A Guide to Food Safety Sourcebook, First Edition

By Infobase Publishing

Provides consumer health information about food safety, antimicrobial use, common foodborne pathogens and illnesses, basic food safety in the kitchen, safety by events and seasons, allergies, and intolerance. Includes index, glossary of related terms, and other resources.

• Language: English
• Publisher: Infobase Publishing
• Release date: Jul 1, 2022
• ISBN: 9780780820395

Book preview

Preface

About This Book

Foodborne illness (also called food poisoning, foodborne disease, or foodborne infection) is common, costly, and preventable. You can get food poisoning after swallowing food that has been contaminated with a variety of germs or toxic substances. The Centers for Disease Control and Prevention (CDC) estimates that every year 1 in 6 Americans (or 48 million people) get sick; 128,000 are hospitalized; and 3,000 die from foodborne diseases. The U.S. Department of Agriculture (USDA) estimates that foodborne illnesses cost the United States more than $15.6 billion each year. During a multistate foodborne disease outbreak, the CDC serves as a lead coordinator between public health partners to detect the outbreak, define its size and extent, and identify the source.

A Guide to Food Safety Sourcebook, First Edition provides information on global food safety issues, antimicrobial use, food contamination, and protecting the food supply chain from intentional adulteration, among other topics. Foodborne pathogens and illnesses such as common foodborne bacterial and viral infections, foodborne illness risk, safe drinking water, water-related diseases and contaminants in public water systems, bottled water and beverages, and safety considerations are also included. Artificial sweeteners, natural toxins in food, and home food safety and consumer responsibility are also covered, as well as allergies, intolerance, food safety, food recalls and outbreaks, and safety tips for dining out, as well as a glossary of related terms and a directory of related resources.

How to Use This Book

This book is divided into parts and chapters. Parts focus on broad areas of interest. Chapters are devoted to single topics within a part.

Part 1: Keeping Food Safe: From Farm to Table briefs about food safety, organic foods, and challenges in food safety. This part also describes food contamination, the impact of antimicrobials on our food systems, and controversies and genetically modified food. It further discusses U.S. food safety monitoring and surveillance systems.

Part 2: Common Foodborne Pathogens and Illnesses briefs about the common foodborne bacterial and viral infections and other foodborne parasite illnesses. It also explains the general principles of diagnosis and treatment for foodborne illness and helps detect, track, and control a foodborne outbreak.

Part 3: An Overview of Toxins in Food briefs about natural toxins, mycotoxins, chemicals, and dangerous levels of heavy metals in the food system. It also talks about food additives and artificial sweeteners.

Part 4: Safe Drinking Water briefs about the water-related diseases, contaminants in public water systems, and water treatment options when hiking, camping, and traveling. It further explains the safety of water used in food production and how to make water safe during an emergency.

Part 5: Home Food Safety and Consumer Responsibility briefs about basic food safety while cooking, storing food, and dining out. It elaborates on basic hygiene and the importance of sanitation in the kitchen and during emergencies. The part also talks about the date labels on packaged food, how to minimize food wastage, and the types of allergies caused by food and gives a brief about dietary supplements.

Part 6: Additional Help and Information includes a glossary of terms related to food safety and a directory of resources for additional help and support.

Bibliographic Note

This volume contains documents and excerpts from publications issued by the following U.S. government agencies: Agricultural Research Service (ARS); Centers for Disease Control and Prevention (CDC); Economic Research Service (ERS); Food Safety and Inspection Service (FSIS); Foodsafety.gov; GlobalChange.gov; MedlinePlus; National Center for Complementary and Integrative Health (NCCIH); National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); National Oceanic and Atmospheric Administration (NOAA); Office of the Director of National Intelligence (DNI); U.S. Agency for International Development (USAID); U.S. Department of Agriculture (USDA); U.S. Environmental Protection Agency (EPA); and U.S. Food and Drug Administration (FDA).

It also contains original material produced by Infobase and reviewed by medical consultants.

