The role of neurosurgeons in global public health: the case of folic acid fortification of staple foods to prevent spina bifida

Nathan A. ShlobinDivision of Pediatric Neurosurgery, Lurie Children’s Hospital, Chicago, Illinois;
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois;

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Jordan T. RoachCollege of Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee;
Graduate School of Biomedical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee;

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Vijaya KancherlaDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia;

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Adrian CaceresDepartment of Neurosurgery, National Children’s Hospital of Costa Rica, "Dr. Carlos Saenz Herrera," San José, Costa Rica;

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Eylem OcalDepartment of Neurosurgery, Arkansas Children’s Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas;

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Kemel A. GhotmeTranslational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia;
Pediatric Neurosurgery, Department of Neurosurgery, Fundación Santa Fe de Bogotá, Bogotá, Colombia;

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Sandi LamDivision of Pediatric Neurosurgery, Lurie Children’s Hospital, Chicago, Illinois;
Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois;

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Kee B. ParkProgram in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;

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Gail RosseauDepartment of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC;

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Jeffrey P. BlountDepartment of Neurosurgery, University of Alabama at Birmingham/Children’s of Alabama, Birmingham, Alabama; and

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Frederick A. BoopDepartment of Neurosurgery, University of Tennessee Health Sciences Center, Memphis, Tennessee

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the Global Alliance for the Prevention of Spina Bifida-F (GAPSBiF)
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OBJECTIVE

The global neurosurgery movement arose at the crossroads of unmet neurosurgical needs and public health to address the global burden of neurosurgical disease. The case of folic acid fortification (FAF) of staple foods for the prevention of spina bifida and anencephaly (SBA) represents an example of a new neurosurgical paradigm focused on public health intervention in addition to the treatment of individual cases. The Global Alliance for the Prevention of Spina Bifida-F (GAPSBiF), a multidisciplinary coalition of neurosurgeons, pediatricians, geneticists, epidemiologists, food scientists, and fortification policy experts, was formed to advocate for FAF of staple foods worldwide. This paper serves as a review of the work of GAPSBiF thus far in advocating for universal FAF of commonly consumed staple foods to equitably prevent SBA caused by folic acid insufficiency.

METHODS

A narrative review was performed using the PubMed and Google Scholar databases.

RESULTS

In this review, the authors describe the impact of SBA on patients, caregivers, and health systems, as well as characterize the multifaceted requirements for proper spina bifida care, including multidisciplinary clinics and the transition of care, while highlighting the role of neurosurgeons. Then they discuss prevention policy approaches, including supplementation, fortification, and hybrid efforts with folic acid. Next, they use the example of FAF of staple foods as a model for neurosurgeons’ involvement in global public health through clinical practice, research, education and training, and advocacy. Last, they describe mechanisms for involvement in the above initiatives as a potential academic tenure track, including institutional partnerships, organized neurosurgery, neurosurgical expert groups, nongovernmental organizations, national or international governments, and multidisciplinary coalitions.

CONCLUSIONS

The role of neurosurgeons in caring for children with spina bifida extends beyond treating patients in clinical practice and includes research, education and training, and advocacy initiatives to promote context-specific, evidence-based initiatives to public health problems. Promoting and championing FAF serves as an example of the far-reaching, impactful role that neurosurgeons worldwide may play at the intersection of neurosurgery and public health.

ABBREVIATIONS

FA = folic acid; FAF = FA fortification; FAS = FA supplementation; GAPSBiF = Global Alliance for the Prevention of Spina Bifida-F; HIC = high-income country; LMIC = lower-middle-income country; SB = spina bifida; SBA = SB and anencephaly; SBA-F = SBA caused by FA insufficiency.
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Figure from Candela-Cantó et al. (pp 61–70).

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