European Health Forum Gastein


03 October 2012 - 06 October 2012


Location: Gastein Valley, Austria

Region: Europe


FFI and the International Federation for Spina Bifida and Hydrocephalus (IF) hosted a three-hour workshop during the annual European Health Forum. Though flour fortification has been practiced in some countries for more than 60 years, most countries in Europe have not embraced this cost effective health strategy.

To begin the workshop, Dr. Francesco Branca, the World Health Organization Director of Nutrition for Health and Development, described the nutritional status of people in Europe and outlined areas needing improvement. Challenges include obesity as well as intakes of salt, saturate fat, and simple sugars. Iodine, iron, and folic acid deficiencies are present in some populations, and deficiencies in vitamin D, vitamin C, and vitamin B12 are emerging concerns. In addition, some population groups are vulnerable to specific nutrient deficiencies because of their socioeconomic situation, dietary habits, or other population characteristics. Read more...

Next Scott Montgomery, FFI Director, outlined the wheat industry in Europe and potential benefits of flour fortification there. More than 600 types of flour are produced in Europe to meet consumer demands, according to the European Flour Milling Association. Foods made with wheat provide 23% of the population's protein supply and 22% of the total calorie intake, according to the Food and Agriculture Organization of the United Nations. Because wheat consumption across the region is at least 150 grams per capita per day, flour could be fortified with minimum levels of vitamins and minerals and still be expected to have a significant public health impact. Read more...

Common concerns about negative consequences of flour fortification are unfounded, said Dr. William Dietz, former director of the U.S. Centers for Disease Control and Prevention (CDC) Division of Physical Activity and Obesity. He presented evidence that:

  • Fortification does not cause people to consume more than the tolerable upper levels of folic acid and iron.
  • Fortifying with folic acid does not cause cancer or mask B12 deficiency.
  • Fortifying with iron does not increase the risk of iron overload in people with beta thalassemia.
  • An approach that targets women for taking folic acid supplements before conception is less effective than fortifying flour with folic acid.
  • Unfortified flour has many ingredients added and is not really 100% "pure."
  • Mandatory flour fortification preserves consumer choice.

In the age of global austerity, flour fortification is a wise investment, said Dr. Sue Horton, CIGI Chair in Global Health Economics and Associate Provost, Graduate Studies, at the University of Waterloo in Canada. While fortification began in industrialized countries, recent progress has been primarily in developing countries, she noted. Some nutrient deficiencies are re-emerging in industrialized countries, such as iodine deficiency in Australia and New Zealand. Deficiencies take a toll on a country's productive and health care expenditures. Iron deficiency is associated with 5% lower productivity in light manual labor and 17% lower productivity in heavy manual labor. Also, children born with spina bifida require a lifetime of medical treatment. In Spain, the annual medical costs per patient per year are 3,500 Euros for a person with spina bifida. In contrast, fortifying flour with iron, folic acid, and other B vitamins could cost 0.16 Euro per person per year. Read more...

Dr. Margo Whiteford, Vice President of the International Federation for Spina Bifida and Hydrocephalus and a Consultant Clinical Geneticist, presented a photo description and scientific explanation of the different types of neural tube defects. She noted that almost 75% of pregnancies affected by a neural tube defect are aborted. However most neural tube defects, such as spina bifida, can be prevented if the mother has at least 400 micrograms of folic acid daily at least a month prior to conception and in the early weeks of pregnancy. Children with spina bifida very often develop hydrocephalus, some paralysis, pressure sores, and incontinency. Dr. Whiteford described spina bifida's physical challenges, as well as the impact on family life, from her professional and persoanl experience as she was born with spina bifida. Read more...


Gastein speakers

Lieven Bauwens, left, Secretary General of the International Federation for Spina Bifida and Hydrocephalus (IF), moderated the joint IF and FFI workshop at the European Health Forum in Gastein. Workshop speakers, standing with Lieven, from left, are Francesco Branca, Scott Montgomery and William Dietz. Seated are Margo Whiteford, left, and Sue Horton. : © EHFG2012 Photographer Nadine Bargard.