About the Health Reference Series

The Health Reference Series is designed to provide basic medical information for patients, families, caregivers, and the general public. Each volume provides comprehensive coverage on a particular topic. This is especially important for people who may be dealing with a newly diagnosed disease or a chronic disorder in themselves or in a family member. People looking for preventive guidance, information about disease warning signs, medical statistics, and risk factors for health problems will also find answers to their questions in the Health Reference Series. The Series, however, is not intended to serve as a tool for diagnosing illness, in prescribing treatments, or as a substitute for the physician–patient relationship. All people concerned about medical symptoms or the possibility of disease are encouraged to seek professional care from an appropriate health-care provider.

A Note about Spelling and Style

Health Reference Series editors use Stedman’s Medical Dictionary as an authority for questions related to the spelling of medical terms and The Chicago Manual of Style for questions related to grammatical structures, punctuation, and other editorial concerns. Consistent adherence is not always possible, however, because the individual volumes within the Series include many documents from a wide variety of different producers, and the editor’s primary goal is to present material from each source as accurately as is possible. This sometimes means that information in different chapters or sections may follow other guidelines and alternate spelling authorities. For example, occasionally a copyright holder may require that eponymous terms be shown in possessive forms (Crohn’s disease vs. Crohn disease) or that British spelling norms be retained (leukaemia vs. leukemia).

Medical Review

Infobase contracts with a team of qualified, senior medical professionals who serve as medical consultants for the Health Reference Series. As necessary, medical consultants review reprinted and originally written material for currency and accuracy. Citations including the phrase Reviewed (month, year) indicate material reviewed by this team. Medical consultation services are provided to the Health Reference Series editors by:

Dr. Vijayalakshmi, MBBS, DGO, MD

Dr. Senthil Selvan, MBBS, DCH, MD

Dr. K. Sivanandham, MBBS, DCH, MS (Research), PhD

Health Reference Series Update Policy

The inaugural book in the Health Reference Series was the first edition of Cancer Sourcebook published in 1989. Since then, the Series has been enthusiastically received by librarians and in the medical community. In order to maintain the standard of providing high-quality health information for the layperson the editorial staff felt it was necessary to implement a policy of updating volumes when warranted.

Medical researchers have been making tremendous strides, and it is the purpose of the Health Reference Series to stay current with the most recent advances. Each decision to update a volume is made on an individual basis. Some of the considerations include how much new information is available and the feedback we receive from people who use the books. If there is a topic you would like to see added to the update list, or an area of medical concern you feel has not been adequately addressed, please write to: [e-mail].

Part 1 | Keeping Food Safe: From Farm to Table

Chapter 1 | Food Safety, a Global Problem

Chapter Contents

Section 1.1—Why Is Food Safety a Public Health Priority?

Section 1.2—How Are Food Safety and Nutrition Connected?

Section 1.3—Linking Food Safety to Economic and Social Outcomes

Section 1.4—Globalization of Food Systems: Impact on Food Safety

Section 1.1 | Why Is Food Safety a Public Health Priority?

This section contains text excerpted from the following sources: Text in this section begins with excerpts from Remarks on World Food Safety Day: Food Safety Is Everyone’s Business, U.S. Food and Drug Administration (FDA), June 7, 2019; Text under the heading The Critical Role of Food Safety in Ensuring Food Security is excerpted from The Integral Role of Food Safety in Strengthening Food Systems, Feed the Future, U.S. Agency for International Development (USAID), May 26, 2021.

When it comes to food safety, we all win or lose together. In a global food system and with the increase in international travel, if foodborne disease exists somewhere in the world, it can exist anywhere in the world. No nation stands alone when faced with the challenge of protecting its citizens from foodborne illnesses.

Food safety is an issue that transcends international borders. Foodborne pathogens do not recognize boundaries or borders. It is estimated that foodborne illnesses are responsible for 420,000 deaths annually around the world, of which 125,000 were children under age five. Think about that. It is not just a sad statistic—it is a public health concern that needs an action plan. It is almost twice the estimated deaths in the earthquake that hit Haiti in 2010. It is roughly 229 times the number of people who died when Hurricane Katrina hit our Gulf Coast in 2005. In the United States alone, the Centers for Disease Control and Prevention (CDC) estimates that 3,000 people die each year from foodborne illnesses.

Taking a world view of food safety is important for all consumers because food moves globally, as do we. In the United States, about 15 percent of the food supply is imported from more than 200 countries or territories, including 32 percent of the fresh vegetables, 55 percent of the fresh fruit, and at least 94 percent of the seafood that Americans eat each year. And these statistics are not unique to the U.S.—similar patterns are seen around the world, and the global movement of foods continues to grow.

