveWell’s podcast sharing the latest updates on our work. Tune in for conversations with GiveWell staff members discussing current priorities of our Research team and recent developments in the global health landscape.
Webinar Promo: Thank you for tuning in to today's episode. Before we dive in, we want to invite you to join us for our upcoming webinar, Looking Back to Give Better: How GiveWell Evaluates Its Grantmaking, on Tuesday, June 9th at 12 PM Eastern, 9 AM Pacific.
GiveWell co-founder and CEO Elie Hassenfeld will moderate a conversation with Program Directors Alex Cohen and Julie Faller about how we evaluate whether a grant achieved the impact we initially estimated, and how we use those findings to make better impact estimates over time.
Our growing research capacity has recently enabled us to expand this step in our research process for select grants, and publish comprehensive evaluations that we call “lookbacks.” Speakers will share real examples from past grants and answer questions about the methodology behind lookbacks, what we've learned, and how findings have informed future grantmaking.
To attend the webinar, register [00:01:00] at givewell.org/lookingbacktogivebetter.
We hope to see you there.
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Elie Hassenfeld: Hey, everyone. This is Elie Hassenfeld. I'm GiveWell's co-founder and CEO, and today I'm talking with Andrew Martin, who's a Researcher on our nutrition team. We're going to be talking about GiveWell's work on iron broadly, and then we're going to zoom in on one organization that we've supported for its work on iron called Fortify Health, which operates in India.
People may not realize this, but iron is a meaningful area of giving for us. Over the last 10 years where we've been working on iron, we've given nearly $50 million to programs that support iron delivery. And because of the burden of iron deficiency worldwide, and the fact that there are cheap ways to deliver iron to people in need, this could be a growing area for us in the future.
Very basically, our bodies need iron in order to function, and people with [00:02:00] insufficient iron can feel tired, weak, or foggy. Insufficient iron can harm children's cognitive development. It can lead to problematic effects in pregnancy. There are randomized controlled trials showing that it can limit people's physical work capacity. And so the ability to deliver this can make a big difference.
There are two basic ways that organizations we've supported address this problem. They can deliver supplements, which are regular pills that mostly children receive. Or it can be delivered via fortification, where iron is added to staple foods.
It took us a while at GiveWell to get into iron because the evidence here is complicated. As you'll hear in this conversation, it can be hard to determine the magnitude of the life outcomes that are improved by getting additional iron. We know less than you might expect about how problematic iron deficiency is. We know it is problematic, but determining [00:03:00] exactly how problematic, and what improvements will come with additional iron, is hard. And then the different approaches to delivering iron are challenging to implement.
Andrew and I are going to talk about an organization called Fortify Health. It's an organization that was founded in 2017. It partners with millers to fortify wheat flour, and when we first funded it, it was really small. We gave it a $300,000 grant many, many years ago, and we recently, based on the success that it's had over time, renewed that support with a $10 million two-year grant. And that grant relied on a large amount of internal research that we've done as a team that Andrew will discuss, but also our own lookback at Fortify Health's track record and what it was able to deliver.
And for me, it's really exciting to be able to look back at the track record of programs that we've supported. Because as you'll hear, we had a lot of open questions going into our initial grants to Fortify Health. We didn't know if their model would work, we didn't know if they would be able [00:04:00] to scale cost-effectively, we didn't know how their costs would change over time. And what we've been able to see with the passage of time in our own reassessment is that they've been very successful. They've also run into some challenges that they've overcome, which they and we are learning from.
So, we're going to talk about all that, and I’m excited to get into it. So Andrew, great to talk to you about this. Thanks for joining and having this conversation.
Andrew Martin: Nice to be here today.
Elie Hassenfeld: So let's just start out with the basics. Why don't you just walk through like what is iron? Why is it important? Why does this matter, and why are we trying to address it?
