Public health policies have the ability to substantially improve the health of…well, the public. Health practitioners and researchers team up to identify and improve effective policies or terminate the poor ones. Some policies have saved millions of dollars in healthcare costs.
One example of an effective nutrition public policy is the 1998 United States FDA mandate of fortifying cereal grain products with 140 µg of folic acid. In 1992, the U.S. Public Health Service began recommending that all women capable of becoming pregnant consume 400 µg of folic acid daily in order to prevent neural tube defects (NTDs). NTDs are major birth defects of the brain and spine that occur in early pregnancy, and can lead to death or varying degrees of disability.
Lifetime direct costs of spina bifida, one of the two most common NTDs, are estimated around $560,000. Anencephaly, the other most common NTD, is a uniformly fatal condition and lifetime costs are estimated at $5,415. When considering that approximately 1,300 NTD-affected births are prevented annually, total direct cost savings can be estimated at approximately $508 million.
Immediately after implementation (1999-2000) this policy was estimated to prevent 1,000 NTD pregnancies annually, but an update released by the Centers for Disease Control and Prevention (CDC) observes an increase to 1,300 averted cases. This could be due to an increase in the number of live births in recent years, or differences in surveillance methods.
However, it is important to note that although a reduction of NTDs has been observed, the prevalence among Hispanic women is consistently greater than that among other racial/ethnic groups. While genetic factors may affect the metabolism of folic acid in Hispanic women, this could possibly be attributed to cultural differences. Cereal grain products are not a traditional staple in the Hispanic diet, which is typically centered on grains such as corn and rice. According to the CDC, implementation of corn masa flour fortification would likely prevent an additional 40 cases of NTDs annually.
I am an advocate for consistency.
Rules, guidelines, expectations and benefits should equally apply to everyone. Ideally, the same opportunities would be available to everyone as well, but unfortunately that is not the world we live in (yet!!). However, it is possible to recognize discrepancies using research methods and to effect change through public policy.
As a future dietitian and health professional, I recognize the importance of equal opportunity and treatment for all.