Thanks to the efforts of the Foodborne Disease Burden Epidemiology Reference Group (FERG) and others, foodborne disease is getting the attention it deserves as a major global health issue.
Children and poor people suffer the most from foodborne diseases — the same groups who also suffer from other health burdens such as undernutrition. In such high-risk populations, it's important to consider these health burdens jointly, and to identify multi-sectoral interventions in areas such as water and sanitation, community health, and climate change/food systems effects, that can address multiple and overlapping health burdens. Food safety interventions can be considered alongside and integrated into the main development interventions. Moreover, improving food safety will benefit from other development initiatives that are a priority for citizens and policy makers — for example, in adaptations to climate change across dry parts of Africa, or women's empowerment interventions in South Asia.
Not only does considering the burdens and interventions jointly make sense, it's crucial in terms of timing: in low and middle-income countries, food systems are rapidly transitioning from traditional to modern, and the evolution of food safety issues is happening equally fast. Addressing food safety issues with other food and health interventions simply cannot wait, given the large burdens.
Risk-based approaches have been a major opportunity for improving transitioning food safety systems. They allow flexibility for managing risks in different contexts. For example, countries that traded needed their products to be free of animal pathogens. With risk-based approaches, Thailand was able to process chickens for export in a way that managed the hazard of highly-pathogenic avian influenza in the exported product.
Poor people face and need to juggle multiple risks. Most nutritious foods, such as milk for children, are risky. Imagine being a mother in Addis Ababa, managing the challenges of milk availability, price, quality, and safety among your other food purchasing decisions. There are no perfect solutions, but lots of tradeoffs. We need to help with information so people, particularly those in high-risk populations, can win more and lose less in these tradeoff decisions.
In identifying appropriate food safety interventions, we need to ensure they fit the daily context of food system actors. We all recognize these actors needs to own, lead, and take responsibility for food safety. However, many food safety investments aren't actually planned and implemented like we believe, in this actor ownership and leadership way. For example, butchers in informal markets like the one pictured here would probably develop different courses of action if they had been involved in the planning and management of the slaughter slab. It is hard for system actors in low and middle-income countries to have the necessary power and voice. They need institutions such as associations of consumers, farmers, and market agents to be able to influence and act.
Because food systems, and food safety systems, are in transition, interventions should be considered temporary, with room to evolve and change. They need to reflect current realities and needs. At early stages of dairy development, for example, it is appropriate to improve the performance of milk-hawkers delivering milk by bicycle: belonging to an association, with training and certification, supports them in being more professional and accepted. Yet while we work to address these current needs, we must also keep an eye towards the next steps in improvements, always with a vision of the end goal in mind. People want to evolve from bicycle delivery to higher-value activities and greater income. They need to see both current benefits as well as a future in which food safety will mean better lives for them and their children.
John McDermott is the director of the CGIAR Research Program on Agriculture for Nutrition and Health (A4NH). This post is based on remarks he delivered on February 12, 2019, at the First FAO/WHO/AU International Food Safety Conference in Addis Ababa, Ethiopia.