Using a predetermined set of criteria, including burden of anemia and neural tube defects (NTDs) and an enabling environment for large-scale fortification, this paper identifies 18 low- and middle-income countries with the highest and most immediate potential for large-scale wheat flour and/or rice fortification in terms of health impact and economic benefit. Adequately fortified staples, delivered at estimated coverage rates in these countries, have the potential to avert 72.1 million cases of anemia among non-pregnant women of reproductive age; 51,636 live births associated with folic acid-preventable NTDs (i.e., spina bifida, anencephaly); and 46,378 child deaths associated with NTDs annually. This equates to a 34% reduction in the number of cases of anemia and 38% reduction in the number of NTDs in the 18 countries identified. An estimated 5.4 million disability-adjusted life years (DALYs) could be averted annually, and an economic value of 31.8 billion United States dollars (USD) generated from 1 year of fortification at scale in women and children beneficiaries. This paper presents a missed opportunity and warrants an urgent call to action for the countries identified to potentially avert a significant number of preventable birth defects, anemia, and under-five child mortality and move closer to achieving health equity by 2030 for the Sustainable Development Goals.

Background: Violence against women (VAW) and violence against children (VAC) are pervasive global health and human rights issues with severe health consequences. Burden estimates alone cannot inform policy without cost data, and existing analyses remain limited. This study addresses this gap by estimating the global cost of the health burden attributable to VAW and VAC. Methods: We used a welfare-based valuation approach to calculate the cost of the attributable health burden of intimate partner and non-partner (sexual and physical) VAW, and physical and sexual VAC. We analysed prevalence, relative risk, and burden estimates from the WHO, UNICEF, and Global Burden of Diseases, Injuries, and Risk Factors Study to estimate the attributable health burden of VAW and VAC for each country. Using value of statistical life estimates, we calculated the cost associated with each form of violence. Scenario analyses examined variations in relative risks, valuation approach, and country inclusion criteria. Results are presented globally, by 2023 World Bank income group, and by country. Findings: The monetary value of the health burden of VAW and VAC is US $1·50 trillion (1·4% of global GDP) and US $1·98 trillion (3·97% of global GDP) respectively. Mental health conditions represent the largest contributor to the economic burden across income groups. Interpretation: The cost of the health burden of VAW and VAC is staggering. Integrated violence prevention strategies and stronger investments in health systems are needed to support survivors, especially to address mental health burden.