Month: November 2024

Why I Support the Fortification of Flour with Folic Acid

From the end of 2026, the UK government will require the addition of folic acid to non-wholemeal flour. This is an important step forward in public health; an intervention that could prevent up to 200 cases of neural tube defects annually as well as improving the health of pregnant women and their babies.

Why Folic Acid Matters

Folic acid is essential for healthy cell growth and development. For pregnant women, folic acid plays a critical role in the early stages of foetal development, particularly in forming the neural tube, which develops into the brain and spinal cord. An insufficient folic acid intake during pregnancy can lead to neural tube defects such as spina bifida and anencephaly—serious conditions that can result in lifelong disability for the child or even loss of life.

While women planning to become pregnant are encouraged to take folic acid supplements, about half of pregnancies in the UK are unplanned. This means that many women may not be taking supplements at the crucial time when the neural tube is developing, often before they even know they are pregnant. Fortifying a staple food such as non-wholemeal flour ensures that more women—and the population in general—have a better intake of folic acid, thereby reducing the risk of neural tube defects.

A Proven Public Health Measure

Folic acid fortification is not a new concept. Countries such as the USA, Canada, Australia and New Zealand have implemented similar policies with with positive public health outcomes. In the USA, for instance, neural tube defect rates dropped after folic acid was added to flour in 1998. This policy has been hailed as one of the most effective public health interventions in recent decades.

By adopting a similar strategy, the UK stands to achieve comparable benefits. The planned fortification could prevent up to 200 neural tube defect cases annually. Beyond these direct health benefits, the policy will also reduce the emotional and financial burden on families and the healthcare system.

Reaching Vulnerable Groups

One of the most main advantages of folic acid fortification is its ability to reach vulnerable populations. People from poorer backgrounds are less likely to take dietary supplements and may have diets that are lower in naturally occurring folate. Fortification ensures that everyone has access to an additional source of this vital nutrient, which can hep in reducing health inequalities.

Safety and Wholemeal Flour Exemption

Some people have expressed concerns about potential risks of folic acid fortification, such as masking vitamin B12 deficiency in older adults. However, evidence from countries with fortification policies shows that these risks are very low and far outweighed by the benefits.

Moreover, wholemeal flour will not be fortified under the new policy, as wholemeal flour is less commonly consumed and many people who choose it also prioritise less processed foods. However, those who consume wholemeal flour should be mindful of their folic acid intake and ensure this is adequate through other sources, including supplements or other products fortified with folic acid.

Looking Ahead

The move to fortify non-wholemeal flour with folic acid is a proactive approach to improving public health. By addressing one cause of neural tube defects, this policy will have a lasting positive impact on many families across the UK. It is a reminder of the power of preventive measures in public health when even a small change can make a large difference at a population level.

As we move toward the implementation of this policy, it is crucial to continue raising awareness about the importance of folic acid, particularly among women of childbearing age. Together, we can support a healthier future for mothers, babies, and society as a whole by supporting positive public health interventions such s folic acid fortification.

Bridging the Digital Divide in Healthcare: Understanding the Use of the NHS App

The NHS App, launched in 2019, was designed to revolutionise how patients engage with their healthcare, offering features such as booking appointments, viewing medical records, and ordering prescriptions. While the app has seen substantial uptake—with millions registering and engaging—it appears that the benefits of this digital innovation are not evenly distributed across the population as we report in our article in the Journal of Medical Internet Research.

The Promise of the NHS App

Digital health tools like the NHS App hold the potential to empower patients, improve self-management of health, and increase access to care. From March 2020 to June 2022, millions of users logged into the app, ordered prescriptions, and accessed medical records. However, a closer look at the data reveals disparities in who is using these features.

The Digital Divide in Action

Our recent study highlights how sociodemographic factors influence app engagement. Key findings include:

  • Socioeconomic Disparities: People in more deprived areas are significantly less likely to use the app. For instance, the rate of app registrations was 34% lower in the most deprived practices compared to the least deprived.
  • Ethnic Differences: Practices serving populations with higher proportions of White patients showed far greater engagement. Prescription ordering rates in these areas were over double those in more ethnically diverse regions.
  • Age and Health Needs: Younger patients were more likely to use appointment booking features, while those with long-term conditions engaged more with medical record views and prescription services.
  • Gender Gaps: Practices with higher proportions of male patients reported lower app engagement overall.

