Folate as solution, folate as problem
Folate as solution, folate as problem
Some reflections on problem formation in public health through the lens of Neural Tube Defects
In 2021, the UK government announced its plans to introduce mandatory fortification of non-wholemeal flour with folic acid to lower the prevalence of neural tube defects (NTDs). Fortifying flour with folic acid is controversial due to the health benefits and risks associated with it. Whilst the scientific evidence related to mandatory fortification has been employed by stakeholders in a predominantly “subtractive” manner (i.e., to “settle” the fortification debate by proposing a for or against position), this paper wants instead to explore how the problem of NTDs might be “opened” up and problematised differently. We begin by providing a brief history of how folic acid becoming “risk-reducing drug” led simultaneously to the prevention of NTDs coming into being as a problem for Public Health. In the second part of the paper, we argue that the manner in which NTDs are currently problematised has the effect of creating boundaries that constrain not only what sort of solutions to the problem of NTDs may be proposed, but also those which may be successfully taken up. Thinking with the May 2018 House of Commons parliamentary debate, we conclude by speculating on what the prevention of NTDs might look like for public health, if folate is viewed not simply as a solution, but also as a problem in its own right. The paper thus contributes with a case study in how problems are formed in public health.