Ffi 28.6.2011


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Ffi 28.6.2011

  1. 1. Preventing NTDs With Fortified Flour Presented by Robert J. Baldwin, FFI Public Sector Liaison June 28, 2011 CS122586
  2. 2. What is Flour Fortification?Fortification is addingvitamins andminerals to flourduring the millingprocess so thatstaple foods aremore nutritious. Modern mill with three feeder lines
  3. 3. FFI Network FFI is network of partnersworking together to make flour fortification standard milling practice so that peopleworldwide are smarter, stronger and healthier.
  4. 4. Flour Fortification StatusJune 2011: Fortifying with at least iron and/or folic acid Mandatory Planning Voluntary No Flour Fortification
  5. 5. Highlight Success Celebrate! 15 Years Of fortifying flour with folic acid Thousands Of birth defects prevented every year Millions Of healthcare dollars saved annually www.FFInetwork.org
  6. 6. Success: Oman NTD Reductions Spina bifida and birth outcome before and after fortification of flour with iron and folic acid in Oman D. Alasfoor, M.KI. Elsayed and A.J. Mohammed
  7. 7. Success: Global NTD Reductions 18 15.8 17.0 16 14 -37% - 46% 14.1 12 10.8 - 35% - 41% - 31%Neural tube 10 8.6 9.7 10.1birth defects 8 9.8 6.6 per 10,000 6.3 6 live births 4 2 0 USA Canada 1998 Costa Rica 1998 Chile 1998 South Africa 2000 2003 Before fortification After fortification Centers for Disease Control and Prevention , “Folic Acid in the Prevention of Birth Defects”  Public Health Grand Rounds, February 18, 2010
  8. 8. Success: Healthcare Savings FromPreventing Spina Bifida Chile $1 spent $12 saved United States $1 spent $48 saved South Africa 1 rand spent 30 rand saved
  9. 9. 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
  10. 10. Two:Understand Limits of Folate IntakeFrom Daily Diet• Unstable in cooking• To get 400 micrograms of folate a day, eat: o 4 slices of fried beef liver or o 44½ medium ripe tomatoes or o 14½ cups of raw broccoli or o 17½ cups of orange juice or o 19½ cups of raw green beans or o 5½ cups of black beans or o 200 medium red apples Source: US Centers for Disease Control and Prevention http://www.cdc.gov/about/grand-rounds/archives/2010/02-February.htm
  11. 11. Three:Understand Benefits of FlourFortification• Most efficient means of delivering folic acid to the greatest number of people• Cost effective• Improves folic acid stores before conception
  12. 12. Four:Be Prepared for Criticism of FlourFortification• Claims that it medicates food• Not natural - genetically modifying food• Nanny state• Eliminates free choice• Excessive folic acid could cause harm
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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. 17. Nine:Prepare for the Media • Identify a media spokesman • Proactively suggest stories to mediaTen:Educate Elected Officials and PolicyMakers• As governments change, newly elected officials need to be educated about fortification’s value 17
  18. 18. For More Information Sheep 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.