To protect the food supply, nations use a variety of tools. Rules, response, and compliance activities are common, and critical, tools for food policymakers and regulators. But nations must go beyond merely having rules and regulations. They must also foster, support, and strengthen food safety cultures on our farms, in our food facilities, and in our homes. We will not make dramatic improvements in reducing the global burden of foodborne disease without strengthening a culture of food safety and doing more to influence and change human behavior. In fact, simply put, food safety equals behavior.

What is a food safety culture? It is the patterned ways of thought and behavior that characterize a social group, whether it be a farm, a company, a geographic region, or a nation. Those patterned ways of thought and behavior can be learned through socialization processes and persist through time. A food safety culture is a prerequisite to an effective food safety management system.

The Critical Role of Food Safety in Ensuring Food Security

Food safety plays a foundational role in achieving food security. Improper food safety practices cause negative health and economic consequences, including foodborne diseases, which are illnesses resulting from consumption of contaminated or naturally harmful foods or beverages. The first global study of foodborne disease by the World Health Organization’s (WHO) Foodborne Disease Burden Epidemiology Reference Group (FERG) examined 31 foodborne hazards and found that they were responsible for 600 million episodes of foodborne illness and approximately 420,000 deaths in 2010. This amounts to a global burden of 33 million disability-adjusted life years (DALYs), in the same order of magnitude as human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), malaria, or tuberculosis. Up to 29 percent of diarrheal diseases are caused by unsafe food, leading to 200,000 deaths per year in children under five years of age. Unsafe food also has significant economic consequences, via reduced productivity and income, due to the time and cost associated with treating foodborne diseases. The World Bank estimates that the total productivity loss associated with foodborne disease in low- and middle-income countries (LMICs) amounts to $95.2 billion and that the cost of treatment constitutes an additional $15 billion.

The WHO Estimates of the Global Burden of Foodborne Diseases revealed that the majority of years lost to illness or premature death from foodborne disease cases were caused by biological hazards, such as bacterial and viral pathogens, and should be prioritized when designing food safety programming. The analysis also revealed that chemicals and toxins, including aflatoxin, make up a smaller fraction of years lost to illness or premature death than biological hazards with the highest prevalence of aflatoxins in Sub-Saharan Africa.

Furthermore, the coronavirus disease of 2019 (COVID-19) has exacerbated inequalities in food security, highlighting the importance of food safety in providing nutritious diets and promoting public health for the world’s most vulnerable populations. Supply chain disruptions, reduced regulatory services, and lack of access to fresh food markets caused global food prices to rise almost 20 percent over the past year, hitting the most vulnerable the hardest. Fresh food markets serve an essential function by providing nutritious diets that include fruits, vegetables, and animal-source foods (ASF) to vulnerable populations. In fact, rural African and Asian consumers now purchase up to 70 percent of food from markets. While access to fresh food markets is essential, the nutrient-dense foods they offer are often at the highest risk for contamination. Improper food safety practices and handling of ASF in fresh food markets may increase the risk of a zoonotic disease outbreak. Zoonotic diseases, which are diseases that result from animal–human interactions, cause 2.7 million deaths per year globally. Animals, including wildlife and livestock, are capable of spreading zoonotic diseases both premortem and via their food products. Access to and safety of fresh food markets are critical to health and nutrition.

Section 1.2 | How Are Food Safety and Nutrition Connected?

This section includes text excerpted from Integrating Food Safety and Nutrition for Improved Health and Wellbeing: A New Lens on Food System Frameworks, Feed the Future, U.S. Agency for International Development (USAID), December 2020.

Food safety and nutrition are inextricably linked. To achieve optimal human health and well-being, people must be both well-­nourished and free from foodborne disease—which requires that they have access to diverse foods, both staple foods and nutrient-dense nonstaples, that are safe to eat. Despite these linkages, the connections between food safety and nutrition have been largely lacking from existing frameworks for nutrition or food safety and those for the food system overall. Bringing a food safety and nutrition perspective to view existing frameworks is motivated by the central idea that food safety and nutrition are interlinked, with causal pathways running in both directions. Food safety issues influence nutrition, and nutrition issues influence food safety, both in terms of processes and outcomes. Both interact in determining health outcomes, as well as impacting livelihoods and other aspects of society.

