AWA: Academic Writing at Auckland

Folic acid is a synthetic form of the B-group vitamin folate. Folate is an essential vitamin that is particularly important during early pregnancy when the neural tube of the foetus is developing.  It is widely accepted that folate deficiency at this time increases the risk of neural tube defects (NTDs) such as spina bifida in the foetus. Not all pregnant women consume the recommended intake of folate during pregnancy (Food Standards Australia New Zealand, 2006; Ministry of Health, 2003).  In New Zealand the decision to introduce mandatory fortification of bread with folic acid was made jointly by Australia and New Zealand under a Labour-led government in 2007(King, 2007). Mandatory fortification was to begin two years later but in 2009 the National-led government made the decision to defer mandatory fortification until 2012, instead supporting the development of a code for voluntary fortification (Wilkinson, 2009). This essay will begin by examining the institutional context that is relevant to this decision. The role of evidence in the decision-making of certain institutions will be explained and evidence supporting mandatory fortification presented. Relevant interest groups will be discussed and the ways interest groups influenced this policy will be demonstrated and the values that underlie their positions examined.

Food regulation in New Zealand is complex and decision-making power is somewhat fragmented compared to decision-making power in other policy areas. This is because, in 1995, New Zealand made a formal agreement with Australia to have joint Food Standards that govern the labelling and composition of foods (Agreement Between the Government of Australia and the Government of New Zealand Concerning a Joint Food Standards System, 1996). These standards, the Australia New Zealand Food Standards Code (the Code) came into effect in 2002. The Code is developed by an independent agency, Food Standards Australia New Zealand (FSANZ) which receives policy guidelines from the Australia and New Zealand Food Regulation Ministerial Council (the Ministerial Council) (Food Standards Australia New Zealand, n.d.-a). The Ministerial Council is made up of representatives from each Australian state, the Australian federal government and the New Zealand government. The New Zealand representative is the Minister of Food Safety (Australia and New Zealand Food Regulation Ministerial Council & Food Regulation Standing Committee, 2005). Under the Food Act 1981, the Minister for Food Safety retains the right to introduce or amend New Zealand Food Standards as long as the Treaty with Australia is taken into account ("Food Act," 1981).  According to the Treaty made between Australia and New Zealand, in order to make modifications to the joint Food Standards, exceptional circumstances must apply. The New Zealand Minister must then notify the Ministerial Council and provide a reason for the proposed modification(Agreement Between the Government of Australia and the Government of New Zealand Concerning a Joint Food Standards System, 1996). In practice, this means that the decision-making power for food regulation is relatively fragmented and it is not as straightforward to make changes to Food Standards as it is to make changes to other areas of policy in New Zealand. Ultimately, however, the Food Safety Minister retains decision-making power as long as the appropriate processes, including public consultation and consideration of the Treaty with Australia, are followed ("Food Act," 1981).

In the case of folic acid fortification the usual process was initially followed. The Ministerial Council requested that FSANZ investigate whether mandatory fortification of a basic foodstuff would be the most appropriate option to reduce the incidence of NTDs. After a thorough investigation, which included public consultation, FSANZ recommended that mandatory fortification of bread at a level of 80-100µg per 100g bread should be introduced in Australia and New Zealand (Food Standards Australia New Zealand, 2006). It was agreed at the time that a separate standard for New Zealand should be developed for the Australia and New Zealand Food Standards Code (Food Standards Australia New Zealand, 2008). In the meantime, a new Food Standard was introduced in New Zealand requiring mandatory fortification of bread to begin in 2009 (New Zealand Food Safety Authority, 2007). Following a change of Government in 2008, the new Minister for Food Safety, Kate Wilkinson was required to undertake a lengthy process of consultation in order to amend the Food Standard (New Zealand Food Safety Authority, 2007) and defer mandatory fortification with folic acid until 2012 (New Zealand Food Safety Authority, 2009a).

Kate Wilkinson made this decision under considerable public pressure. The relative fragmentation of decision-making power means that there are two major opportunities to influence food regulation policy in New Zealand. The first is by making submissions to FSANZ during the development stage of the Food Standards Code. This opportunity is relatively limited as while submissions are taken into account and addressed in the decision-making process, FSANZ is likely to base their decisions primarily on scientific evidence that they review independently (Food Standards Australia New Zealand, n.d.-b).

