Global Health & Environment
winter 1996, Vol. 4, Issue 2
Food Poisoning and Avoidable Death
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Center for Communications, Health, and the Environment
by Drs. Wilfried Kreisel, Tord Kjellstroem, and Alan Reilly, World Health Organization, Geneva, Switzerland
We humans depend on air, water, and food to survive. Four minutes without air, four days without water or four weeks without food, and we die. Air, water and food also need to be clean to be safe. If they are not, microbial agents can grow in them and spread communicable diseases, and chemicals and physical agents can remain in them and cause poisoning and acute and chronic non-communicable diseases.
Healthy Lives Lost
Almost 1.4 billion years of healthy life are lost world-wide every year to preventable premature deaths or disability from all causes. According to the World Bank's 1993 World Development Report, 60 percent of these deaths result from diseases related to environmental exposures and food contamination accounts for at least 100 million lost years. Major outbreaks of "environmental diseases" over the last 40 years have contributed to a number of these food-related incidents. Examples that stand out are: Minamata disease in Japan due to methyl mercury poisoning in fish in1956; Itai-ltai disease, also in Japan, linked to cadmium in rice in 1958; and the Chernobyl nuclear accident in Ukraine in 1986, the largest health impact of which to date is thyroid cancer in children, primarily due to radioactive iodine in food.
Sources and types of food-borne hazards vary across the globe: in developing countries poverty and poor sanitation are the chief causes of microbiological or traditional hazards; in the industrialized world, agricultural and industrial technologies are often the culprits of chemical or modern hazards. The global consequences of food contamination, however, are often not fully appreciated, as most incidents never come to the attention of health services. Nevertheless, the World Health Organization (WHO) estimates that up to 70 percent of diarrheal episodes around the world arise from contaminated food or water. In the developing world alone, this could explain most of the1.5 billion episodes of diarrhea and the 3 million deaths that occur annually in children under the age of five.
Rapid urbanization in many developing countries and the recent political and economic challenges in Central and Eastern Europe, though diverse phenomena, have shown a common impact outstripping of the efficacy of basic sanitation facilities and practices, increasing the risk of food and water contamination or the actual resurgence of common human pathogens in the food supply.
Biological contaminants, such as bacteria, viruses and parasites, are a major cause of food-borne disease worldwide. Salmonella spp., contamination of animal foods is becoming a serious public health problem and source of economic losses around the world; Campylobacter spp., is the leading cause of food-borne illness in several European countries, with poultry, meat, and unpasteurized milk being the main vehicles of transmission Escherichia. ColiO257:H7 contaminated hamburgers in 1993 caused more than 500 bouts of severe illness in the northwestern United States.
Shellfish grown in contaminated coastal waters is commonly implicated in virally transmitted food-borne diseases. As these foods are usually eaten raw or lightly cooked, the risk of such disease is high. An epidemic of shellfish-borne hepatitis A in China caused by consumption of contaminated clams affected some 292,000 people in 1988. Resulting from the consumption of raw or inadequately cooked freshwater fish or aquatic plants, food-borne trematode infections affect more than 40 million people throughout the world and approximately two million people in Siberia and Ukraine are infected with liver fluke (Opisthporchis). Accidental chemical contamination or adulteration of the food supply is also a concern. In 1981-82, for example, consumption of adulterated cooking oil in Spain caused about 600 deaths and serious bouts of illness in some 20,000 people. Indiscriminate use of antibiotic residues in foods can lead to the development of antibiotic resistant pathogens, and some chemical contaminants, such as mercury and polychlorinated biphenyls that can bio-accumulate in the food chain are a potential problem.
An unsafe food supply is a health hazard as well as an economic liability resulting in increased health care costs, lower productivity, lost tourism, and poor competitiveness of food products in export markets. Salmonella contamination in the United States is estimated to cost between $ 1.6 and $5 billion annually. The lost revenue from food exports due to a cholera outbreak in Peruin1991 was estimated at $700 million.
Considerable investment in extensive food safety infrastructures can go a long way to alleviate contamination and the ensuing economic woes. Such investment in legislation, enforcement mechanisms and surveillance systems, is generally limited to industrialized countries. Furthermore, public action at the community level is among the most important complements to government surveillance to ensure smooth links in the chain of a safe food supply.
WHO has been active since its inception in promoting food safety programs. The Joint FAD/WHO Codex Alimentarius Commission establishes safe levels for food additives, contaminants, pesticide and veterinary drug residues for inclusion in internationally recognized food standards. For consumers, WHO offers 10 Golden Rules of Food Safety (see below.). The global organization is also spear heading the development of guidelines for the implementation of the Hazards Analysis and Critical Control Point (HACCP) system of food safety assurance by the private sector. In addition it is helping to develop educational programs for the primary health care sector in the promotion of safe weaning foods and assisting national governments in food surveillance. Inter-sectoral action, which often functions best at the local level, is fundamental to assuring food safety. It is at the local level that the health, food, industry, and transportation sectors can intersect closely and mount stronger action. Such impetus can catalyze sustainable public and private sector collaboration as witnessed in the unprecedented number of WHO's successful Healthy Cities partnerships sprouting up around the globe.
WHO's Golden Rules for Safe Food
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