The opening line of Charles Dickens' classic, A Tale of Two Cities, is of course talking about social unrest during the French Revolution, but that line frequently comes to mind when I think of the contrast between those with abundant access and those that face real and impenetrable barriers.
This line came again to me as I read commentary on a recent Canadian study that showed that thanks to fortified foods easily accessible in Canada, almost no one there is deficient in folic acid. In fact forty percent have levels of the B vitamin in their blood that may be too high.
The natural form of the B vitamin is folate, and it is found in leafy vegetables, dried beans and orange juice. Folic acid helps prevent birth defects of the brain and the spinal cord, it helps prevent anemia and can possibly help prevent breast cancer, colon cancer and heart disease. In the West folic acid is easily accessible. So accessible, in fact, that we get it in our diet without even knowing it through fortified cereals, breads and wheat flour. In the West, it is the best of times.
Contrast this access with the developing world. The results are unsettling. Folic acid deficiency leads to many health problems, most significant being neural tube defects in children. An estimated 300,000 children are born each year with severe neural tube defects of spina bifida and anencephaly. Infants born with anencephaly, a birth defect of the brain, usually die within a few days of birth, and those with spina bifida, defects of the spinal cord, have life-long disabilities with varying degrees of paralysis. Folic acid deficiency is highest in India followed by South East Asia and then South Africa. In Nepal folic acid deficiencies are particularly high with the prevalence of anemia among pregnant women placed at an alarmingly high 75%. In the developing world, it is the worst of times.
These diseases are largely preventable and could have been avoided by consumption of folic acid by expecting moms. We know folic acid fortification works. South Africa experienced a 66% reduction in infant mortality from neural tube defects after establishing folic acid fortification programs. And what of the return on investment beyond the benefits of saving lives and preventing disabilities? Published economic evaluations have shown that folic acid fortification of food has provided significant costs. The cost of fortification is approximately $1.50 U.S. dollars per metric ton of wheat flour, which is pennies per person per year. In the U.S. folic acid fortification has an estimated economic benefit of $312-$425 million annually.
Neural tube defects are life-threatening and cause-life long disabilities. We know this is a serious global health problem, but it is one that is preventable. There are solutions that are cost-effective and feasible. Folic acid fortification of flour and other staples that are consumed widely is a safe, economical and effective solution. We must expand fortification of staple foods to those countries that face the worst of times and don't have access to necessary folic acid for pregnant moms.
We know what the best of times would look like. Approximately 75% of birth defects can be prevented through increased consumption of folic acid. Assuming the estimated number of 300,000 children born each year with severe neural tube defects, worldwide folic acid fortification could lead to the prevention of 225,000 children being born with out these debilitating diseases each year. We have the science, the technology and the cost effective solutions to stop these unnecessary deaths. So why aren't we?