WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR AFRICA
ORGANIZATION MONDIALE DE LA SANTE BUREAU REGIONAL DE L’AFRIQUE
ORGANIZAÇÃO MUNDIAL DE SAÚDE ESCRITÓRIO REGIONAL AFRICANO
REGIONAL COMMITTEE FOR AFRICA Fifty-third session Johannesburg, South Africa, 1–5 September 2003 Provisional agenda item 8.5
AFR/RC53/12 Rev.1 19 June 2003 ORIGINAL: ENGLISH
FOOD SAFETY AND HEALTH: SITUATION ANALYSIS AND PERSPECTIVES Report of the Regional Director EXECUTIVE SUMMARY 1. Foodborne illness is a major public health problem which also lowers economic productivity. Every year millions of people worldwide become sick as a result of consuming contaminated and unsafe food. Ensuring food safety is a critical and fundamental component of public health and food security. The Fifty-third World Health Assembly adopted Resolution WHA53.15 urging WHO and its Member States to recognize food safety as an essential public health concern. 2. Reducing the incidence of foodborne illness is a continuing challenge in the African Region. Though some positive steps have been taken to improve food safety, success has been elusive. Most national policies and programmes indicate gaps and inadequate linkages between strategies to ensure food safety. There is a need to strengthen the capacities of countries to develop comprehensive, sustainable and integrated food safety systems. The development of food safety legislation, application of preventive risk-based approaches, surveillance and capacity building are important elements in the reduction of foodborne diseases. 3. In view of the involvement of different sectors in food production, handling, inspection, import and export, there is need for multisectoral collaboration under the coordination and leadership of ministries of health to ensure synergy. This will necessitate clarification of the roles and responsibilities of the respective sectors by governments to avoid duplication of efforts. 4. This document highlights the dimensions of the food safety problem in the African Region. It examines the linkages between food safety, health and development and proposes approaches and priority actions for strengthening food safety activities in countries. 5. The Regional Committee is requested to consider and adopt this document entitled “Food safety and health: Situation analysis and perspectives”.
CONTENTS Paragraphs
INTRODUCTION ...................................................................................................................... 1–6 SITUATION ANALYSIS ....................................................................................................... 7–24 MAIN CHALLENGES TO FOOD SAFETY ....................................................................... 25–30 PERSPECTIVES OF FOOD SAFETY ACTIVITIES .......................................................... 31–36 ROLES AND RESPONSIBILITIES ..................................................................................... 37–42 CONCLUSION....................................................................................................................... 43–45
AFR/RC53/12 Rev. 1 Page 1 INTRODUCTION 1. Food safety is a worldwide public health problem. Microbial pathogens and chemical contaminants in food represent serious threats to health. Emerging diseases such as bovine spongiform encephalopathy (BSE)1 have received widespread media coverage and present challenges to governments worldwide. 2. The World Health Organization estimates that some 1,500 million children under five years of age annually suffer from diarrhoea and over three million die as a result. Even in industrialized countries, about one-third of the population experiences foodborne diseases annually.2 3. In May 2000, the Fifty-third World Health Assembly unanimously supported Resolution WHA53.15 on food safety. It called upon Member States and WHO to give greater priority to food safety and urged them to become involved in a range of multisectoral and multidisciplinary actions to promote the safety of food at all levels. 4. The intrinsic links between food security, quality and safety have been well established. The 1996 World Food Summit plan of action recognizes that food security exists only when all people have physical and economic access to sufficient, safe and nutritious food. 5. Food is central to the prosperity, health and social well-being of individuals and societies. Good health promotes productivity and cognitive functions. As with the economic well-being of individual households, good health is critical for poverty reduction, economic growth and longterm development. Therefore, WHO considers safe and nutritious food a basic human right and prerequisite to health.3 6. WHO posits that investments in food safety will not only boost national health status and economic productivity but will also improve the export potential of many countries and significantly alleviate rural poverty. SITUATION ANALYSIS Foodborne hazards 7. Food hazards include foodborne microbial pathogens as well as chemical and physical contaminants. Microbiological hazards present the greatest threat to safe food supply. At the micro level, the principal human and environmental factors that predispose food to contamination relate to improper food handling, storage and sanitation practices.
