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1, MARCH 2018 1

Iron Fortified Tea for Distribution in India

Mohamed Ali, Andrew Lau, Hao Jin, Luckshya Mehta, Oliver Wu

Index Terms—India, Iron, Tea, Anemia, Global Development.

Anemia has been described as a silent killer in cer- over 50% of women and children, this has been linked to
tain Asian countries such as India, Pakistan, Sri Lanka, death, and a 0.9% loss in GDP [11]. The low levels of iron are
Bangladesh and Nepal, however it has the highest mortality partially caused by the diet in India. The culture and religion
rate in India with approximately 87% of women in the re- in India leads to a large portion of the population having a
gion suffering from the condition. [1] Anemia is a condition vegetarian diet, and meat has much higher iron absorption
that develops when the individual has a severely low blood than non-vegetarian alternatives [12]. Changing the diet to
cell count (low hemoglobin levels). This means that their incorporate more iron would prove a substantial task, much
organs are not receiving enough oxygen, thus hindering less efficient than fortifying foods. Therefore, considering
their function or leading them to fail. [2] A major cause of the diet and the culture of tea consumption, iron fortified
anemia is an iron-deficient diet, and a possible explanation tea has a high probability of success in India.
for why India is such a susceptible region is because of the
religion of Hinduism. An article published by Al Jazeera
in April of 2015 cited that the Indian population of Hindus 3 PESTLE A NALYSIS
declined from 80.5% in 2014 to 79.5% in 2015, which signifies The PESTLE method was selected as the framework for
that Hinduism is the most commonly practised religion in the analysis of Iron-Fortifying tea in India, with consists
India. A cornerstone of the Hindu faith is the view that cows of analyzing the political, economic, social, technological,
are sacred, and thus are forbidden from being eaten. [3] This legal, and environmental aspects of the project. This method
lead researchers to try and think of an innovative, cost- was chosen as it provides a holistic view on the implications
effective, non-disruptive and sustainable solution to this of the project, which is critical for the real world implemen-
issue since it affects the majority of the female population tation of this technology. As 70% of India’s tea production
with catastrophic consequences, comprising up to 200,000 is consumed domestically and India exported 10% of the
annual maternal deaths and a million infant and neonatal worlds tea exports (by value) in 2016, making a small
deaths. [4] change to tea production has potential to systematically
alter the development of India as a whole. The PESTLE
method minimizes this risk by analyzing each component
of the market environment (India), which in turn creates a
Two main reasons that make India a suitable candidate for business case that can integrate with the existing physical
this technology are, high amounts of tea consumption, and and cultural infrastructure of India.
the need for increased iron intake. Tea consumption has al-
ways been high in India, and the trend is not slowing down,
furthermore it is important to consider the discrepancies 3.1 Technological
between different states [7]. For example, in the south coffee Insight was gained into the chemical processes and limi-
is a growing trend but in places like Kerala, tea consumption tations of iron fortified tea, and some surprising informa-
is much higher [7]. Tea is major part of the cultural identity tion was obtained regarding how frequent tea consumption
in India, and has been for many years. Even with develop- might be inhibiting the individuals body from absorbing
ment occurring and many small communities becoming in- sufficient iron from their already iron-deficient diet. Tea
dustrial hubs, those small stores selling tea have continued contains a chemical called Tannin which phenolically reacts
to prosper [8]. Furthermore, the largest tea manufacturer with non heme iron (plant derived iron) in food and hin-
in India, Tata, serves one-third of the population, allowing ders the bodys ability to absorb it efficiently. [13] Doctors
for easier distribution and negotiation [9]. The challenge recommend waiting an hour or two after eating to drink
would be in reaching the rural market, in these areas the tea so that it does not interfere with nutrient absorption,
income is lower and people tend to drink more milk than however when you review tea consumption rates in India,
tea, but the government is working to change this [10]. The the average rate of consumption is 2 cups per day for adults.
Tea Board chief is taking advantage of the governments Coupled with the fact that about 80% of the population
plan for economic development in rural India to increase is Hindu meaning that they do not consume red meat,
consumption of commercial tea, this will further increase which is a primary source of heme iron, the majority of the
distribution [10]. The second reason for this product is that, population is anemic. This poses an even greater danger
iron deficiency (anemia) is a major issue in India, affecting to expecting mothers, females that have reached the age of
JOURNAL OF APS420, VOL. 1, NO. 1, MARCH 2018 2