There is some debate about how evidence supporting mandatory fortification should be interpreted. It is widely agreed that folic acid supplementation of 400µg a day around the time of conception greatly reduces the risk of NTDs (King, 2007; Ministry of Health, 2003; Wilkinson, 2009). The best method for increasing pregnant women’s intake of folic acid is not as clear. Evidence used to argue for the introduction of mandatory fortification focused on fall in NTD rates following mandatory fortification in other countries and increased effectiveness compared to voluntary fortification (Food Standards Australia New Zealand, 2006). By the time the decision was made to introduce mandatory fortification in Australia and New Zealand, mandatory fortification had already been introduced in the USA (in 1998), Canada (in 1998) and Chile (in 2000). Rates of NTDs fell in all these countries following the introduction of mandatory fortification by between 31% and 78%. (Eichholzer, Tönz, & Zimmermann, 2006).

Voluntary fortification combined with health promotion to increase use of supplements has also been shown to be effective at reducing rates of NTDs to some extent. In Western Australia, for example, rates of NTDs fell by 29% following efforts at voluntary fortification and health promotion (Bower, Eades, Payne, D'Antoine, & Stanley, 2004). While not as effective as mandatory fortification, this is still a significant drop. However the same study also found that rates of NTDs did not drop significantly amongst Indigenous Australians, who had higher rates of NTDs (Bower et al., 2004).  Studies in other areas found that voluntary fortification had only a small effect on NTDs (Food Standards Australia New Zealand, 2006).  Ultimately, FSANZ decided that the evidence available supported the introduction of mandatory fortification with folic acid (Food Standards Australia New Zealand, 2006).

The second opportunity is to attempt to influence Cabinet and the Minister for Food Safety. This is likely to be more effective as Ministers naturally want to be re-elected and therefore their decisions are more likely to be based on public opinion. In the case of folic acid fortification, a media campaign by relevant interest groups contributed to strong public opposition to mandatory fortification of bread with folic acid. This campaign was led primarily by the New Zealand Association of Bakers.

There are a number of interest groups for whom policy on mandatory fortification of bread with folic acid is relevant. The most relevant sectional interest groups are those that represent the milling and baking industry, including the New Zealand Association of Bakers. These groups have a financial interest in mandatory fortification of bread with folic acid as they are the ones that bear the cost of ensuring that bread is fortified. A less obvious financial interest could be that if fortification in voluntary rather than mandatory, bread companies can charge higher prices for bread that is fortified, increasing profits. In submissions to both FSANZ in 2006 and the New Zealand Food Safety Authority in 2009 industry groups were almost universally opposed to mandatory fortification (Food Standards Australia New Zealand, 2006; New Zealand Food Safety Authority, 2009b).

Advocacy groups involved in influencing policy about folic acid fortification include consumer groups such as the Consumers Institute of New Zealand and Health Freedom New Zealand generally oppose mandatory fortification (Consumer Institute of New Zealand, 2009; Health Freedom New Zealand, 2009) while and those representing public health interests and the interests of those affected by NTDs such as the Paediatric Society of New Zealand and the Coalition of Parents of Children with Spina Bifida generally support mandatory fortification (Coalition of Parents of Children with Spina Bifida, 2009; Paediatric Society of New Zealand, 2009). These groups have varying motivations for their positions. Some of these groups’ positions are based on values while others are based on evidence.

In the media campaign against mandatory fortification interest groups such as the New Zealand Association of Bakers and Health Freedom New Zealand most frequently used values to justify their positions. The main value that emerged in the debate was consumer choice. The importance of this value was evident early on in submissions both to FSANZ when mandatory fortification was first under consideration (Food Standards Australia New Zealand, 2006) as well as later in submissions to the New Zealand Food Safety Authority when delaying the introduction of mandatory fortification was being considered (New Zealand Food Safety Authority, 2009b). Interest groups took this value to an extreme, labelling mandatory fortification with folic acid “mass medication” that not only violated consumer’s choices about what they eat but also about what ‘medicines’ they take (Health Freedom New Zealand, 2009; New Zealand Association of Bakers, 2009). While other groups supporting mandatory fortification also made press releases (Coalition of Parents of Children with Spina Bifida, 2009; Paediatric Society of New Zealand, 2009), the overall representation in the media was anti-mandatory fortification. This media representation is likely to have influenced public opinion and ultimately contributed to Kate Wilkinson’s decision to delay mandatory fortification of bread with folic acid in New Zealand.

New Zealand decisions about the fortification of bread with folic acid are the result of a complex interplay between institutions, ideas and interests. There is some fragmentation of relevant institutional power and interest groups had some influence over the decision to delay mandatory fortification. The most recent decision reflects the conflict between values and evidence that is evident in the debate.

