Why can’t Public Health U-turn?

When experts recommended removal of fortifications from flour – nothing happened

Dr Clare Craig

The last time public health in the UK moved to keep flour pure was 1875. Ever since, there has been a push to add more and more to it.

A serving scientist employed by Unilever was handed the chair of a working group of the Scientific Advisory Committee on Nutrition – the body that tells the British government what the country should eat.

Unilever is one of the largest food manufacturers on earth and David Mela was a ‘Science Leader’ at its research laboratories in Vlaardingen.

His group’s recommendation was to put folic acid, a drug, into all of Britain’s “non-wholemeal wheat flour” i.e. white and brown flour.

How was that allowed to happen?

The obvious suspicion is money but that was not the explanation. Unilever does not make folic acid and does not sell it. The firms that profit when a government fortifies a nation’s flour are the vitamin houses, like DSM-Firmenich and BASF, and the suppliers who sell premix to the mills. Mela was not enriching his employer. So that is not the issue.

The issue is harder to legislate against. Mela had spent his career reformulating food for a living. In that trade fortification is a sales pitch. It is sold as a benefit and the people who make the pitch come to believe their own propaganda. He was then asked to judge whether the nation’s food needed fortifying. Given the culture he was from he may honestly have concluded that it did. This is not a charge against his integrity. It is a question about who you put in the chair. A man whose working life was built on adding things to food does not arrive as a blank slate with no opinion on fortification.

His conflict was declared but nothing else was done about it. As Chris van Tulleken told the BMJ, “even small financial conflicts affect behaviour and beliefs in subtle or unconscious ways,” which is precisely why naming an interest does not remove it. And the conflict that matters most here is not financial. Mela has written that worries about financial conflicts of interest in nutrition are overdone and that intellectual allegiance is itself a form of bias. He is right about the second point but he did not turn it on himself.

It would be comforting to call this just one poor appointment. It was not. Zoë Harcombe investigated the make-up of the SACN, using their register of interests. She called Mela “the most inexcusable panel member of all” for his seat on the committee’s saturated-fat review, where Unilever’s spreads gave him a plain commercial stake; a company that built its spreads to replace butter was never going to find for butter. In 2024 the BMJ counted the rest: eleven of the seventeen members of SACN held financial ties to food companies, Nestlé and Unilever among them. The committee that tells Britain what to eat is staffed, in large part, by the people who make money from what Britain eats.

The U-turn that never came

Britain’s flour has been fortified since the Second World War – calcium, iron, thiamin and niacin, added under wartime emergency. In 1981 a government committee reviewed those additions and found the country no longer needed any of them. It recommended taking them out. Nothing happened; the proposal to deregulate was opposed at consultation and the additions stayed. Worse, the doses have increased since.

Who sat on that committee is the converse of this one. The 1981 panel was chaired first by the Cambridge biochemist Sir Frank Young and then by John Cummings of the Medical Research Council and its members were drawn from the universities, the research councils, the teaching hospitals and the government’s own scientists – among them Elsie Widdowson, who had co-written the standard reference on the composition of British food during the war. One member came from the industry-funded British Nutrition Foundation; the rest were independent. The millers and the bakers are in the report too – Rank Hovis, Spillers, the milling association, the baking research association – but in the acknowledgements, as witnesses called to give evidence not as decision makers. In 1981 the industry was in the witness box. By 2017, most of the committee had financial ties to the food industry and the chair was an employee.

The 1981 panel voted unanimously to take all four wartime additions out of flour. Asked whether anything else should go in, it listed the vitamins it could see no case for – riboflavin, pyridoxine, pantothenic acid and folate.

After the recommendation to take them out, the proposal went to public consultation, the consultation opposed it and the fortificants stayed – where they remain today, their minimum levels raised, not lowered, by the 2024 regulations.

By 2006 the committee was recommending folic acid be added. It reaffirmed that in 2017. In 2019 the public was consulted, 68% were in favour and the changes to the law began.

Look at who had the last word. The one time experts said take something out, consultation kept it in. Why bother having an expert panel if public consultation is the deciding factor?

Permanent committees exist to solve problems, so they go looking for problems to solve. A standing body asked to improve the national diet will rarely conclude that nothing needs changing. It finds the next thing to add. The UK does not just have SACN thinking about adding folic acid, the public health bodies also have committees who want a legacy too. What is never asked at these committees is what should come out of the food.

The public is the last to know. Most people have no idea folic acid is coming to their bread. The risk that kept British regulators cautious for twenty years has not gone away either: extra folic acid can hide the early signs of vitamin B12 deficiency and let nerve damage advance undetected, a danger that falls hardest on the old. The health service still warns specific patients about it; doctors still check for it before they prescribe folic acid. From December it enters everyone’s flour regardless. The NHS also advises anyone with cancer, a heart stent or haemodialysis should see their doctor before taking any folic acid. But how can they when it is in the flour?

Public health almost never reverses itself. Across its whole history the clear reversals can be counted on one hand. The starkest is the advice, repeated for years, to lay babies to sleep on their fronts which was abandoned only in 1991, once the link to cot death could no longer be denied, by which time a great many infants had already died.

In 1875, Parliament made it an offence to sell food that was not, in the words of the Act, “”not of the nature, substance and quality demanded.” Wartime emergency began chipping at that in the 1940s. In 1981 the government’s own advisers tried to undo it and were refused. From December 2026 British flour will sit further from that ideal than at any point in its history.

Every generation inherits the last intervention and adds its own. The committee asks what more should go into the nation’s food; it does not ask what could come out. The machine runs in one direction only. The folic acid in our bread will almost certainly still be there in fifty years – not because anyone will have shown it was needed, but because the system that puts things into food has no mechanism and no appetite for taking them back out.