Folic acid in flour

Joint letter to UK Health Secretary.

The Scottish and Welsh Governments have written jointly to the UK Health Secretary urging him to take action and introduce mandatory fortification of flour with folic acid on a UK wide basis.

The Scottish Government, along with Wales, believes this will help to reduce neural tube defects, such as spina bifida, in unborn babies. Folate levels are low across the UK by international standards – figures published today show that in Scotland they are particularly low.

Minister for Public Health and Sport, Aileen Campbell and Welsh Cabinet Secretary for Health and Social Services, Vaughan Gething sent the following letter to Jeremy Hunt.

Text of letter follows.

Dear Mr Hunt

As the Ministers respectively responsible for health in Scotland and Wales we write jointly following Food Standard Scotland’s (FSS) recommendations on mandatory fortification of flour with folic acid on a Scotland only basis.

Both our Governments have long called for further action in this area at a UK level.  In the absence of UK action, the Scottish Minister for Public Health formally requested that FSS look at options for mandatory fortification of bread or flour with folic acid on a Scotland only basis. As part of this remit, FSS undertook a number of strands of work, including: commissioning an updated folic acid risk assessment by Scientific Advisory Committee on Nutrition (SACN); new dietary modelling, on folic acid intakes, potential fortification scenarios and estimated neural tube defect (NTD) risk reductions; and an evaluation of initial industry engagement regarding practical implication and likely business impact of folic acid fortification.

FSS has completed this work and the key recommendations are as follows: firstly, mandatory fortification should not be introduced on a Scotland only basis. The cost and practical implications of introducing mandatory fortification of flour on a Scotland only basis militated against effecting a Scotland only solution in a way that was straightforward and with minimal cost to industry; and, secondly, that mandatory fortification should, in line with previous recommendations, be taken forward on a UK basis.

It is of concern that today’s blood folate results show that 81% and 79% of women of childbearing age in Scotland and Wales respectively are below the threshold for increased risk of an NTD affected pregnancy which reinforces the case for action. This compares to 83% in Northern Ireland and 75% across the UK as a whole.  We are therefore clear that there remains a compelling case for action across the UK to reduce NTD incidence, particularly in the most socio-economically deprived areas. The recent work by FSS and SACN further reinforce the need for action and provide up to date analysis and evidence for taking this forward on a UK wide basis.  UK Chief Medical Officers, SACN and FSS welcome the recent work and are all supportive of the recommendations for a UK wide approach.  This position is also supported by the Department of Health in Northern Ireland.

We want to work together to make this happen.  We strongly urge you and your ministerial colleagues to reconsider your position and press ahead quickly with a decision on mandatory fortification of flour with folic acid for England, and to agree to a uniform approach to the introduction of legislation across the UK.

Yours sincerely


Minister for Health              Cabinet Secretary for Health and Social Services

Scotland                                 Wales



Between 2007-2011, 158 babies were born in Scotland & detected with Neural Tube Defects at birth or during infancy.

Between 2007-2011, 131 terminations were performed in Scotland with diagnosis of Neural Tube Defect.


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