The bidirectional impact mechanisms between food safety and nutrition can be categorized into four types such as health and physiology, consumers, supply chains and markets, and policy and regulation.

Health and Physiology

The most obvious linkages between food safety and nutrition are physiological ones—which exist in addition to numerous other negative physiological and health consequences of foodborne disease (both chronic and acute). Eating unsafe food can lead to disease, which can be defined as adverse health impacts caused by an external agent (usually excluding injuries caused by physical agents such as glass or metal fragments). Foodborne diseases can be caused by microbial, chemical, or radiological hazards. While several foodborne diseases do not affect nutrient intake or metabolism (e.g., ocular toxoplasmosis), many others do. Specifically:

Many foodborne diseases involve acute gastrointestinal distress, including reduced appetite, vomiting, and/or diarrhea. Diarrhea and other acute gastrointestinal disease mechanisms can lead to decreased nutrient absorption, either acute or chronic.

For foodborne as well as for other infections, during or following acute illness, the organism may have increased nutrient needs to recover.

Foodborne exposure to some hazards can impair metabolic processes (acute or chronic) needed for the organism to properly utilize nutrients.

Disease and subclinical chronic exposure to microbes may also disrupt the gut health and gut microbiome composition, with potential implications for longer-term nutrient absorption and use, as well as disruption of nutrient production by the gut microbial community.

Pharmaceuticals used to treat foodborne infections may decrease appetite and disrupt the gut microbiome; they could also adversely impact nutrient intake, absorption, or metabolism.

In all these cases, the main impact on nutrition would be to increase the risk of undernutrition; temporary decreases in nutrient intake/absorption due to acute illness could temporarily reduce overweight/obesity but would likely have little long-term impact. Framed more positively, improved food safety can lead to improved absorption of nutrients and improve overall health.

In addition to the impact of foodborne disease on nutrient intake or absorption, foodborne diseases and malnutrition can both contribute to longer-term developmental outcomes. For example, some foodborne toxins (e.g., aflatoxins) may directly harm growth, though this is disputed, and certain diseases (e.g., listeriosis, toxoplasmosis) during pregnancy may impair fetal growth and result in reduced birth weight.

At the same time, nutrition also has physiological impacts on foodborne disease burden: with optimal nutrition in the longer term, overall resilience to diseases (likely including foodborne infectious diseases) is enhanced, including via microbiome processes and gut health, which impact the immune system. Hence, improving nutrition could be important in reducing foodborne disease.

Consumer Behavior

Food safety and nutrition are also linked through consumer behavior. Unlike health and physiology, consumer behavior is malleable: it is shaped, dominated, and modifiable by consumers’ and supply chain actors’ own perceptions. Consumers are regularly trading off concerns like safety with other characteristics, such as affordability, tradition, and convenience; these trade-offs vary in the short and long term and may depend on other constraints.

The most obvious pathway within this category is that fear of food being potentially unsafe can lead to the avoidance of nutritious food; this is particularly relevant because some of the most nutritious foods are also those that pose the greatest food safety risk (e.g., animal source foods, fresh vegetables). This effect could be particularly important for groups at high risk of malnutrition, such as pregnant women and young children, who may be particularly vulnerable to foodborne disease (and, if aware of that fact, averse to taking such risks). Food fears can arise either directly, through illness of oneself or a personal contact, or through media coverage of foodborne disease outbreaks. The negative association with getting sick from food could also lead to a longtime aversion to that specific food, particularly if an exposure or event happened during a formative period for food preferences, such as childhood or adolescence. This is more likely to operate for acute illness, as the effects of chronic illness are not as perceivable to consumers (unless clearly communicated to them by a trusted source). This aversion can be weakened as it is difficult to associate a disease with its source, as traceability systems may be weak or nonexistent, particularly in informal settings. It can also be weakened by a lack of purchasing power: poor consumers may be less able to afford to change their diets and food sources, weakening the extent to which food safety can influence their decisions. Avoidance of particular foods can lead to substitution with less nutritious ones.