Andrew Martin: Yeah. So I would say that there are two related but distinct conditions. One of them is iron deficiency, which is when your body's iron stores are depleted. Then there's also anemia, which means that a person doesn't have enough functional red blood cells to deliver oxygen throughout their body.
So the relationship is that [00:05:00] iron is needed for your body to produce hemoglobin, which is the protein in red blood cells that carries oxygen. So a person with insufficient iron may develop anemia because their body isn't able to produce enough hemoglobin. And so iron deficiency is a common cause of anemia but not the only one.
And then in terms of why this matters, anemia has these direct negative health impacts. It can lead to fatigue and weakness, difficulty with concentration, shortness of breath. It's also extremely common, especially in South Asia and in countries in Africa. In addition to those direct negative health impacts on people's quality of life, it has these kind of downstream impacts. It's especially important during pregnancy, so especially moderate or severe anemia can have negative impacts related to low birth weight, or [00:06:00] neonatal mortality, or possibly maternal mortality.
And then we also think that there are economic impacts related to this as well. So early in childhood, iron is important for cognitive development, and we think that averting anemia in childhood could have long-run developmental impacts, and those could translate into economic impacts in adulthood. For adults, we also think that being anemic could lead to lower productivity in terms of difficulty with concentration or physical fatigue. So alleviating that could also have these economic benefits for adults.
And then I think one other piece of why this is something that we are focusing on is that it's something that can be reduced very cheaply. So for Fortify Health, the organization that we're going to talk about more later, we did this lookback analysis on the grant that we made to them in 2021. And looking back, we thought that their cost per [00:07:00] person reached with iron-fortified flour in India was something like forty cents. And going forward, as they're scaling up further, we think it could get lower, like maybe closer to twenty cents.
In comparison to other programs that GiveWell supports, like seasonal malaria chemoprevention or insecticide-treated bed nets, the cost per person reached is just very, extremely low, and a person reached doesn't eliminate anemia by any means, but we think it does lead to a meaningful reduction. And the cost being so low means that a given amount of funding can reach a very large number of people and have a large impact.
Elie Hassenfeld: Okay, so lack of iron and then anemia are a major global health problem. How big of a problem is this around the world?
Andrew Martin: So I think it's a surprisingly large issue. The sort of standard estimates from GBD, Global Burden of Disease project, are that something like [00:08:00] two billion people are anemic, so it's a quarter of the world's population is one of the most common estimates.
And it is most common among children under five, women of reproductive age, and women during pregnancy. The basic reasoning for why those groups are particularly vulnerable is, for women of reproductive age, it's due to menstrual blood loss, which can kind of deplete iron, makes it more difficult for a person to consume enough iron in their diet to replace that. For women in pregnancy and for young children, the basic reason is that there are very high iron demands on the body at those times for pregnancy and also for growth in young children. So in those groups, in some countries like in India, it can be something more like 30% to 40% of people in those groups are anemic. So it's a very common problem.
Elie Hassenfeld: And so maybe a sort of very basic question is, if so [00:09:00] many people are anemic, on some level, I have the intuition that it couldn't be that bad. Because if it were, it would sort of be self-evidently visible in some ways. So, how do you think about that question? Like, how bad is it to be anemic? And what does it mean that, say, I don't know, 40% of people in India may be anemic?
Andrew Martin: Yeah, so I think that there are gradations of anemia. Usually it's termed as mild, moderate, and severe. So a very common framework for estimating how bad different types of health conditions are is the disability-adjusted life years framework. The way that basically works is, for a condition, there's a numerical estimate of how much worse off somebody is in terms of their health, compared to an ideal, perfectly healthy year of life. And the disability weight for mild anemia is, I believe it's the lowest weight [00:10:00] that is in this disability weight system. So the intuition that mild anemia is understood to be a fairly small-scale difference in a person's quality of life, I think is fairly well-supported. And for moderate or severe anemia, the case that this makes a very significant difference to your quality of life is stronger.
