Failure to fortify flour is 'public health malpractice'
week's British Medical Journal damning Europe's failure to
introduce mandatory fortification of flour.
The failure of European governments to fortify flour with folic acid has allowed a continuing epidemic of preventable human illness, according to an editorial in this week's British Medical Journal.
Fortification could save as many lives as are lost each year in vehicle crashes, Professor Godfrey Oakley of Emory University in the United States wrote in the article. However in Europe, fortification has been delayed because of "erroneous speculation" of possible harm for elderly people.
Last week the UK's Food Standards Agency (FSA) chairman defended the board's decision not to go ahead with mandatory fortification of flour, but some believe that a fortification policy throughout Europe is long overdue.
There is much evidence to show that fortification improves the lives of adults, including elderly people, and that it is safe. Oakley highlighted figures from 1998 - the year in which fortification was made mandatory in the United States - showing that deaths from stroke and heart attack declined by 3.4 per cent.
He wrote: "It is ironic that the United Kingdom has not required fortification, as it was a randomised controlled trial from the United Kingdom that conclusively proved that supplementation with synthetic folic acid prevents about 75 per cent of spina bifida and anencephalycommon and serious birth defects. This study provided the primary scientific basis for the United States, Canada, Chile, and other countries to require fortification."
He said that ministers should not accept the FSA's recommendation and should instead follow the advice of the Department of Health committee on medical aspects of food and nutrition policy, requiring the universal fortification of flour with folic acid. This action, he claims, would improve the health of children and adults.
He added that the FSA decision had been influenced by two "weak arguments" : he countered the technical one with the reasoning that fortification was easily accomplished in the US, Canada, and Chile, so millers in the UK could easily do likewise. The other argument is that consumers should have the choice to buy flour that is not fortified, but Oakley said that choice could be easily preserved by not requiring fortification of wholewheat flour.
"Rare is the opportunity to implement a sustainable, inexpensive, and effective intervention to prevent major human diseases," argued Oakley. "Folic acid fortification of flour is one of those rare opportunities. Governments that do not ensure that flour is fortified with folic acid are committing public health malpractice," he concluded.
