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Folate:Text of email sent to John Key 20 July 2009


Dear Prime Minister
The Paediatric Society of New Zealand is deeply concerned about the proposal to defer implementation of the mandatory fortification of bread with folate. The evidence that folate supplements will reduce the number of cases of neural tube defects is strong and not challenged by opponents of mandatory fortification. I would ask you to consider the following issues before you and your colleagues in cabinet make your decision today:

Benefits of folate fortification:
- Reduced numbers of neural tube defects
- A reduction of 5-6% in incidence of congenital heart disease has been observed in countries which have mandatory fortification
- Potential beneficial effects on cardiovascular disease and stroke in older people ? more evidence required
- Potential protective effect against colorectal cancer in people who do not have early lesions ? more evidence required

Costs of deferral
- Lost opportunity cost of reducing terminations of pregnancy ? the health service related cost is minimal as if we assume that folate fortification will reduce the number of terminations by about 30%, only about 10 terminations would be prevented. However there are hidden costs to the affected woman’s reproductive and psychiatric health. We also lose 10 potential citizens who would have been productive healthy individuals, if they had received adequate folate to prevent NTD.

- Cost of health care for individuals born with spina bifida. Again assuming we reduce the number of affected births by 30%, we reduce the number of liveborn affected children by about 10. In 1997, Singh and Elliott estimated the cost of health care for an individual with spina bifida over 20years at $355,060. Even using this figure (which would be significantly higher if calculated at 2009 costs), each year that the folate fortification is deferred conservatively results in a cost to the health services of $3,500,000 over the ensuing 20 years or over $10 million with a 3 year delay. I emphasise that these figures are conservative.

- If, as is likely to be the case, there are other health benefits to folate fortification, then the economic benefits become even more significant.

Industry issues
In the USA, where mandatory fortification has been in place for over 10 years, the baking industry estimates that the cost of fortification is about 25 cents per person per year. Given the huge increase in the price of bread over the last couple of years, this increase in cost will be absolutely insignificant. Bread will still remain a healthy low cost option for feeding families.
Many food manufacturers add a range of chemicals to their products. Many members of the Grocers’ Council must be concerned at the demonisation of folate, an essential nutrient that has occurred over the last few weeks.
The health supplements industry is an important industry commercially in New Zealand as in other developed countries. There may well be a public backlash against supplements. It would be unfortunate in the current economic climate, if New Zealand manufacturers and distributors of nutritional supplements were to have to lay off workers because of reduced demand.
I urge you therefore to consider the scientific facts and the potential economic implications before proceeding with deferral.
1.   'Improving Folate Intake in New Zealand Policy Implications' 2003
Pg 26 (data over 10 years old re. estimates)
"estimated the 20-year cost of treating, managing and caring for one person with spina bifida in NZ is about $355,060 (Singh & Elliot 1997).  On average there are approximately 15 children born with spina bifida per year.  It we assume that this rate occurs every year for the next 20 years, then the cost of 300 people with spina bifida would come to $106, 518, 000 over 20 years, which equate to approximately $5 million per year.  These costs do not take into account other potential costs, such as the loss of parental income, special schooling needs, family stress, wheelchairs, crutches and occupational therapy.  In addition, the emotional costs associated with stillbirths, miscarriages and therapeutic abortions cannot be quantified."

2.  Singh S, Elliott RB.  1997. Prevention of Spina Bifida in New Zealand.  Auckland: University of Auckland (unpublished)

Rosemary Marks
Paediatric Society of New Zealand

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