Comments came during a symposium organised by WHO and the Dutch National Institute for Public Health and the Environment (RIVM) in Amsterdam (see part 1 of our coverage here).
Awilo Ochieng-Pernet, chairperson of the Codex Alimentarius Commission, called for urgent action and suggested creating a World Food Safety day following the theme of World Health Day this year being food safety.
“The data is robust proof to prompt authorities and stakeholders to prevent foodborne diseases. It is a critical time as food safety has increased attention, there are incidents with fatal consequences all over the world. Foodborne diseases are preventable we should take more action.”
Markus Lipp, from the Food and Agriculture Organization (FAO) of the UN, told attendees if it is not safe it is not food.
He added that if people come out of poverty food safety will improve and individual stakeholders need to change behaviours.
Country approach
Rob Lake, from the Institute of Environmental Science and Research (ESR), New Zealand, presented the work of the Country Studies task force with data on Albania, Uganda, Thailand and Japan.
Frederick Angulo, from the US Centers for Disease Control and Prevention (CDC), said it was not just an academic exercise but the estimates should be used to influence policy as burden would not decline without interventions.
Angulo identified three immediate actions, one being vaccines for norovirus and non-typhoidal Salmonella (NTS) that could prevent 13% of all foodborne diseases.
The other steps were putting in place known control measures in areas such as water and sanitation and the third was developing novel control measures.
Certain diseases, such as those caused by non-typhoidal Salmonella, are of concern in high- and low-income countries.
Others, such as typhoid fever, foodborne cholera, and those caused by pathogenic E. coli, are more common to low-income countries, while Campylobacter is an important pathogen in high-income countries.
WHO African and South-East Asia Regions have the highest incidence and highest death rates, including among children under the age of five.
Risk of foodborne diseases is most severe in low- and middle-income countries, linked to preparing food with unsafe water; poor hygiene and inadequate conditions in food production and storage; lower levels of literacy and education; and insufficient food safety legislation or implementation of such legislation.
Estimates come from work started in 2007 by the Foodborne Epidemiology Research Group (FERG).
The second day of the event included country testimonials from Karen Keddy talking about South Africa, Yuko Kumagai of Japan, Gijs Theunissen from the Netherlands, Lisa Indar from Trinidad and Tobago and Mohammed Rokni of Iran.
Region burden estimates
The WHO African Region was estimated to have the highest burden of foodborne diseases per population. More than 91 million people fall ill and 137,000 die each year.
The South-East Asia Region has the second highest burden per population with more than 150 million cases and 175,000 deaths a year.
The Eastern Mediterranean Region has the third highest estimated burden as an estimated 37,000 people die each year from unsafe food.
Every year, 125 million people in the Western Pacific Region become ill from contaminated food, causing more than 50,000 deaths.
The Region of the Americas is estimated to have the second lowest burden of foodborne diseases globally with 77 million people falling ill every year with an estimated 9000 deaths annually.
The European Region has the lowest, more than 23 million people ill from unsafe food every year, resulting in 5,000 deaths.
Arie Havelaar, chair of FERG, said foodborne diseases are complex with numerous hazards, health outcomes with the effects on different timescales, limited data availability and food not being the only transmission pathway for many hazards.
“Data availability and quality was a problem in low income countries, many countries lack of data made the presentation at a regional level rather than a country level. There was imputation and expert knowledge used to fill some gaps,” he said.
“[Underestimation factors are] the limited number of hazards, not all relevant endpoints were included such as malnutrition and stunting, public health metrics do not quantify full societal impact of foodborne diseases, the economic burden and indirect transmission of disease agents from food production systems.
“Differences in burden between regions suggests foodborne diseases are preventable by available methods. For effective food safety we must change from reactive, repressive systems to preventative risk-based systems and have effective surveillance at country, regional and global level.”