References

Agreement Between the Government of Australia and the Government of New Zealand Concerning a Joint Food Standards System. (1996). Retrieved 22nd August 2011. from http://www.foodsafety.govt.nz/elibrary/industry/Agreement_Between-Member_States.pdf.

Australia and New Zealand Food Regulation Ministerial Council, & Food Regulation Standing Committee. (2005). Operating Proceedures for the Australia and New Zealand Food Regulation Ministerial Council and the Food Regulation Standing Committee.   Retrieved 22nd August 2011, from http://www.health.gov.au/internet/main/publishing.nsf/Content/foodsecretariat-operating-procedure.htm

Bower, C., Eades, S., Payne, J., D'Antoine, H., & Stanley, F. (2004). Trends in neural tube defects in Western Australia in Indigenous and non-Indigenous populations. Paediatric and Perinatal Epidemiology, 18(4), 277-280.

Coalition of Parents of Children with Spina Bifida. (2009). Bakers win babies die.   Retrieved 22nd August, 2011, from http://www.scoop.co.nz/stories/PO0908/S00328.htm

Consumer Institute of New Zealand. (2009). Folic acid in bread on hold.   Retrieved 22nd August, 2011, from http://www.consumer.org.nz/news/view/folic-acid-in-bread-on-hold

Eichholzer, M., Tönz, O., & Zimmermann, R. (2006). Folic acid: a public-health challenge. Lancet, 367(9519), 1352-1361.

Food Act, no.45 11C, 11E, 11L, (1981).

Food Standards Australia New Zealand. (2006). Final assessment report: Proposal p295: Consideration of mandatory fortification with folic acid. from http://www.foodstandards.gov.au/_srcfiles/FAR_P295_Folic_Acid_Fortification_%20Attachs_1_6.pdf

Food Standards Australia New Zealand. (2008). Australia and New Zealand Food Standards Code - Standard 2.1.1 - Cereals and cereal products. Retrieved 22nd August, 2011. from http://www.comlaw.gov.au/Details/F2009C00856.

Food Standards Australia New Zealand. (n.d.-a). About FSANZ.   Retrieved 22nd August, 2011, from http://www.foodstandards.gov.au/scienceandeducation/aboutfsanz/

Food Standards Australia New Zealand. (n.d.-b). FSANZ Service Charter 2010.   Retrieved 22nd August, 2011, from http://www.foodstandards.gov.au/scienceandeducation/aboutfsanz/servicecharter.cfm

Health Freedom New Zealand. (2009). Call off Mass Medication.   Retrieved 22nd August, 2011, from http://www.scoop.co.nz/stories/GE0907/S00060.htm

King, A. (2007). Folic acid decision prevents suffering.   Retrieved 22nd August, 2011, from http://www.beehive.govt.nz/node/29838

Ministry of Health. (2003). Improving Folate Intake in New Zealand: Policy implications. Wellington: Ministry of Health.

New Zealand Association of Bakers. (2009). Work Starts on Wilkinson's Mass Medication Plan.   Retrieved 22nd August, 2011, from http://www.scoop.co.nz/stories/BU0907/S00210.htm

New Zealand Food Safety Authority. (2007). New Zealand (Mandatory Fortification of Bread with Folic Acid) Food Standard 2007. Retrieved 22nd August, 2011. from http://www.foodsafety.govt.nz/elibrary/industry/proposed-amendment-nz-folic-acid-standard/attachment-1-nz-folic-acid-standard.pdf.

New Zealand Food Safety Authority. (2009a). New Zealand (Mandatory Fortification of Bread with Folic Acid) Amendment Food Standard 2009. Retrieved 22nd August, 2011. from http://www.foodsafety.govt.nz/elibrary/industry/zealand-mandatory-fortification-food-standards/bn09-058-folic-acid-amendment-standard.pdf.

New Zealand Food Safety Authority. (2009b). NZFSA Consultation - Proposed Amendement to the New Zealand Folic Acid Standard: NZFSA public discussion paper no. 10/09.   Retrieved 22nd August 2011, from http://www.foodsafety.govt.nz/elibrary/industry/proposed-amendment-nz-folic-acid-standard/index.htm

Paediatric Society of New Zealand. (2009). Mandatory bread fortification with folate. Retrieved 22nd August, 2011, from http://www.scoop.co.nz/stories/GE0907/S00079.htm

Wilkinson, K. (2009). Government defers folic acid fortification.   Retrieved 22nd August, 2011, from http://www.beehive.govt.nz/release/government-defers-folic-acid-fortification