puberty and are at heightened risk due to menstrual cycles The proper resources will need to be secured in order to
and infants that are born to anemic mothers and thus also have the tea approved for import, as the process is long and
inherit the trait. Dr. Diosady directed the majority of the complicated. Iron is not on the list of prohibited substances,
Grand Challenges Canada grant towards funding research nor is it on a list of high-risk foods such as baby powder.
regarding micro-encapsulation of the iron fortification so This means that getting an import license should not be
that it can be implemented into the tea without reacting with very difficult [18]. However, another aspect to consider are
tannin, and so that it may withstand the heat of the liquid import tariffs, which can increase the cost of the tea if
surrounding it. He likened the coating of the capsule to that not manufactured in India. The current tea tariff is at 110
of the coating used on Aspirin, however he stated that this percent as of 2017 [19], which would cause a major issue
delivery system technology is utilized on the microscopic for anything imported into the country. An appropriate
level so that each iron particulate is coated. What this solution would be to work with local tea manufacturers to
essentially means is that the iron will only be carried by manufacture and supply the iron supplemented tea.
the tea as a means of reaching the patient’s stomach, and
the iron will begin to break down once it comes in contact 3.3 Political
with the stomach acid.
Despite India being the first country to launch the National
Tea manufacturing is a lengthy process with various op-
Nutritional Anemia Prophylaxis Program in 1970, the prob-
portunities throughout to implement the iron fortification,
lem of iron deficiency anemia remains widespread, which
however it is best done just before the tea is packaged
is still a major public health problem in India nowadays.
into tea bags in order to contain the iron particulates. The
[20] In 2007, the Indian government implemented the 12 by
tea bag is a partially permeable membrane that can allow
12 initiative, aimed at ensuring that all Indian adolescents
the iron particulates to flow through and mix in with the
have 12g/dL hemoglobin by 2012, listed the main causes
hot water in order to be consumed by the drinker. These
of anemia in India. [21] In 2016, the Indian government
companies would require financial incentives to allow their
allocated $5.5 billion to nutritional schemes such as the
product to be fortified with iron, but possible ways to reduce
National Health Mission and the Integrated Child Develop-
resistance is to benchmark the salt iodizing process used
ment Scheme. [22]However, this is $700 million below the
in Somalia. The Indian government can sponsor or erect a
estimate requirement stated in the Global Nutrition Report.
number of tea fortification plants for companies to outsource
[23] The Indian government is still attempting to reduce the
this process and thus avoid implementing it into their in-
problem of anemia in India. One of the goals for the 12th
house manufacturing processes, which could prove to be
Five Year Plan, the last five year plan between 2012- 2017, is
very expensive and might discourage them from partaking.
to reduce anemia in girls and women by 50 percent. Other
Smaller distributors can send their tea to fortification plants,
existing strategies such as Supplementation Interventions
where the tea gets fortified and packaged, then sent back
by the Ministry of Health and Family Welfare (MoHFW) and
to the manufacturer, ready for distribution. Larger distrib-
National Iron+ Initiative are also widely applied through the
utors like TATA could possibly field the costs themselves
nation. [24]Although the Indian government has increased
to create an in-house fortification process. It is important
national and internal awareness and prompted intervention
to emphasize the fact that the iron addition will not affect
programs, the prevalence of anemia due to the iron defi-
the quality of the product since it is both colourless and
ciency still remains high. [21]
tasteless. TATA seems to be invested in providing fortified
solutions to its consumers since it was one of the leading
companies to adopt Iron Fortified Salt under its subsidiary 3.4 Economical
TATA Salt Plus to combat anemia in 2012. [14] As stated in a 2003 paper published in Food Policy, due to
iron-deficiency anemia, India loses 0.9 percent of its gross
domestic product. [25] This means that India loses up to
3.2 Legal precautions $20.25 billion, according to the World Bank’s estimate of
The toxicity of iron is dependent on the weight of the India’s GDP in 2016. [26] [27]Thus, iron-deficiency anemia
person. From Merck Manuals; ”Toxicity depends on the has impacted India’s economy significantly.
amount of elemental iron that has been ingested. Up to 20 The Inclusive Business Model we suggest is to cooperate
mg/kg of elemental iron is not toxic, 20 to 60 mg/kg is with top tea manufacturing companies in India to distribute
mildly to moderately toxic, and a >60 mg/kg can cause to local people. 70% of the tea produced in India is con-
severe symptoms and morbidity.” [15]. Careful analysis of sumed within its borders, and the leading distributors are
the intake of tea for the average Indian Citizen must be Indian companies such as TATA coffee and Brooke Bond
taken into account to ensure no overdoses of iron will result Taaza. Possible distribution networks can be established by
from large amount of ingested tea. offering these companies business propositions in the form
According to the patent for iron fortified tea, the iron of increased profits. The expected cost of iron fortification is
comprises of 0.1 - 0.3% the tea by weight [16]. With the 10-20 cents/person/year which would not impose a steep
average cup of tea using around 2 grams of tea per 8 ounces price hike in terms of average tea price, meaning that
of water, this results in around 6 mg of iron per cup of consumption would stay relatively constant.
tea [17]. A 70kg person would need to ingest 700 cups of If the iron fortification tea technology can be managed to
tea within a short period in order to reach toxic levels of be spread across the India, the whole economic condition of
iron within the body. This calculation proves that it will be India will be revitalized because of the boost in tea industry
impossible to overdose on iron through the fortified tea. and the decreased cost spending in the health care. As the
JOURNAL OF APS420, VOL. 1, NO. 1, MARCH 2018 3