Nutrition may also impact food safety issues through consumer behavior. Better-nourished, healthier consumers are likely to have more physical and mental energy to spend in food procurement and preparation. As a result, they may be better able to make ­optimal choices regarding food safety. They may also be more economically productive and thus face fewer constraints to purchasing safer foods. Over the long term, better nutrition in early life is associated with higher cognitive levels and educational attainment; this may lead to better informed, more literate consumers, with the income and the ability to recognize and demand safer foods. These nutrition to food safety pathways relate to both acute and chronic illness but maybe more important in the case of chronic illness or where acute illness is particularly frequent.

Supply Chains and Markets

Food safety and nutrition may also impact one another through dynamics within the supply chain and within markets. For example:

If consumers demand that the safety of a food commodity is improved, market vendors may respond to this demand, either by improving the safety of a commodity at the retail stage (i.e., with actions under their control) or by sourcing safer products.

If this demand for safer foods were communicated to producers and processors, in a sustained way over time, the supply chain may have incentives to increasingly invest in these foods products, including in their safety. It may be important to distinguish the demand for increased safety of a food (i.e., a feature of a product) from increased demand for a food that is already perceived as fairly safe (i.e., a product). In either case, increased supply chain investments may lead to greater availability, accessibility, quality, or affordability of the food product. The reverse would be true if fears of a food being less safe led to less demand or investment.

Vendors may choose to sell the foods that they perceive as posing a lower food safety risk, without considering its nutrition value, to avoid the reputational or legal harm that could result from an adverse food safety event, such as a foodborne illness outbreak or recall of unsafe food. Over time, this could reduce the overall availability of highly nutritious foods for consumers. As these less-risky foods are likely to include shelf-stable staples and highly processed foods, this could also lead to their increased availability, accessibility, quality, or affordability. That could, in turn, increase consumption, with potentially negative effects on nutrition. For this pathway to operate, there would need to be at least a minimum awareness of relative food safety risks among vendors and either awareness among consumers or adequate regulation and enforcement. This mechanism is more likely to operate with foods causing acute illness, as that can be more clearly connected with a given food type or source than chronic illness. This dynamic may also play out in the short term following food safety scares or detected foodborne illness outbreaks when either consumers may reduce their demand for the product involved in the outbreak or vendors may choose to temporarily discontinue the product. This mechanism can be weakened by the fact that it can be difficult to associate disease with its source.

Upgrades to community market infrastructure and efforts to improve environmental health (e.g., installing improved water, sanitation, and hygiene (WASH) facilities in markets) can positively impact both food safety and nutrition.

Food safety concerns may also impact supply chain actions with implications for nutrition. Some potential mechanisms include:

Storage and handling practices within a value chain, aimed to improve safety, could affect nutrient levels—positively or negatively.

Vendors of ready-to-eat foods and processors may process or prepare foods (e.g., deep frying, salting) in ways that may be safer, but adversely affect nutritional content; on the other hand, other processes that are beneficial for food safety (e.g., fermentation) may have positive effects on nutrition.

Food safety measures in the supply chain may increase prices, perhaps leading to reduced consumption of certain foods. Where the foods affected are highly nutritious, this would lead to an adverse effect on nutrition; where they are less nutritious, higher prices leading to lower consumption could have a positive impact on nutrition. In contrast, some food safety measures could be low-cost, or even lead to reduced costs in the long term (due to greater production efficiency or less waste), leading to lower prices and incentivizing greater consumption.

Nutritious foods known to be contaminated could be diverted to markets serving poorer consumers, making those foods more accessible and affordable to them—but also less safe.

Wider supply-and-demand dynamics could have price or availability affects: for example, increased demand for foods that are seen as safer could increase short-term prices (or decrease availability), affecting what consumers (particularly lower-income ones) can purchase; in the long run, however, the market would likely respond—perhaps even being able to offer such foods for lower prices, due to greater efficiencies of scale in production of larger volumes of foods under higher safety standards.

Considering linkages in the other direction:

As mentioned above, increased demand for nutritious foods could incentivize supply chain actors to improve food safety (and vice versa for reduced demand). While in the short-term increased consumption of high-risk nutritious foods could lead to an increase in (primarily acute) foodborne disease burden and avoidance of certain foods, over time foodborne illnesses and outbreaks (primarily acute ones) may trigger increased awareness and demand for food safety, leading to longer-term and more widespread food safety controls.