But I think that when we're thinking about the impact of these programs, to some extent, the impact is driven by just the massive numbers of people involved. It's kind of like the impact per person can be pretty small in terms of benefits to their health. But even compared to I think a lot of the other types of programs that GiveWell funds, the sort of numbers of people involved are just really, really massive.
Elie Hassenfeld: Is there any way, and I don't know if this is possible, to conceptualize the level of impact on a person's life for addressing mild, moderate, severe anemia? I mean, we're potentially able [00:11:00] to improve the lives of this vast number of people. How much do we know about the magnitude of the improvement that we're able to affect?
Andrew Martin: So this is actually something where we have some uncertainty, and that GiveWell has funded a trial that I think is actually quite relevant to this.
So when we're estimating the proportion of people that are anemic, we're relying on these hemoglobin concentration cutoffs where you take a sample of somebody's blood. You can measure the hemoglobin concentration in that blood, and the World Health Organization has a set of thresholds, which differ a bit based on age group and demographic group, for what would count as mild anemia, moderate anemia, or severe anemia.
And the thing that we are…is surprisingly uncertain is exactly how those sort of anemia thresholds map onto anemia symptoms. This is something that we looked into a [00:12:00] couple of years ago, and if you go way back in the World Health Organization document archive, it's like in the 1960s that there was a study of a population that was estimated to be generally healthy. And they took a measurement of their hemoglobin concentrations, and the kind of bottom 5% was determined to be the threshold for anemia. So this kind of definition that we have is actually not tied to the types of anemia symptoms that we're talking about in as clear of a way as you might expect. It's kind of a semi-arbitrary statistical cutoff.
So the trial that GiveWell funded is a trial in Bangladesh that is going to provide iron repletion through IV iron, which is a very highly effective way of alleviating iron deficiency and anemia. And it's going to involve measurement of subjective well-being outcomes. [00:13:00] This is something that's actually not been done before at all, and that GiveWell is trying to get more information on because this question of how much worse off is a person with anemia is actually surprisingly understudied.
Elie Hassenfeld: Right, it's so interesting. So it's like, we know mechanically, iron is really important. We then know that there's wide variation in iron levels in people's bodies, and there are these cutoffs where, if you're below a certain level, you're considered anemic. So therefore, we know that on some level, the people who are at the lowest level would be better off with more iron. But it sounds like we don't have a great sense of the magnitude of the benefit in sort of concrete life outcome terms that follows from more iron.
So we are trying to do more to get more information, but do we know more than that? I guess maybe the pointed question is, if that is our understanding, how do we come to feel confident directing money to this program where we have this sort of [00:14:00] limited sense of the impact it has on people's lives?
Andrew Martin: Yeah, so I don't want to overstate the uncertainty here. I think that maybe one way to look at it is thinking about it from a kind of individual perspective versus a population level perspective. From an individual perspective, like maybe from a clinician who has a patient who was complaining of very low energy, or difficulty concentrating, being out of breath easily. It seems likely that they would end up doing a blood test to measure hemoglobin levels and serum ferritin, which is a biomarker of iron deficiency. And in that sort of individual case, my impression is that doctors who work with patients, this is very well-established that it’s common that people feel these types of symptoms.
But then the thing that is, I think, more uncertain is when we say something like, 40% of children under five in India are anemic. I think we're less confident about exactly how that maps [00:15:00] onto those types of symptoms at that kind of population level.
One other thing I'd emphasize is that in the way that GiveWell estimates the benefits of these types of iron supplementation or fortification programs, one part of it is this, what we've been discussing, which are the direct health effects of having anemia. We're aiming to get an estimate of how much better off somebody is if they can move from being anemic to non-anemic, in terms of their quality of life.