1 2 3
BSE is a fatal, transmissible neurodegenerative disease of cattle affecting the brain and spinal cord. WHO, Basic food safety for health workers, 1999. WHO, Macroeconomics and health – Investing in health for economic development: Report of the Macroeconomics and Health, 2001.
Commission on
AFR/RC53/12 Rev. 1 Page 2 8. In most countries, there has been a significant increase in the incidence of disease caused by microorganisms in food. Developing countries suffer the most from a wide range of diseases including cholera and infections due to campylobacter, Escherichia coli, salmonella, shigella, brucella and hepatitis A.4 9. Although reliable surveillance data are not available in the Region, the high prevalence of diarrhoeal diseases suggests major underlying food safety problems. The total number of cholera cases officially notified by African countries in 2001 was 173,359; this was a 46% increase from 2000.5 Occasionally, acute illness directly associated with food is documented as in the 1991 Tanzanian botulism outbreak.3 Excluding the most recent outbreak, approximately 1,500 cases of Ebola haemorrhagic fever6 have been documented, with slightly over 1,000 deaths. 10. The contamination of food by chemical hazards remains a worldwide concern. While the lack of monitoring capabilities in developing countries does not allow a direct assessment of the health impact of chemical contamination, outbreaks of acute poisoning are frequently reported, suggesting that such contamination may be a significant public health issue in countries.7 11. Despite the ban on dichlorodiphenyltrichloroethane (DDT) in agriculture, the food chain remains contaminated because of DDT persistence and fat solubility. Levels of DDT in breast milk is a good indicator of levels in food. Dietary intake of DDT complex by infants8 in some countries may exceed the WHO recommended provisional tolerable intake of 20 microgram DDT per kg body weight per day.2 12. The effects of food additives such as synthetic colours and flavouring are not documented but they may be used to mask poor quality, deterioration or deliberate adulteration.2 13. Naturally occurring toxins such as cyanogens were implicated in the paralytic disease konzo in the Democratic Republic of the Congo where the traditional three-day soaking period of cassava was reduced.2 High levels of aflatoxins have been found in groundnut and cereal grains in countries such as Guinea, The Gambia, Nigeria and Senegal. Exposure to aflatoxins can cause increased incidence of liver cancer and is a potent synergist of hepatitis B.9 A local cooking salt in Nigeria was found to contain very high levels of lead due to mining in a nearby region.
4 5 6
7 8
9
WHO, Foodborne disease, press release, WHO/58,1997. Weekly epidemiological record no, 31, 2002. Ebola haemorrhagic fever, one of the most virulent viral diseases known to humankind, causes death in 50-90% of all clinically ill cases and is believed by scientists to have been transmitted by eating meat from infected apes such as chimpanzees and gorillas. The Ebola virus is also transmitted by direct contact with the blood, body fluids and tissues of infected persons. WHO Food safety: An essential public health issue for the new millennium, 1999. DDT can interfere with natural processes that regulate growth and development in infants. Research continues on how endocrine disrupters such as DDT may damage the ability to fight disease, learn and integrate socially. Workshop Report on Mycotoxins in Food in Africa, 6–10 November 1995, Cotonou, Republic of Benin, International Institute of Tropical Agriculture.
