JOURNAL OF APS420, VOL. 1, NO.
1, MARCH 2018
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.
1 I NTRODUCTION
Anemia has been described as a silent killer in cer-
tain Asian countries such as India, Pakistan, Sri Lanka,
Bangladesh and Nepal, however it has the highest mortality
rate in India with approximately 87% of women in the re-
gion suffering from the condition. [1] Anemia is a condition
that develops when the individual has a severely low blood
cell count (low hemoglobin levels). This means that their
organs are not receiving enough oxygen, thus hindering
their function or leading them to fail. [2] A major cause of
anemia is an iron-deficient diet, and a possible explanation
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
declined from 80.5% in 2014 to 79.5% in 2015, which signifies
that Hinduism is the most commonly practised religion in
India. A cornerstone of the Hindu faith is the view that cows
are sacred, and thus are forbidden from being eaten. [3] This
lead researchers to try and think of an innovative, cost-
effective, non-disruptive and sustainable solution to this
issue since it affects the majority of the female population
with catastrophic consequences, comprising up to 200,000
annual maternal deaths and a million infant and neonatal
deaths. [4]
2 S ELECTION OF G EOGRAPHIC A REA
Two main reasons that make India a suitable candidate for
this technology are, high amounts of tea consumption, and
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
between different states [7]. For example, in the south coffee
is a growing trend but in places like Kerala, tea consumption
is much higher [7]. Tea is major part of the cultural identity
in India, and has been for many years. Even with develop-
ment occurring and many small communities becoming in-
dustrial hubs, those small stores selling tea have continued
to prosper [8]. Furthermore, the largest tea manufacturer
in India, Tata, serves one-third of the population, allowing
for easier distribution and negotiation [9]. The challenge
would be in reaching the rural market, in these areas the
income is lower and people tend to drink more milk than
tea, but the government is working to change this [10]. The
Tea Board chief is taking advantage of the governments
plan for economic development in rural India to increase
consumption of commercial tea, this will further increase
distribution [10]. The second reason for this product is that,
iron deficiency (anemia) is a major issue in India, affecting
1
over 50% of women and children, this has been linked to
death, and a 0.9% loss in GDP [11]. The low levels of iron are
partially caused by the diet in India. The culture and religion
in India leads to a large portion of the population having a
vegetarian diet, and meat has much higher iron absorption
than non-vegetarian alternatives [12]. Changing the diet to
incorporate more iron would prove a substantial task, much
less efficient than fortifying foods. Therefore, considering
the diet and the culture of tea consumption, iron fortified
tea has a high probability of success in India.
3 PESTLE A NALYSIS
The PESTLE method was selected as the framework for
the analysis of Iron-Fortifying tea in India, with consists
of analyzing the political, economic, social, technological,
legal, and environmental aspects of the project. This method
was chosen as it provides a holistic view on the implications
of the project, which is critical for the real world implemen-
tation of this technology. As 70% of India’s tea production
is consumed domestically and India exported 10% of the
worlds tea exports (by value) in 2016, making a small
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
business case that can integrate with the existing physical
and cultural infrastructure of India.
3.1 Technological
Insight was gained into the chemical processes and limi-
tations of iron fortified tea, and some surprising informa-
tion was obtained regarding how frequent tea consumption
might be inhibiting the individuals body from absorbing
sufficient iron from their already iron-deficient diet. Tea
contains a chemical called Tannin which phenolically reacts
with non heme iron (plant derived iron) in food and hin-
ders the bodys ability to absorb it efficiently. [13] Doctors
recommend waiting an hour or two after eating to drink
tea so that it does not interfere with nutrient absorption,
however when you review tea consumption rates in India,
the average rate of consumption is 2 cups per day for adults.
Coupled with the fact that about 80% of the population
is Hindu meaning that they do not consume red meat,
which is a primary source of heme iron, the majority of the
population is anemic. This poses an even greater danger
to expecting mothers, females that have reached the age of
JOURNAL OF APS420, VOL. 1, NO. 1, MARCH 2018
puberty and are at heightened risk due to menstrual cycles
and infants that are born to anemic mothers and thus also
inherit the trait. Dr. Diosady directed the majority of the
Grand Challenges Canada grant towards funding research
regarding micro-encapsulation of the iron fortification so
that it can be implemented into the tea without reacting with
tannin, and so that it may withstand the heat of the liquid
surrounding it. He likened the coating of the capsule to that
of the coating used on Aspirin, however he stated that this
delivery system technology is utilized on the microscopic
level so that each iron particulate is coated. What this
essentially means is that the iron will only be carried by
the tea as a means of reaching the patient’s stomach, and
the iron will begin to break down once it comes in contact
with the stomach acid.