Then a second sort of set of things that we estimate in our model are downstream health effects. I think this is especially relevant during pregnancy. There can be increased risk of low birth weight if a person is iron deficient or anemic, and that could have long-run impacts on the child. And then also a big part of it is that for children, we think that there could be benefits for those children into adulthood if they have iron deficiency anemia that's alleviated [00:16:00] in childhood. Iron is especially important for cognitive development.
And for the iron supplementation programs that target children, like Evidence Action's program that we funded in India, it's often the case that a large proportion, like more than half of the benefits that we're estimating are these long-run development benefits instead of the more direct health effects.
Then the third one is economic impacts. Part of the symptoms of anemia that we've been discussing are this kind of like physical fatigue, and then also difficulty with concentration. And we think that correcting that iron deficiency or anemia for adults could lead to income gains, if the person is unable to function at their job fully with anemia or iron deficiency. So yeah, I think that's also relevant.
Elie Hassenfeld: Yeah, that makes sense. And so, in both of those cases, I think there's some serious evidence pointing to the effects, both on [00:17:00] the adults earning more with iron supplementation, and also the effects that iron can have on cognitive development for children.
Can you just, in both of those cases, talk through what the evidence looks like?
Andrew Martin: Sure. So I think maybe the place to start would be on what we've called physical work capacity, where I think these were mostly in the 1970s, but there were a handful of randomized control trials that measured productivity for agricultural laborers or other people with physically demanding jobs, and found that iron supplementation can lead to increases in productivity.
The story there I think is fairly intuitive, that if you think that anemia can cause a lot of physical fatigue and sort of difficulty maintaining physical activity, alleviating those symptoms could lead to higher productivity. We also need to make an assumption about how much of those productivity gains could go to increased income [00:18:00] for workers versus be captured by others. So that's the randomized controlled trial evidence, most of it is fairly old, about the impact of physical work capacity and anemia.
Then for cognitive effects, there's a set of trials related to iron supplementation and cognitive benefits. The sort of summarized finding would be that having iron deficiency anemia can lead to measurable deficits in cognitive ability as measured by different types of cognitive tests. And that iron supplementation can alleviate those cognitive deficits.
The part where we have to make another sort of assumption is that we don't have direct evidence on iron supplementation leading to increased income, but kind of we are translating this expected cognitive benefit into an expected income increase, based on other literature on the relationship [00:19:00] between cognition and earnings.
Elie Hassenfeld: Okay, got it. So that's the case for iron. You know, there are these potentially very large benefits, and potentially they can accrue to a very large group of people, and the evidence itself is fairly complicated to work through in various ways.
Now I want to turn us to kind of move away from iron as a whole and focus in on one organization in particular that we've supported over the years, which is Fortify Health, which works on iron fortification. So Andrew, maybe just to start, could you just say what Fortify Health does, and then we can sort of tell their backstory and get on to some of what they've accomplished.
Andrew Martin: So Fortify Health works in India, and the very basic version is that they partner with these wheat flour mills, and they cover these costs of fortifying wheat flour. When they establish a partnership with a wheat flour mill, they provide that mill with [00:20:00] the equipment and the what's called micronutrient premix, which is the powder that contains iron and other micronutrients, that is mixed in with flour at the mill. And so, Fortify Health will reach out to a mill and say, if you agree to fortify your flour, we will cover these costs for you over the period of a contract.
Elie Hassenfeld: Cool. Yeah, I mean, how did they...walk us through their backstory and how they got to be doing what they're doing.
Andrew Martin: So they were founded back in 2017. I think they were one of the very earliest organizations that was incubated through what's now called Ambitious Impact, or was formerly known as Charity Entrepreneurship.
I think that the two founders of Fortify Health, Brendan Eappen and Nikita Patel, they had arrived at this conclusion that iron fortification could be a very highly [00:21:00] cost-effective intervention, particularly in India. And the basic reasoning was that anemia burden in India is very high, and the cost per person reached with these types of fortification programs are just extremely low.
