ffi 28.6.2011
TRANSCRIPT
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.