AFR/RC53/12 Rev. 1 Page 3 14. The long-term safety threat of genetically modified foods (GMFs) to health and the environment has been a subject of much debate in recent years. Since gene inserts vary markedly, individual GMFs and their safety should be assessed on a case-by-case basis.10 The Director-General of WHO in the August 2002 meeting for the Health Sector Response to the Humanitarian Crisis in Southern Africa, declared the WHO commitment to provide the scientific basis for decisions regarding GMFs. Work is underway in WHO to present a broader view of the evaluation of such foods. 15. In many African countries preparation of traditional foods is based on fermentation. Examples include maize and other grain porridges in Nigeria, Tanzania, Uganda and Kenya. Fermentation improves the hygienic quality of foods. Nevertheless the improper application of the technology has been implicated in some outbreaks.11 Factors in the increased incidence of foodborne disease 16. The World Bank reports that Africa now has the largest share of people living on less than US$ 1 per day.12 The poor are under-served and live in precarious life-threatening conditions. They are the least informed, and yet they are the most exposed to foodborne illnesses. 17. About twenty years ago, Africa was still considered rural. Rapid urbanization is changing this picture. In many areas, the population outstrips the ability of local governments to provide infrastructure and services. This increases the risks of contamination and foodborne diseases. Ageing, malnutrition and HIV/AIDS have also increased the susceptibility to foodborne illness. 18. Street foods provide affordable sustenance for large numbers of the urban poor, and food vending is a source of employment for many women. Street food vending is both beneficial and risky. Street vendors are often poor, uneducated and ill-informed; they lack knowledge of basic safe food handling. The rapid and unregulated growth of street foods has exacerbated congestion and littering in many cities. National food safety programmes 19. Only 43% of the countries in a WHO regional survey expressed satisfaction with national food safety legislation. Implementation of food control practices is hindered by lack of both financial and physical resources. A recent survey reported that 80% of countries have at least two ministries and departments involved in food safety activities; however, there is little coordination, resulting in conflict and duplication of effort. The same survey indicates that a mere 46% of countries receive sufficient involvement from food scientists, and only 29% of countries have a food inspectorate that receives adequate back-up from toxicologists.13
10 11 12 13
WHO, Twenty questions on genetically modified foods, 2002. WHO, Food technologies and public health (WHO/FNU/FOS/95.12), 1995. World Bank, Poverty trends and voices of the poor, May 2001. WHO, Regional food safety assessment report, 2002.
AFR/RC53/12 Rev. 1 Page 4 20. In Africa, the problem of food control has been tackled piecemeal: there is overemphasis in some segments and token attention in others. As global trade in food continues to grow, the need to monitor and control imports and exports is becoming urgent. Few countries (25%) have mechanisms to collect and analyse information on food exports. On the other hand, a high proportion (82%) of reporting countries have monitoring systems for imported food; however, monitoring systems often have inadequate resources and insufficient coordination.13 21. Survey results of national food safety programmes reveal a need to intensify efforts to educate food-handlers and consumers on safe food handling practices. Only 43% of the respondent countries had implemented educational programmes that included the food industry and trade. A mere 46% have targeted housewives and school children in their educational programmes. Despite this, 61% of the countries have set up consumer protection organizations.13 22. African countries have shortages of trained inspectors, licensed chemists and qualified microbiologists. Only 7% of reporting countries have adequate numbers of inspectors, while 14% have trained personnel to support laboratory services and activities.13 Problems are further compounded by inadequate laboratories, storage, processing and transportation. 23. Water is a limited resource in both quantity and quality. In the year 2000, over 270 million people in Africa did not have access to safe drinking water. Water scarcity leads to unsanitary conditions that cause food contamination.14 24. There is limited monitoring and foodborne disease surveillance in the Region. Only 32% of the respondent countries provided data on epidemiological systems.13 There is need to learn from the experiences of industrialized countries and adopt holistic approaches tailored to national needs. MAIN CHALLENGES TO FOOD SAFETY 25. Poverty and urbanization: The control of foodborne diseases is compounded by the interdependent complexities of health and developmental concerns. The provision of basic urban infrastructure and services to improve urban health and social environmental conditions is also a challenge. 26. Establishing effective and sustainable food safety regulatory systems: The development of comprehensive and enabling food safety legislation based on scientific risk assessment and prevention is a challenge to countries when considering food from source to consumer. 27. Ensuring interdisciplinary collaboration and coordination in food safety management: Given the breadth of the food production continuum, it is necessary to harmonize the efforts of all stakeholders and ensure effective coordination of food control activities. There is an increasing need to develop and strengthen collaboration with institutions and centres involved in food safety. 14
WHO, Africa 2000, Water Supply and Sanitation Sector Assessment Report, 2000.