However, if increased demand for nutritious but more risky foods is not accompanied by improved food safety, this could increase the foodborne disease burden. If this burden is not reported or attributed (e.g., due to the limited capacity of a surveillance system or due to the chronic nature of the foodborne disease in question hindering attribution), demand for food safety and resulting interventions are unlikely to be triggered.

Food processing aimed at improving nutrition (e.g., fortification) could, if done poorly, have negative implications for the safety of the food in question; however, such processing for nutritional goals could offer an easy in-road to improve food safety at the same time (e.g., through the installation of improved equipment and upgrading of processes).

Finally, as with consumers, the health and nutrition of supply chain actors influences their energy and (in the long term) cognitive capacity/education, perhaps affecting their ability to adopt improved practices related to food safety. This is likely to be more important in the case of chronic illness or where acute illness is particularly frequent.

Policy, Regulation, and Incentives

At the higher level of policy and regulation, there are numerous potential linkages between food safety and nutrition. Some policy and regulation impact mechanisms include:

Safety-driven market recalls and diversion of food products (e.g., condemnation of products or culls of live animals) could lead to food loss and waste as well as increased price and decreased access to the foods in question. These potential impact mechanisms are more likely to apply to formal food systems and the suppliers within them. Also, in many cases, diverted product can be reprocessed to be made safe (e.g., sold cooked instead of raw) instead of destroyed thus limiting losses. Recalls and market diversions may also affect the livelihoods of those whose product is rejected, with implications for their own and their families food security and nutrition.

In contrast, food safety certifications that allow producers and vendors to sell certified safe products at a premium, or to access export markets, could improve livelihoods, with positive nutrition implications for producers and vendors.

Strict food safety standards could also lead to reduced supply of the foods in question if producers decide to produce less of those products or switch to products that pose lower regulatory or financial hurdles (assuming such a switch is feasible and economically beneficial). Context-appropriate and achievable standards could, in contrast, incentivize greater supply of nutritious foods.

Consumers trust in food safety regulations, enforcement, and vendors’ compliance could make them more willing to consume foods that were previously considered at higher risk, likely leading to improved dietary quality. This is more likely to operate in a more formal and upper-middle-income country contexts, where national food safety systems are more developed and trust in them is higher.

Processing, storage, or preparation guidelines put in place for food safety reasons may also alter nutrient content for the better or worse.

Beyond regulations and policies, appropriate educational and economic tools and incentives can also serve to improve food safety, leading to an increase in supply of nutritious foods.

Considering linkages from nutrition to food safety, nutrition-­related policies and programs that take food safety into account could increase demand for safer food, improving incentives for supply chains to provide it (and regulators to enforce appropriate safety standards). Certain nutrition-related policies could have negative impacts on food safety. For example, increasing the demand for a food (or a way of consuming a food, e.g., raw vegetables) that is currently at the high-risk could increase the burden of foodborne diseases in a population, unless appropriate food safety measures are also put in place at the production and retail levels. In addition, mandated or voluntary nutrition labeling or certain types of marketing may be misinterpreted by consumers to imply safer food when it in fact only relates to nutrient content and provides no information on foodborne hazards; this could lead to effects on the behavior of supply-chain actors and consumers (e.g., less careful cleaning and processing).

Section 1.3 | Linking Food Safety to Economic and Social Outcomes

This section contains text excerpted from the following sources: Text in this section begins with excerpts from Consumer-Facing Interventions to Improve Food Safety Perceptions and Practices in Low- and Middle-Income Countries: A Review, U.S. Agency for International Development (USAID), September 2020; Text beginning with the heading Linking Food Safety across Sectors is excerpted from The Integral Role of Food Safety in Strengthening Food Systems, U.S. Agency for International Development (USAID), May 26, 2021.

Food safety generally refers to the control of adverse human health effects from consuming foods containing hazards, such as pathogens in the food supply, harmful chemical compounds (e.g., ­pesticides), extraneous objects that can cause injuries (e.g., plastics or glass pieces), or radioactive elements that have the potential to cause acute or long-term adverse health outcomes. In addition to the global public health burden, the socioeconomic burden caused by these diseases is also significant, especially in low- and middle-­income countries (LMICs). The World Bank estimates that these countries lose approximately $110 billion in productivity and medical expenses each year. This translates to reduced productivity and inability to care for self and family, which can perpetuate cycles of poverty in individuals and families. Broader societal effects also include impacts on national economies, trade, tourism, and sustainable development.

