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Is fortification of flour with folic acid folly?

BBC Scotland Health Correspondent Eleanor Bradford reported on Friday that Scotland is considering whether to add folic acid to flour. Health Food Standards Agency and Public Health  Scotland have been recommending the fortification of foods with folic acid for years. However the UK government has been slow to respond, with decisions delayed since before 2014.

The benefits of folic acid fortification for pregnant mothers have been demonstrated to be considerable, with a reduction in the incidence of neural tube defects of around 40% according to the Committee on Medical Aspects of Food and Nutrition Policy (COMA*).


What bread looks like.

Whether or not the British public is willing to pay for these benefits is another matter. Dixon & Shackley (2003) undertook a willingness to pay study which aimed to quantify the intensity of preference of the British Public for the fortification of foodstuffs with folic acid. Around two thirds of respondents were in favor of fortification with one in eight remaining unsure. Importantly, the average (both mean and median) willingness to pay for fortification was double the willingness to pay for non-fortification.

A quote from an individual, interviewed as part of the study, who expressed a willingness to pay for non-fortified foods is now one of my favorite quotes of all time:

“It can’t [the benefits] be proven. I have a general problem with science, it is all lies!”

Perhaps unfamiliarity, or a lack of faith, in the science is what is holding back public health initiatives in the political sphere.

*we appreciate a good acronym here at CHILL.

Dixon S, Shackley P. The use of willingness to pay to assess public preferences towards the fortification of foodstuffs with folic acid. Health Expectations 2003;6; 140-148.

The author: Robert Smith is a Research Assistant at the University of Nottingham’s Centre for Health Innovation Leadership and Learning. His research is focused on the provision of and preferences for Primary Care services.





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