fourth largest exporter of tea in the world, India has one of energy system towards renewable sources is required to
the largest tea industries in the world. [28] Currently, there mitigate this concern.
are at least 1.1 million workers employed in various tea com- From a water perspective, improper wastewater treat-
panies around the country. [28] The industry also created ment has significant potential to harm the ecosystem, es-
income opportunities for almost another 10 million people. pecially if increased iron levels are introduced from the
[28] When the iron fortified tea becomes a daily source of iron fortification process. Increased iron concentrations have
absorbing iron for the Indian population, the government indirect effects on aquatic ecosystems, although DNA and
will invest more in the tea industry, and thus create more job membrane damage can result from iron toxicity. [38] Given
opportunities. Therefore, the Indian economy will benefit the large potential impact and scalability of iron fortified
immensely due to the iron fortified tea. tea in India, proper wastewater treatment should be im-
plemented in parallel with the fortification, which would
reduce the environmental harm as a result of tea processing.
3.5 Social
Tea has an interesting cultural development in India, it all
began when the British started employing Indians to grow
tea in the 1800s [29]. Then the concept of tea time was slowly 4 M ONITORING AND E VALUATION
established by the British, and started spreading throughout
India, the product become cheaper and all classes of people Impact assessment will be performed using RCTs (random
could enjoy it, now it is everywhere in the country [29]. control trials). This requires random sampling of the pop-
One reason it become so well established was due to large ulation in both treatment (where tea fortification is imple-
amounts of advertising, appearing in movies and commer- mented) and control (where tea fortification is not imple-
cials claiming health benefits, and even cartoons [30]. Now mented) communities, which will be decided randomly to
it is at the point where any gathering, professional or social, eliminate any bias. The challenge would be controlling the
requires tea to be present [30]. Indians have easy access to distribution of fortified tea to the chosen treatment commu-
tea, through sellers known as chai wallahs, small towns and nities, which can be achieved through partnering with the
large cities have these individuals throughout and they have India Tea Board and local tea distributors. Within a year,
become an integrated part of the culture [31]. Therefore, tea a random population from each community will be tested
plays a large part in social interaction in India. Considering, to compare the iron levels between a treated population
fortified tea does not alter the taste or have negative health and an untreated population, evaluating the effectiveness of
implications, the social aspects should be unaffected. the tea. If treated communities report healthier iron levels,
the fortified tea will be distributed to the next community
(chosen at random) and its effectiveness will be monitored.
3.6 Environmental
This distribution and assessment method will continue on
Tea leaves, like any other natural resource, must be handled a community by community basis. If the trial results return
in a sustainable and environmentally responsible manner. negative, the treatment community will be analyzed to find
Severe environmental consequences are present in both the the root cause of ineffectiveness, then the implementation
cultivation and processing stages of tea production, but not and monitoring structure will iterate until overall public
in the fortification process itself. Although the proposed health improves on a country-wide level.
technology is limited to the fortification process, the most
prevalent risks in the tea’s life cycle are discussed.
Deforestation is required to make land usable for agri-
cultural processes, such as tea leaves farming [32]. Not only 5 C ONCLUSION
does this eliminate trees and reduce carbon absorption,
it also leads to habitat fragmentation [33]. As global tea With the goal of reducing the mortality rate in India due
production rises [34]., so does the land required for tea cul- to Anemia, iron fortified tea is a technology that takes
tivation, which is often converted land that divides animals advantage of the high tea consumption in Indias culture to
and their vital resources, therefore decreasing biodiversity. increase the iron intake of the population. The challenges as-
The pesticides used in tea cultivation are harmful for sociated with fortifying tea are similar to those of other food
both the environment and consumers. According to Green- fortification technologies, such as preserving the authentic
peace India, 23 of 34 pesticides found in Indian tea are tea taste, smell, and physical appearance while preventing
not registered for safe usage [35]. On the other hand, non- negative bodily reactions. The wholistic PESTLE analysis
pesticidal management practices are being adapted which only yielded a minor technological concern as tea contains
will reduce pesticide usage, such as using light traps to tar- Tannin, which impedes the bodys ability to absorb iron. The
get moths, or using a cow dung/urine extract to discourage solution proposed by Dr. Diosady includes encapsulation
leafhopper disturbances [36]. of the iron to protect it from the Tannin in the tea until
The environmental consequences of tea leaves process- it is ingested. Otherwise, iron fortification does not pose
ing comes from the energy required for drying, and poor problems outside of tea production itself. Using an inclu-
wastewater management. The fermentation and drying pro- sive business model that stems from the PESTLE analysis
cess requires consistent heating, which is powered by non- and includes partnership with existing tea suppliers and
renewable energy sources like firewood, gas, or coal (which producers, iron fortified tea can easily improve the health
makes up 44% of Indias energy source) [37]. A shift in Indias of Indias population with minimal systemic disruptions.
JOURNAL OF APS420, VOL. 1, NO. 1, MARCH 2018 4

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