Tea manufacturing is a lengthy process with various op-
portunities throughout to implement the iron fortification,
however it is best done just before the tea is packaged
into tea bags in order to contain the iron particulates. The
tea bag is a partially permeable membrane that can allow
the iron particulates to flow through and mix in with the
hot water in order to be consumed by the drinker. These
companies would require financial incentives to allow their
product to be fortified with iron, but possible ways to reduce
resistance is to benchmark the salt iodizing process used
in Somalia. The Indian government can sponsor or erect a
number of tea fortification plants for companies to outsource
this process and thus avoid implementing it into their in-
house manufacturing processes, which could prove to be
very expensive and might discourage them from partaking.
Smaller distributors can send their tea to fortification plants,
where the tea gets fortified and packaged, then sent back
to the manufacturer, ready for distribution. Larger distrib-
utors like TATA could possibly field the costs themselves
to create an in-house fortification process. It is important
to emphasize the fact that the iron addition will not affect
the quality of the product since it is both colourless and
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
TATA Salt Plus to combat anemia in 2012. [14]
3.2 Legal precautions
The toxicity of iron is dependent on the weight of the
person. From Merck Manuals; ”Toxicity depends on the
amount of elemental iron that has been ingested. Up to 20
mg/kg of elemental iron is not toxic, 20 to 60 mg/kg is
mildly to moderately toxic, and a >60 mg/kg can cause
severe symptoms and morbidity.” [15]. Careful analysis of
the intake of tea for the average Indian Citizen must be
taken into account to ensure no overdoses of iron will result
from large amount of ingested tea.
According to the patent for iron fortified tea, the iron
comprises of 0.1 - 0.3% the tea by weight [16]. With the
average cup of tea using around 2 grams of tea per 8 ounces
of water, this results in around 6 mg of iron per cup of
tea [17]. A 70kg person would need to ingest 700 cups of
tea within a short period in order to reach toxic levels of
iron within the body. This calculation proves that it will be
impossible to overdose on iron through the fortified tea.
2
The proper resources will need to be secured in order to
have the tea approved for import, as the process is long and
complicated. Iron is not on the list of prohibited substances,
nor is it on a list of high-risk foods such as baby powder.
This means that getting an import license should not be
very difficult [18]. However, another aspect to consider are
import tariffs, which can increase the cost of the tea if
not manufactured in India. The current tea tariff is at 110
percent as of 2017 [19], which would cause a major issue
for anything imported into the country. An appropriate
solution would be to work with local tea manufacturers to
manufacture and supply the iron supplemented tea.
3.3 Political
Despite India being the first country to launch the National
Nutritional Anemia Prophylaxis Program in 1970, the prob-
lem of iron deficiency anemia remains widespread, which
is still a major public health problem in India nowadays.
[20] In 2007, the Indian government implemented the 12 by
12 initiative, aimed at ensuring that all Indian adolescents
have 12g/dL hemoglobin by 2012, listed the main causes
of anemia in India. [21] In 2016, the Indian government
allocated $5.5 billion to nutritional schemes such as the
National Health Mission and the Integrated Child Develop-
ment Scheme. [22]However, this is $700 million below the
estimate requirement stated in the Global Nutrition Report.
[23] The Indian government is still attempting to reduce the
problem of anemia in India. One of the goals for the 12th
Five Year Plan, the last five year plan between 2012- 2017, is
to reduce anemia in girls and women by 50 percent. Other
existing strategies such as Supplementation Interventions
by the Ministry of Health and Family Welfare (MoHFW) and
National Iron+ Initiative are also widely applied through the
nation. [24]Although the Indian government has increased
national and internal awareness and prompted intervention
programs, the prevalence of anemia due to the iron defi-
ciency still remains high. [21]
3.4 Economical
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
$20.25 billion, according to the World Bank’s estimate of
India’s GDP in 2016. [26] [27]Thus, iron-deficiency anemia
has impacted India’s economy significantly.
The Inclusive Business Model we suggest is to cooperate
with top tea manufacturing companies in India to distribute
to local people. 70% of the tea produced in India is con-
sumed within its borders, and the leading distributors are
Indian companies such as TATA coffee and Brooke Bond
Taaza. Possible distribution networks can be established by
offering these companies business propositions in the form
of increased profits. The expected cost of iron fortification is
10-20 cents/person/year which would not impose a steep
price hike in terms of average tea price, meaning that
consumption would stay relatively constant.