Why Does This Matter?

The NHS App aims to make healthcare more accessible for all, but these disparities suggest that its benefits may not be reaching those who need them most. This mirrors the “digital inverse care law,” where digital solutions are disproportionately used by those with better access and resources, potentially exacerbating health inequalities.

How Can We Close the Gap?

To ensure the NHS App works for everyone, targeted efforts are needed:

  1. Digital Literacy Programmes: Equip underserved communities with the skills needed to navigate digital tools.
  2. Tailored Outreach: Highlight the App’s benefits to specific groups, such as ethnic minorities and those in deprived areas.
  3. Enhanced Support Services: Offer helplines or in-person assistance for individuals less familiar with digital health platforms.
  4. Collaborations with Community Groups: Partner with local organizations to raise awareness and build trust in digital healthcare solutions.

A Call for Inclusive Digital Health

The findings of our study underscore the importance of continuously monitoring and adapting digital health strategies to meet the needs of diverse populations. The NHS App is a powerful tool with the potential to enhance healthcare accessibility, but its success depends on equitable adoption and use.

Let’s work towards a future where digital health bridges gaps rather than widens them, ensuring better health outcomes for everyone, regardless of their background.

Improving Migrant Healthcare: An Evaluation of of Health Catch-UP!

In today’s interconnected world, migration is a key feature of modern societies. The UK has become home to a significant number of migrants seeking new opportunities or fleeing difficult circumstances. Yet, this group often faces unique healthcare challenges, including the risk of undiagnosed infectious and non-communicable diseases and incomplete vaccination records. Addressing these issues is crucial not only for individual well-being but also for broader public health. In a recent article published in the journal BMC Medicine, we evaluated Health Catch-UP!, a digital tool designed to bridge these healthcare gaps.

Understanding the Need

Migrants when compared to local populations are more vulnerable to certain health conditions that are common in their countries of origin. These range from infectious diseases like hepatitis and latent tuberculosis (TB) to non-communicable conditions like diabetes and high cholesterol. Unfortunately, current healthcare services in the UK often overlook these needs, leading to underdiagnosed health issues and missed opportunities for early treatment and prevention.

What is Health Catch-UP!?

Developed as a Clinical Decision Support System (CDSS), Health Catch-UP! is integrated into primary care practices to prompt healthcare providers to offer tailored screening and catch-up vaccinations for at-risk migrant patients. The tool works by collecting key demographic information (such as age, sex, and country of origin) and using this data to recommend relevant health checks and vaccinations according to current UK guidelines.

Key Findings from the Study

Our recent evaluation of Health Catch-UP! in two London-based primary care practices revealed several important insights:

Successful Data Collection: The tool enabled almost complete coding of essential patient demographics, which are often missing from standard records.

High Screening Uptake: Over 60% of the participating migrant patients were eligible for screening, with an impressive 87% choosing to undergo the tests.

New Diagnoses: Through the screening, 12 new health conditions were identified, showcasing the tool’s potential to detect previously unrecognized health issues.

Challenges with Vaccinations: Despite identifying gaps in vaccination coverage, the actual uptake of vaccines was low. This highlights the need for more patient engagement and support in this area.

Patient and Healthcare Staff Perspectives

The feedback from both patients and healthcare professionals was largely positive. Patients appreciated being offered comprehensive health checks, especially when these were explained clearly by their providers. Clinicians found the tool to be user-friendly and felt it integrated well with existing practices. However, they noted that certain questions, such as asking about the date of arrival in the UK, could make some patients uncomfortable. Clear communication was key to overcoming this challenge.

The Road Ahead

While Health Catch-UP! has shown promise in improving healthcare access and outcomes for migrants, there are hurdles to overcome. Low vaccination uptake suggests that more robust patient education and logistical support are needed. Additionally, financial and staffing resources will be critical for widespread implementation, particularly in high-migrant areas.

Conclusion

Health Catch-UP! is a step forward toward more inclusive and effective healthcare for migrants in the UK. By tailoring healthcare to the needs of this diverse group, we can ensure better health outcomes and a stronger, more equitable healthcare system for all.