ffi 28.6.2011
TRANSCRIPT
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CS122586
Presented by Robert J. Baldwin, FFI Public Sector Liaison
June 28, 2011
Preventing NTDs With Fortified Flour
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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
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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
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Mandatory
Planning
Voluntary
No Flour Fortification
Flour Fortification StatusJune 2011: Fortifying with at least iron and/or folic acid
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Highlight Success
Celebrate!15 YearsOf fortifying flour with folic acid
ThousandsOf birth defects prevented every year
MillionsOf healthcare dollars saved annually
www.FFInetwork.org
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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.