Maybe some relevant context is that in some countries, fortification of wheat flour or other staple foods is mandated by the government, but that is not the case in India. And so they had the idea to partner with individual wheat flour mills to provide fortified wheat flour, in absence of a kind of government mandate enforcing it for all mills.
Elie Hassenfeld: Well, it's kind of interesting because a lot of the groups that work in this kind of area are focused on affecting regulation and government rules, and they went in straight to try and work directly with individual mills to enable them to fortify. How do you think about that trade-off, and what they focus on, and I don't know, what have been the pros and cons of that [00:22:00] approach?
Andrew Martin: Yeah, so I think that it is a bit, maybe unusual, in the food fortification space for an NGO to cover the costs of fortification directly. I guess maybe one way to think about it is the aim is to get wheat flour millers to do this additional process that has some costs. And a couple of approaches to getting them to do it, one is just that the government mandates it and that the government enforces compliance. So all wheat flour millers need to do the same thing. The other approach, the one that Fortify Health is taking, is offering to cover these costs.
I think that the sort of standard objection to Fortify Health's approach is about whether this is a sustainable approach over time, whether donors would need to continue covering these costs in the long run. And I think that Fortify Health's response to that is that a lot of [00:23:00] other organizations take what they think is a top-down approach to food fortification, where the aim is to start by working with the government to get appropriate regulations in place, and then to train government workers on how to enforce that mandate and how to monitor the quality of the implementation of the program.
And the track record for that type of work, I think, is at least in my view, mixed. It can also be very difficult to tell whether what a specific organization is doing, like how much of a difference it's really making to what the government is doing in terms of food fortification.
Fortify Health would describe their approach as being more bottom-up, where in a particular state in India, they will partner with a set of wheat flour mills. And over time, their aim is to show state governments that this approach can work. And then [00:24:00] once it's kind of already up and working, and millers are already fortifying their wheat flour, it could lead to the environment in which a state-level, or possibly national-level, policy change of mandating wheat flour fortification could occur.
Elie Hassenfeld: Got it. So, they've now been at this for a while, and we recently completed this sort of post hoc reflection on how their previous work had gone that informed our renewal of a grant for their work. And so, how has it gone? Like what have they actually delivered? What's gone well, and maybe better, or in line with expectations? And then also what's been challenging?
Andrew Martin: Yeah, so, we had our initial grant to Fortify Health back in 2018. Then we made them another grant in 2021. And then just as you said, we've done a renewal grant just this year. So at the start of the 2021 grant period, we were I think quite uncertain about whether this model was really going [00:25:00] to work at all. At that time, after they had been working at this for a few years, they had seven wheat flour mills that they were partnering with.
And maybe the more intuitive way to think about it is that it would be reaching something like 350,000 people per year with people who are consuming the wheat flour produced at those mills. And in the context of India, that was still just like very, extremely small scale. And we were just highly uncertain about whether they would realistically be able to scale up this program model further.
But we recently did a, what we've called a lookback, on this 2021 grant. And the sort of headline conclusion there was that Fortify Health, over the past few years, between 2021 and now, they scaled up more than we'd expected. So they moved from seven mills to 125 mills over three years, [00:26:00] and they increased the amount of flour that they're fortifying around thirty times. So, compared to our expectations, they actually scaled their program up further than we had expected and sort of demonstrated that it can operate at a higher scale.
It also ended up being quite a bit more cost-effective than we had guessed, when we first made that grant. So in 2021, we had thought that the grant to Fortify Health would be five times as cost effective as our benchmark. But we thought that it could become more cost effective as they scaled up and had lower cost per person due to economies of scale. What we ended up learning was that this grant retrospectively was 12 times as cost effective as our benchmark. So it more than doubled.
Most of that change was because we had substantially overestimated how much it would cost per person reached, per year for Fortify [00:27:00] Health's program. Instead of something like eighty cents, it was closer to forty cents. So the costs per person reached were around half. That's partially because they ended up not needing to spend as much money as they had budgeted in order to run their program. Some of the reasons for that are that they were able to negotiate lower costs for this premix, and that they didn't require quite as many program staff as they had expected.