Linking Food Safety across Sectors

Beyond food safety’s economic, health, and food security impacts, it also impacts core development outcomes of other sectors and issues, including:

Nutrition. Increased consumption of fruits, vegetables, and animal-source foods (ASF) is often associated with increased food safety risks. For example, ASF including meats, fish, shellfish, dairy products, and eggs provides an excellent source of protein and micronutrients including iron, zinc, vitamin A, vitamin B12, and calcium. However, they are easily contaminated by biological contaminants. Food safety interventions should be applied to fresh food markets to help ensure that nutritious ASF and fresh fruits and vegetable products are available to vulnerable populations year-round.

Agricultural-led economic growth. Improving food safety practices can help reduce food loss and waste, therefore improving the economic potential of food producers, handlers, and processors. It is estimated that food losses result in $4 billion loss annually in sub-Saharan Africa alone. In Africa, food loss primarily occurs between harvest and the point of sale. Improving cold-chain logistics, storage facilities, and food processing ability can improve food safety and reduce food loss, improving agricultural-led economic growth.

Water, sanitation, and hygiene (WASH). Water consumed by livestock or used to irrigate crops may contain sewage, pathogens, toxins, or heavy metals. Access to clean water for production, food processing, and preparation plays an important role in ensuring food safety and preventing foodborne disease. Furthermore, poor personal hygiene accounts for roughly 97 percent of foodborne illnesses in food service establishments and homes globally. Interventions, such as handwashing before and after food handling and preparation, can help reduce the burden of foodborne illnesses caused by poor hygiene practices.

Trade. An overall improvement in local or domestic food safety management systems can result in improved regional trade flows of safe, nutritious food and stimulate economic growth. Interventions that improve agricultural production at a domestic level can lead to spillover effects that allow a country to meet sanitary and phytosanitary (SPS) standards and further engage in international trade.

Resilience. Food safety is an important consideration in resilience programming since mass contamination of food products can lead to foodborne disease outbreaks with prolonged negative nutrition, health, and economic consequences. Food safety concerns, such as avian influenza, Rift Valley fever, and melamine contamination, have been shown to adversely affect the livelihoods of smallholder farmers and pastoralists. Interventions that strengthen country capacity and commitment to monitor and manage food safety risks minimize the threat of foodborne disease.

Gender. Women tend to suffer more negatively than men from the impacts of foodborne illnesses, and pregnant and lactating women are especially vulnerable. In addition, some foodborne diseases cause fetal abnormalities, miscarriage, and stillbirths, and some chemical and biological hazards can be transmitted to newborns through breast milk. Furthermore, women are often key risk managers when it comes to food consumption, preparation, processing, selling, and, to a lesser extent, production. However, women are often disadvantaged by less access to resources, support, and services, such as education and extension. Because of these links, gender analysis is important in assessing and designing interventions to improve food environments by enhancing food safety.

One Health and antimicrobial resistance (AMR). A proactive food safety approach is an important part of a One Health approach to control the spread of disease and the emergence of pandemics. One Health is a collaborative, transdisciplinary approach that recognizes the interdependence among the health of the environment, wild and domestic animals, and humans to achieve resilient and sustainable outcomes across complex systems from local to global levels. Interventions should prioritize promoting these nutrient-dense products while adopting proper food safety practices to minimize the risk of zoonotic disease spread. A growing food safety concern that also affects public health is AMR. While antimicrobials are crucial to treat disease and maintain herd health in both livestock and aquaculture, they must be used judiciously and correctly within the sector to prevent selection and dissemination of AMR organisms to humans via food. Key strategies to mitigate the risks of AMR are as follows: i) reduction in the use of antimicrobials, ii) judicious use of antibiotics to treat clinical disease using the recommended dosage and regimen, and iii) integrated surveillance systems for AMR.

Food Safety: Alignment with Global Commitments

Unsafe food threatens public health and nutrition and undermines food security at local, regional, and global levels. Food safety policies are needed to meet global commitments like the United Nations Sustainable Development Goals (SDGs). Reducing biological and chemical hazards in foods is an essential step to achieve a well-nourished population.

