January 27th, 2000
Dr. Henry: I welcome the Minister of State, Deputy Moffatt, to the House. It is nice to see a familiar face from the Department of Health and Children. I hope he will enjoy working with the new Minister who, I am sure, will be a splendid appointment.
I cannot remember if the Minister of State took this Adjournment Matter previously but on 22 October 1997 I asked the then Minister for Health and Children to consider the need for the fortification of flour with folic acid. As the Minister of State is well aware, we have one of the highest incidences of spina bifida and hydrocephalus in the world and the knowledge that this could be greatly reduced by a higher intake of folic acid in early pregnancy should have been addressed at that time. It is well known that this is an important way to address this problem.
The Minister said then that the fortification of flour with folic acid would "have to be considered in an EU context in view of the implications for the free movement of goods". In fact, I got the impression that the entire confectionery trade might collapse if I continued to pursue it. He said this was well outside the remit of the Department of Health and Children and that consultation would have to take place with some other Departments. As that was nearly two and a half years ago, I hope the Minister of State will be able to tell me the result of these consultations and his views on the fact the United Kingdom Government is considering supplementing flour with folic acid. The health benefits additional to that of preventing neural tube defects have now become obvious.
As the Minister of State knows, flour in the United States has been fortified with folic acid for many years. This was done on the recommendation of the Food and Drugs Administration which is a fairly conservative body when it comes to recommending anything such as that. This was done because it was recognised that the inference of folic acid on the synthesis of DNA in many cells was of great importance. It felt it was an important course of action for it to take.
Folic acid has been shown to be very helpful in the prevention of heart disease and bowel cancer. Some of the most important research in this area has been done in Ireland because we, unfortunately, have a very high level of heart disease, as can be seen around the periphery of the European continent. High levels of folic acid have been found to reduce the level of homocysteine in the blood. This is important in the prevention of heart disease because we have found that many of the population are short of an enzyme which is needed for the lowering of homocysteine in the blood. This is probably a genetic problem. Similarly, bowel cancer increases where there are high homocysteine levels. What is interesting is that we may have been blaming our diet for many years for problems we had which are due to in-built genetic problems.
There is only one satisfactory argument of which I have heard against the fortification of flour with folic acid and that is that it may mask B12 deficiency. The Minister of State and I know that B12 deficiency is fairly unusual and that we can also have B12 deficiencies without anaemia. The argument is that giving folic acid will improve the anaemia so it may mask the neurological signs which occur with B12 deficiency. In the overall health scene, we have to take that chance and hope people will carry out a better clinical examination of those expected to have B12 deficiency rather than use this as an excuse to persist in blocking the fortification of flour.
Professor John Scott of Trinity College, who is an expert in this area, has said there is a convincing argument to add folic acid to all flour. Surveys on the uptake of folic acid supplements have been very disappointing. Women of child bearing age have been advised that they should try to increase their intake of folic acid prior to conception. Clonmel Chemicals and other drug companies have been good at trying to promote the uptake of folic acid, as has the health promotion unit but, unfortunately, the uptake has been extremely poor and is worse among public patients than private patients. Public patients are quite likely to have a less nutritious diet so they may already have a diet which is low in folic acid.
It is sad that promoting additional folic acid in the diet will not totally eliminate cases of spina bifida. The Department of Heath and Children advisory group on this matter reckoned that it would cut the present rate which is about 70 to 80 per year by half. In other words, nearly 100 children are born with the serious defect of spina bifida who could have been saved from this problem if flour had been fortified when I suggested it in 1997. I hope the Minister will address this matter with a sense of urgency because it is one of the most distressing of the congenital defects and is one about which we are at liberty to do a great deal if we put our minds to it now.
Minister of State at the Department of Health and Children (Dr. Moffatt): I thank Senator Henry for raising this issue again. The prevention of neural tube defects is an important public health issue for society at large and for women in particular. My Department attaches particular importance to seeking a means of reducing the incidence of what is largely a preventable condition.
I am aware that it was scientifically proven in 1991 that folic acid - a B12 vitamin - taken prior to conception and during the first 12 weeks of pregnancy could greatly reduce a woman's risk of having a baby with a neural tube defect. In 1993, my Department issued a recommendation that women likely to become pregnant should take an extra 400 microgrammes of folic acid prior to conception and during the first 12 weeks of pregnancy. I am also aware of recent research linking the consumption of folic acid with the reduction of heart disease.
The Food Safety Advisory Board published a report in 1998 on the value of folic acid in the prevention of neural tube defects and discussed the possibility of the fortification of food with the vitamin. The report considered different ways in which food could be fortified with folic acid on a voluntary or a mandatory basis. Foods fortified on a voluntary basis are foods to which folic acid has been added at the discretion of manufacturers. This occurs at present in the case of certain breakfast cereals, milk and bread. Mandatory food fortification would require that a certain dietary staple or staples would be fortified to a specific agreed level.