AFR/RC53/12 Rev. 1 Page 5 28. Street-vended foods: Regulating the street food industry to ensure that the population has access to wholesome, safe and nutritious foods is another challenge. Strategic interventions and regulatory measures need to be implemented and maintained in order to minimize risks and fully benefit from food intake. 29. Genetic engineering: Genetically-engineered foods have stimulated discussion and remain a controversial challenge for governments, especially in testing, regulation, good labeling and provision of adequate information to consumers. 30. The pressure of trade agreements: Despite the associated problems for governments, the World Trade Agreements have contributed immensely to the provision of safe and nutritious diets for world populations. The success of food trade at the international level depends largely on the structure and degree of control at the national level. Government food control agencies must therefore ensure enforceable standards for the quality and safety of foods. PERSPECTIVES OF FOOD SAFETY ACTIVITIES 31. The reduction of foodborne diseases involves risk reduction and control interventions targeted at processes from production to consumption. These include the system of Hazard Analysis and Critical Control Points (HACCP), education of consumers and food handlers, elaboration of scientific and enforceable policies, and commitment to foodborne disease surveillance. 32. HACCP is a proactive rational, scientific, and systematic approach to preventing, eliminating and reducing the risks posed to consumers by hazardous contaminants in food. The system is recognized by the Codex Alimentarius Commission as the most cost-effective means to assure food safety at all stages of supply. It involves the systematic evaluation of actual or potential hazards in food processes, the identification of critical control points in a process and the application of control measures. The basic thrust of HACCP is prevention. 33. Risk analysis is a key feature of decision-making. The risk posed by hazards in food depends on the degree of control exercised by producers, processors and food control authorities to prevent contamination or minimize it to safe levels. The risk analysis process comprises risk assessment, risk management and communication. 34. Health education in food safety is a major factor in combating foodborne diseases. Health promotion initiatives such as the Healthy Marketplaces Food Safety concept and the Healthy Schools Initiative are viable settings for the promotion of food safety. 35. Formulation of scientific research-based policies and legislation that are responsive to current and emerging food safety concerns will significantly reduce foodborne disease.
AFR/RC53/12 Rev. 1 Page 6 36. An integrated national foodborne surveillance system is instrumental for estimating the burden of foodborne diseases, assessing its relative impact on health and economics, and evaluating disease prevention and control programmes.15 Functional and adequate laboratory facilities and resources as part of the national surveillance system would ensure the preparedness of countries to tackle the issue of food hazards such as radioactive, chemical and bacteriological contamination at national and subregional levels. The formation of networks at national and subregional levels will assure the exchange of information on food safety incidents. ROLES AND RESPONSIBILITIES Role of countries 37. Countries should establish coordinated, enforceable updated food safety policies and regulations based on international standards. In addition, there is a need to establish or reinforce participation in the activities of the Codex Alimentarius Commission. 38. Well-structured national food safety programmes that are responsive to the present and future needs and challenges of food safety should be a high priority for all governments. Such programmes should include promotion and integration of preventive and scientific risk-based approaches to food safety systems. These include HACCP; risk analysis; strengthening of foodborne disease surveillance and analytical capabilities in food safety; ensuring effective education of food handlers, high risk population groups and professionals. Role of World Health Organization 39. WHO should continue to provide the necessary technical support and cooperation to countries by assisting them to develop and implement food safety legislation and regulations. Likewise, WHO should encourage participation in the Codex Alimentarius Commission. 40. WHO should assist in strengthening the analytical capabilities of national food safety programmes and provide support for setting up information systems for monitoring and evaluation of foodborne diseases. 41. WHO, in consultation with Member States, will prepare a regional strategy on food safety that will define actions and mechanisms to further strengthen food safety. Role of other partners 42. Partners and multilateral agencies should provide the necessary financial resources and assist countries in the promotion and development of preventive and sustainable food safety systems.
15
WHO, A Global WHO Food Safety Strategy: Exposure Draft, 2001.
AFR/RC53/12 Rev. 1 Page 7 CONCLUSION 43. To ensure the safety of food, an effective food safety structure within the national food control system is necessary. Structures and systems must be developed at the national and regional levels to meet present and emerging food safety challenges. 44. The application of sound preventive and risk-based initiatives coupled with a strong commitment to food safety will enhance and raise the profile of food safety within the Region. 45. The Regional Committee is requested to consider and adopt this document entitled “Food safety and health: Situation analysis and perspectives”.