Chapter

Case study 2: mandatory flour fortification with folic acid

Mark Lawrence

in Food Fortification

Published in print January 2013 | ISBN: 9780199691975
Published online January 2013 | e-ISBN: 9780191748806 | DOI: http://dx.doi.org/10.1093/acprof:oso/9780199691975.003.0006
Case study 2: mandatory flour fortification with folic acid

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Mandatory flour fortification with folic acid (MFFFA) is a controversial public health policy intervention for reducing the risk for certain women having a neural tube defect-affected pregnancy. It was the case study selected to assess and analyse food fortification as a policy option to tackle public health problems that arise when certain individuals have nutrient requirements higher than reference standards. MFFFA has a moderate-high effectiveness, its cost-effectiveness varies depending on assumptions about its benefits and risks and it is equitable. It is associated with a moderate level of public health risk and a high degree of adverse ethical consequences – with a concern that it represents a form of food supply ‘medicalisation’ impinging on the rights of the majority for the potential benefit of the few. Global health governance arrangements have empowered public-private partnerships to gain access to critical policy-making activities influencing the adoption of this intervention in many countries.

Keywords: folic acid; folate; fortification; neural tube defects; medicalisation; ethics

Chapter.  18541 words.  Illustrated.

Subjects: Public Health and Epidemiology

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