We would be obliged to try to ensure that the staple food chosen provides effective cover of women of childbearing age with as little excess exposure as possible to other groups. Unfortunately, there is no particular staple that is exclusive to women of childbearing age. It would, therefore, be inevitable that any introduction of mandatory fortification would impact to a greater or lesser extent on other sectors of the community. However, there is some concern that the mandatory fortification of a staple food such as flour could lead to the masking of pernicious anaemia, thereby preventing the early diagnosis of this condition.
The Food Safety Advisory Board made three key recommendations in its report - first, that a comprehensive and sustained health promotion campaign be introduced at national and local level to promote the use of periconceptional folic acid, second, that the sub-committee on folic acid should examine the fortification of a staple food or foods with folic acid as an alternative or complementary strategy and, third, that a study be undertaken to provide the data necessary for a comprehensive evaluation of the periconceptional use of folic acid. The Food Safety Advisory Board was subsumed into the Food Safety Authority of Ireland in January 1998 and the folic acid sub-committee continues to meet under the auspices of the Food Safety Authority of Ireland.
In the context of voluntary fortification, the health promotion unit of my Department, in conjunction with the Food Safety Authority of Ireland, is currently examining the possibility of using a folic acid "flash scheme". Under this scheme, foods which are fortified will be able to feature one of two logos, called flashes, thereby making it easier for women to identify foods fortified with folic acid.
At European level, a White Paper on Food Safety was introduced on 12 January 2000 by the Commissioner for Public Health and Consumer Protection, Mr. David Byrne. This White Paper reflects the EU's priority of ensuring that the highest standards of food safety are set and maintained throughout the EU. The White Paper, co-written by the Enterprise Commissioner, Mr. Erkii Likkanen, contains a detailed 80 point action plan on legislation in food safety, with a precise timetable for regulation and implementation of the action plan over the next three years. In this White Paper the Commission has committed itself to submitting a proposal for a directive on fortified foods to the European Parliament and the Council by September 2000. This directive will lay down the provisions for marketing of foodstuffs to which nutrients such as vitamins and minerals have been added. It is unlikely that this directive will make fortification of a staple food mandatory. Rather, it will lay down the conditions under which fortification of food is permitted. The target date for adoption of this draft directive by the Council and Parliament is September 2001.
I look forward to engaging in detailed discussions with interested parties in Ireland and with the Commission on this draft directive. My Department does not propose to develop national, unilateral legislation prior to the deliberations of the Commission having been completed.
At the standing committee for foodstuffs meeting in Brussels on 15 December last, the Austrian delegation presented a request for an exchange of views on the issue of mandatory fortification of flour with folic acid. A number of member states were opposed to EU level action for reasons such as varying rates of unplanned pregnancy in member states, varying local eating habits and different recommended daily allowances for vitamins and minerals in member states, existing information campaigns in member states targeted at women planning pregnancies, labelling requirements and ethical issues. At this standing committee for foodstuffs meeting the Commission concluded that the issue of the possible regulation on an EU basis of the fortification of flour with folic acid should be revisited in the context of the proposed draft directive on the addition of vitamins and minerals to food which I referred to earlier. I understand that the EU scientific committee for food is currently examining the upper safe limits for vitamins and minerals including folic acid. Its report is due for publication in October of this year and should provide a scientific basis to the draft directive.
As Minister of State with responsibility for food, I look forward to engaging in detailed discussions on this matter in the future. I am aware that the fortification of a staple food with folic acid is a complex issue with commercial, legal and logistical aspects. I would like to thank Senator Henry for again raising this important issue in the House. I take this opportunity to assure the House that the Department and I are committed to ensuring that no effort is spared to ensure that the number of babies born with neural tube defects can be reduced or eliminated altogether.
I agree with the Senator that this matter should not be placed on the long finger. As she said, it is over two years since she raised this issue in the House. Despite what I said earlier, namely, that we would not take unilateral action, in my opinion the time has come to consider this matter if there is no movement on it at EU level. I again thank the Senator for her support in respect of this issue.
Dr. Henry: I thank the Minister of State for his reply. The use of food flashes is a novel idea which could prove helpful. Will the Minister of State, when he next addresses the standing committee for foodstuffs, take into account the situation regarding cardiac disease? I am sure he has been approached by increasing numbers of cardiologists who, particularly those from the rim of Europe, say that this could be very important. It is sad to think that we were warned to stop eating crubeens and a morning fry because cardiovascular problems were caused by fat when it has emerged that such problems may be due to a genetic predisposition. I will ask cardiologists to contact the Minister of State in the hope that he can raise this matter at the committee.
Dr. Moffatt: I presume the next issue the Senator proposes to raise will be homocysteine.