So, the headline is that they were able to scale up this program like quite a lot when we were highly unsure about whether that was actually going to happen. And then they also had lower costs than we expected.
Elie Hassenfeld: Those are the parts of their work that have gone really well. They've scaled up more quickly than we anticipated, and also were able to reduce their cost per person reached by a significant amount.
What's been hard for them? What hasn't worked as well as we had hoped?
Andrew Martin: So Fortify Health has two different parts of their work. One part, which is most of what we've been talking about, is what they call open market fortification, where they are working [00:28:00] with wheat flour mills that provide wheat flour for general retail consumers. And then the other part is government partnerships.
So in India there are some very large social safety net programs that operate on just a really massive scale. One of them is the public distribution system, which provides free or reduced price grains to low-income households, including wheat flour depending on the region. The public distribution system in India reaches something like 800 million people, so it’s just like a very massive scale program. And then the government also provides school meals and other programs that also reach a very large scale. So, the work that Fortify Health is doing is kind of inspired by the possibility for very large impact if they can work with governments to provide fortified wheat flour through these programs rather than unfortified.
When we did this lookback on our 2021 grant, the thing that we thought went less well than we had hoped was that, in [00:29:00] the first few years of that grant, their progress on reaching these government partnerships was slower than we had hoped for. When we've talked with Fortify Health about this, they've said that some of the challenges were that they might be in conversations with a specific state about working with them on a government partnership program for a while, and then maybe there was some kind of personnel turnover, and then their kind of conversations had to start all over again. Or just generally a lot of bureaucratic hurdles that were difficult to overcome. So the progress on that was slow.
But in the past few years, things have turned around more. So they now have partnerships in a few states, working on these school meal programs, providing fortified flour for the wheat flour that's provided in meals in schools. And they're continuing to work on that and continuing to work on other partnerships.
Elie Hassenfeld: And so, what does that mean for their future? Like, is it possible that they will [00:30:00] just keep scaling up the standard work with mills, provide equipment, and that is a reasonable, long-term, scalable strategy, or do they really need these partnerships to succeed?
Andrew Martin: Yeah, this grant that we made them this year for $10 million, that grant was only for this open market part of Fortify Health's work. And we think that they do still have room for further scale-up of that program over time. Within India, some states consume more wheat flour as a staple food, compared to other states that consume more rice as a staple food. So, Fortify Health is working in the parts of India that consume more wheat flour. But I think even within that, we think that they do have more room to scale-up to reach additional mill partners. But, yeah, I think that it definitely is their goal to continue to work on these government partnerships, due to the possibility of very large scale impact.
Elie Hassenfeld: And then are [00:31:00] there ways in which the open market partnerships have struggled? I mean, it sounds like that has been overall fairly successful over the last few years, but are there parts of it where they haven't, some have been harder for them than others?
Andrew Martin: So I think that there were some sort of implementation hiccups along the way as they started to scale up this program. I think one thing that has come up is the amount of time it took a mill to go from reaching an agreement with Fortify Health to actually producing fortified flour. I think in the earlier years, that ended up being quite long, I think something like, nine months. And that was due to various logistical and regulatory hurdles. Over time, they were able to improve on that, and I think it's closer to two months now. But, yeah, I think that's one example.
Elie Hassenfeld: So it sounds like they've improved that a lot too, which makes sense as they're a growing organization. So, I mean, we're sort of coming to the end here. I'm curious just when you look forward in iron as a whole, so not Fortify Health specifically, what's on tap [00:32:00] in the next couple of years for our work in iron, and what do you expect?
Andrew Martin: I think the biggest thing going on right now is that we did a request for information for iron fortification and supplementation programs in countries in Africa earlier this year, and we got a lot of responses. We are still kind of reviewing and going through all these proposals from different organizations.