If the iron fortification tea technology can be managed to
be spread across the India, the whole economic condition of
India will be revitalized because of the boost in tea industry
and the decreased cost spending in the health care. As the
JOURNAL OF APS420, VOL. 1, NO. 1, MARCH 2018
fourth largest exporter of tea in the world, India has one of
the largest tea industries in the world. [28] Currently, there
are at least 1.1 million workers employed in various tea com-
panies around the country. [28] The industry also created
income opportunities for almost another 10 million people.
[28] When the iron fortified tea becomes a daily source of
absorbing iron for the Indian population, the government
will invest more in the tea industry, and thus create more job
opportunities. Therefore, the Indian economy will benefit
immensely due to the iron fortified tea.
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
established by the British, and started spreading throughout
India, the product become cheaper and all classes of people
could enjoy it, now it is everywhere in the country [29].
One reason it become so well established was due to large
amounts of advertising, appearing in movies and commer-
cials claiming health benefits, and even cartoons [30]. Now
it is at the point where any gathering, professional or social,
requires tea to be present [30]. Indians have easy access to
tea, through sellers known as chai wallahs, small towns and
large cities have these individuals throughout and they have
become an integrated part of the culture [31]. Therefore, tea
plays a large part in social interaction in India. Considering,
fortified tea does not alter the taste or have negative health
implications, the social aspects should be unaffected.
3.6 Environmental
Tea leaves, like any other natural resource, must be handled
in a sustainable and environmentally responsible manner.
Severe environmental consequences are present in both the
cultivation and processing stages of tea production, but not
in the fortification process itself. Although the proposed
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
does this eliminate trees and reduce carbon absorption,
it also leads to habitat fragmentation [33]. As global tea
production rises [34]., so does the land required for tea cul-
tivation, which is often converted land that divides animals
and their vital resources, therefore decreasing biodiversity.
The pesticides used in tea cultivation are harmful for
both the environment and consumers. According to Green-
peace India, 23 of 34 pesticides found in Indian tea are
not registered for safe usage [35]. On the other hand, non-
pesticidal management practices are being adapted which
will reduce pesticide usage, such as using light traps to tar-
get moths, or using a cow dung/urine extract to discourage
leafhopper disturbances [36].
The environmental consequences of tea leaves process-
ing comes from the energy required for drying, and poor
wastewater management. The fermentation and drying pro-
cess requires consistent heating, which is powered by non-
renewable energy sources like firewood, gas, or coal (which
makes up 44% of Indias energy source) [37]. A shift in Indias
3
energy system towards renewable sources is required to
mitigate this concern.
From a water perspective, improper wastewater treat-
ment has significant potential to harm the ecosystem, es-
pecially if increased iron levels are introduced from the
iron fortification process. Increased iron concentrations have
indirect effects on aquatic ecosystems, although DNA and
membrane damage can result from iron toxicity. [38] Given
the large potential impact and scalability of iron fortified
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.
4 M ONITORING AND E VALUATION
Impact assessment will be performed using RCTs (random
control trials). This requires random sampling of the pop-
ulation in both treatment (where tea fortification is imple-
mented) and control (where tea fortification is not imple-
mented) communities, which will be decided randomly to
eliminate any bias. The challenge would be controlling the
distribution of fortified tea to the chosen treatment commu-
nities, which can be achieved through partnering with the
India Tea Board and local tea distributors. Within a year,
a random population from each community will be tested
to compare the iron levels between a treated population
and an untreated population, evaluating the effectiveness of
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.
This distribution and assessment method will continue on
a community by community basis. If the trial results return
negative, the treatment community will be analyzed to find
the root cause of ineffectiveness, then the implementation
and monitoring structure will iterate until overall public
health improves on a country-wide level.
5 C ONCLUSION
With the goal of reducing the mortality rate in India due
to Anemia, iron fortified tea is a technology that takes
advantage of the high tea consumption in Indias culture to
increase the iron intake of the population. The challenges as-
sociated with fortifying tea are similar to those of other food
fortification technologies, such as preserving the authentic
tea taste, smell, and physical appearance while preventing
negative bodily reactions. The wholistic PESTLE analysis
only yielded a minor technological concern as tea contains
Tannin, which impedes the bodys ability to absorb iron. The
solution proposed by Dr. Diosady includes encapsulation
of the iron to protect it from the Tannin in the tea until
it is ingested. Otherwise, iron fortification does not pose
problems outside of tea production itself. Using an inclu-
sive business model that stems from the PESTLE analysis
and includes partnership with existing tea suppliers and
producers, iron fortified tea can easily improve the health
of Indias population with minimal systemic disruptions.
JOURNAL OF APS420, VOL. 1, NO. 1, MARCH 2018
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