CS122586

Presented by Robert J. Baldwin, FFI Public Sector Liaison

June 28, 2011

Preventing NTDs With Fortified Flour

What is Flour Fortification?

Fortification is adding vitamins and minerals to flour during the milling process so that staple foods are more nutritious.

Modern mill with three feeder lines

FFI is network of partners

working together to make flour

fortification standard milling

practice so that people

worldwide are smarter, stronger

and healthier.

FFI Network

Mandatory

Planning

Voluntary

No Flour Fortification

Flour Fortification StatusJune 2011: Fortifying with at least iron and/or folic acid

Highlight Success

Celebrate!15 YearsOf fortifying flour with folic acid

ThousandsOf birth defects prevented every year

MillionsOf healthcare dollars saved annually

www.FFInetwork.org

Success: Oman NTD Reductions

Spina bifida and birth outcome before and after fortification of flour with iron and folic acid in OmanD. Alasfoor, M.KI. Elsayed and A.J. Mohammed

Centers for Disease Control and Prevention , “Folic Acid in the Prevention of Birth Defects” Public Health Grand Rounds, February 18, 2010

Neural tubebirth defectsper 10,000live births

-37%

1998USA

0

2

4

6

8

10

12

14

16

18

Before fortification After fortification

10.8

6.6

- 46%

1998Canada

15.8

8.6

- 41%

2000Chile

10.1

17.0

- 31%

2003South Africa

14.1

9.8

- 35%

1998Costa Rica

9.7

6.3

Success: Global NTD Reductions

Success: Healthcare Savings From Preventing Spina Bifida

Chile

United States

South Africa

$1 spent$12 saved

$1 spent$48 saved

1 rand spent30 rand saved

One:Understand Limits of Supplementation• Limited population coverage

• Costly

• Is it sustainable as government distribution program?

• Compliance - often forgotten

• Frequently not taken before conception

• Not taken if pregnancy is not planned

Two:Understand Limits of Folate Intake From Daily Diet• Unstable in cooking

• To get 400 micrograms of folate a day, eat:o 4 slices of fried beef liver oro 44½ medium ripe tomatoes oro 14½ cups of raw broccoli oro 17½ cups of orange juice oro 19½ cups of raw green beans or o 5½ cups of black beans oro 200 medium red apples

Source: US Centers for Disease Control and Preventionhttp://www.cdc.gov/about/grand-rounds/archives/2010/02-February.htm

Three:Understand Benefits of Flour Fortification • Most efficient means of delivering folic acid to the

greatest number of people

• Cost effective

• Improves folic acid stores before conception

Four:Be Prepared for Criticism of Flour Fortification • Claims that it medicates food

• Not natural - genetically modifying food

• Nanny state

• Eliminates free choice

• Excessive folic acid could cause harm

Five:Arm yourself with data• Effectiveness of fortifying flour globally

• Cost to fortify (US$2 - $3 per metric tonne of flour)

• Healthcare savings

• NTD rates

• Folate status

• Number of abortions due to NTD diagnosis

• Average cost of treating child with spina bifida

Six:Partner With Other Sectors• Identify champions

• Look outside the healthcare sector

• Identify benefits to other sectors

• Recognize your bias

• Establish a national fortification alliance

Seven:Support Mandatory Fortification• For Millers:

o Equalizes costs

• For Consumers:

o Delivers health benefits equitably

• For Economists:

o Improves productivity and saves health care expenditures

• For Regulatory Staff:

o Simplifies compliance testing

Eight:Advocate Fortifying Flour, Not Bread• Technology for flour fortification is readily available

• Milling is a centralized process

Flour mill in Turkmenistan. Photo courtesy of UNICEF

17

Nine:Prepare for the Media• Identify a media spokesman

• Proactively suggest stories to media

Ten:Educate Elected Officials and Policy Makers• As governments change, newly elected officials need to be educated about fortification’s value

For More InformationSheep blocking a road on the South Island in New Zealand symbolize the roadblocks faced in attempting to implement mandatory flour fortification in Ireland and New Zealand.