One reason that that's exciting and different is as we've been talking about, GiveWell has funded these programs in India, where we think that there is a large anemia burden. In lots of different countries in Africa, we also think that the anemia burden is high, but historically, we have been hesitant about funding iron fortification and supplementation programs there, and that's related to malaria. And so there are two sort of considerations that we've been thinking about. One is the risk of potential harm of iron programs in areas with high malaria, and [00:33:00] one is a risk of limited effectiveness.
So for this risk of harm, the main issue is that there's one RCT, a randomized control trial, from Zanzibar in the early 2000s, which was in a very high malaria prevalence context and provided high-dose iron folic acid supplementation to children under five. And when you look at the results of that trial, it looks like the iron and folic acid supplementation could have increased the risk of hospitalization or death from malaria in these young children, to the point where I think that they stopped the trial, due to ethical concerns.
And from research we've done on this, our understanding is that there's a mechanistic reason why this could make sense. We've spent a lot of time looking more into this research and speaking to different experts. And the conclusion that we reached is that this context of this trial again, was a much higher malaria prevalence in the early 2000s than I think anywhere in Africa today. Also, [00:34:00] people that we spoke to thought that this type of risk would be more likely for these high-dose supplementation compared to fortification, and especially for young children.
So when we put out this RFI, we decided to be a bit conservative about it. We limited it to countries that have relatively low malaria prevalence, and then also, for supplementation programs, we were not likely to move forward with programs that aim to reach children under five. And so we think with those safeguards, we think that the risk of harm is low. For any programs that we fund through this RFI, we're hoping to also fund some impact evaluations along with it, ideally with measurements of the impact of the program on anemia or iron deficiency. So, aiming to see through programs we fund how much of a concern this actually is.
So the second thing that I think is exciting and interesting is that earlier I mentioned when talking about these potential developmental impacts for children, this is something that [00:35:00] we have a lot of uncertainty about. One pathway that I mentioned where we've tried to estimate this is estimating the impact of iron on cognition in children who are anemic, and then the impact of cognitive gains on income later in life. This is kind of this tenuous, multi-step process where you have to make these assumptions.
Another way that we've looked at this problem is that we've tried to find some natural experiments. There's actually one study on the rollout of iron fortification in the United States, I think like in the 1940s, and using variation in that rollout to try to estimate long-run economic impacts over decades. Our interpretation of the conclusion of that study is that it implies just like really, really large economic benefits to the point where we're unsure whether it could really be that high. This is the only study of this type that we've been able to find.
So one thing that we're considering this year is whether we could fund someone to either do a replication of this US-based study, or possibly see whether there could be a [00:36:00] way to do a similar sort of historical analyses, based on the rollout of iron fortification in other countries, that would maybe improve our understanding of the scale of these kind of economic impacts that could occur.
Elie Hassenfeld: Well, thanks so much, Andrew. Yeah, really appreciate your taking the time to walk through this.
Andrew Martin: Thanks, Elie.
Elie Hassenfeld: Hey, everyone. It's Elie again. I just think this conversation is so interesting because iron deficiency is such a significant and important problem. You know, it's one that we took some time to get into because of some of the methodological and evidentiary problems that Andrew described. It's hard to measure. It's hard to figure out exactly how well programs work, and what impact they have on people. But when we look at it as a whole, we can see that it's very likely having very significant effects on people's lives, and so we're very glad to be able to fund it.
I'm also very glad that we now have the team and the tools [00:37:00] to assess the past work we've done so that we can more confidently expand into a wider set of areas to help people in need in low and middle income countries. And that's both being in a position where we ourselves have enough of a track record of funding programs that we can look back at them and learn from our own track record, but also that we have the team and the funding to go out and support the research that helps us make better decisions in the future. I hope that came through in the episode.
As always, thanks for your interest and for your support. We really appreciate it.