By Delia Grace Randolph, Program Leader (joint) Animal and Human Health Flagship Leader Food Safety A4NH International Livestock Research Institute (ILRI)
This changes everything
In the past, foodborne disease was rarely seen as a development priority. This all changed when the World Health Organization (WHO) published the first assessment of the global burden of foodborne disease. Covering just 31 hazards, the study found the health burden was comparable to that of HIV-AIDS, malaria or tuberculosis. Unsurprisingly, burden was most intense in Asia and sub-Saharan Africa and fell most heavily on children under five years of age. But surprising to many, most of the known burden comes from microbes and worms and not from the chemicals people tend to worry about more (although the study is not complete, and results are anticipated showing a high burden from heavy metals).
The huge economic burden of foodborne disease: driven by public health not trade
While evidence on the health burden of foodborne disease may motivate concern, knowing its costs may be more likely to lead to action. A new report by the World Bank launched this week provides first estimates of the economic burden of foodborne disease. The total productivity loss from foodborne disease (that is, loss in terms of human capital) in developing countries amounts to US $95 billion a year. Fifteen countries, led by China and India, have an economic burden of more than $1 billion a year. Adding the costs associated with treatment adds another $15 billion to the bill. Losses associated with trade, long the major focus of donor investments, may be an additional $5 billion a year.
The worst is yet to come
An important, if not cheering, finding from the report was that for many developing countries the burden of foodborne disease is likely to get worse before it gets better. According to “the food safety lifecycle” food safety will first worsen then improve, driven by shifts in demand and supply that occur along with population increase, urbanisation and increasing wealth.
When a chicken lives in the back yard and is killed in the back kitchen, then plucked and put in the pot, there is little time and distance for contamination and cross-contamination. But with development this short food chain becomes wide, long and complex. Diets diversify, and people want more of the most risky foods: that is, meat, milk, eggs, fish, and vegetables. These fresh foods are perishable and production moves to peri-urban sites where hygiene is poor. A host of middlemen and women emerge to move, process and cook food. But this crowded and dynamic food scene is hard to regulate and provides many incentives for the persistence of contaminated and adulterated in food. In some countries, black markets exist where you can sell your livestock that have died of disease, which then ends up in someone else’s dinner plate.
Food safety is a solvable problem
So, foodborne disease is going in the opposite direction to most infectious diseases which thankfully have been trending down for decades, albeit it with bumps on the way. Yet, once through the messy middle where things gets worse, there is good prospects that food safety will get better. This was clearly the case of the developed world, where filthy and fake food reached a nadir in the nineteenth century before a series of scandals pushed it into a safer direction. This inverted U curve also makes the dynamics of foodborne disease different from diseases of over-consumption: while also rapidly worsening in developing countries, there is less evidence of an inflection point. It seems that people say they want nutritious diets but act as if they want fatty, salty and sweet snacks: but people say they want food free from hazardous chemicals, faecal bacteria and pathogens, and their behaviour backs them up. This important World Bank report sets out a range of practical recommendations that can speed the transition to a safer food system. Importantly, consumer demand for safe food is a key lever.
Published 6 November 2018