Consumption of unsafe food impedes progress toward achieving several of the SDGs, including:

SDG 1—No poverty. Foodborne diseases are a major cause of ill health among the poor and are associated with lost workdays, out-of-pocket expenses, and reduced value of livestock and other assets. Unsafe food hazards can cause acute or chronic illnesses that, in extreme cases, lead to permanent disability or death. The presence of food safety hazards can lead to food loss, thus inhibiting economic opportunities, including trade.

SDG 2—Zero hunger. Unsafe foods have multiple complex interactions with nutrition. For example, unsafe food reduces the uptake of nutrients, particularly for vulnerable consumers, and is associated with malnutrition.

SDG 3—Good health and well-being. Foodborne diseases negatively impact the most vulnerable populations. Up to 29 percent of diarrheal diseases are caused by unsafe food, leading to 200,000 deaths in children under five years of age. Pregnant women and the elderly are other vulnerable groups.

SDG 12—Responsible Consumption and Production. When countries strengthen their regulatory, scientific, and technological capacities to ensure that food is safe and of the expected quality, they move toward more sustainable patterns of food production and consumption.

Section 1.4 | Globalization of Food Systems: Impact on Food Safety

This section includes text excerpted from Global Food Security, Office of the Director of National Intelligence (DNI), September 22, 2015. Reviewed May 2022.

As the world faces significant food security problems, food safety is likely to gain even more prominence as a global issue through 2025 and require increased collaboration among nations. The continued globalization and diversification of the food market and greater public demand for health protection will increase the global focus on food safety. Major food exporters will most likely adopt more stringent food safety standards to remain competitive in global markets. Stricter international food safety regulations, however, will inhibit the ability of small-scale producers to penetrate international markets. Such restrictions will probably ultimately contribute to higher food prices because of the added costs of meeting the regulations. Food safety scandals might cause international tensions, boycotts, and political and structural changes.

Highly publicized food scandals have shifted the global emphasis beyond the price and basic quality of food to food safety and animal health concerns. As emerging countries play a larger role in expanding world agricultural trade, these countries will be pressed to improve their food-safety programs.

The proposed tightening of food-safety regulations will probably generate controversy as food producers seek to meet growing demands, and policymakers in developing countries struggle to balance food safety modernization with preserving traditional activities.

The globalization of the food market, which increases the exportation and importation of food products among countries, poses new food safety risks from emerging diseases, reintroduces previously controlled risks, and may foster the spread of contaminated food across wider geographical areas. Food contamination incidents will almost certainly be more difficult to prevent in the coming years, even with significant improvements to national food safety regulations. The greatest challenge arising from food contamination is that the use of unconventional contaminants could go undetected until populations report significant adverse health effects.

Consumer-ready foods (seafood, fresh fruits and vegetables, and processed foods), particularly those originating from low- to middle-income countries (LMICs), are the foods most likely to be contaminated. The dietary preferences of growing middle classes in developing countries increase the demand for fresh products; such demand is predominantly being met by countries with underdeveloped food safety programs. Food contamination with microbial pathogens is still one of the greatest food safety risks causing human diseases, although other contaminants, such as veterinary drugs and pesticide residues, are gaining more global attention.

Seafood is likely to be the source of a major contamination incident in future years, given that aquaculture (farm fishing) is the fastest-growing sector of the global food production industry and that aquaculture farms are not uniformly regulated. Common aquaculture practices result in food contamination caused by excessive antibiotics and pesticides and other chemicals that are used to prevent the fish from getting diseases and parasites.

It is predicted that growing food demand will perpetuate and possibly increase the economically motivated adulteration (EMA) of food products. Intentional food contamination incidents motivated by economic gain will be a rising threat and could spread food safety fears more broadly than accidental contamination or terrorist threats to the food supply. The increasing global demand for certain food products, particularly processed foods, will most likely result in the illegal adulteration of food items by profit-seeking individuals.

Although EMA aims to inflate profits through fraudulent means—rather than harm people—it is anticipated that serious public health consequences will result from EMA and that the incidence of EMA of food products is likely to increase.

Difficulties in testing food for safety will increase with the new and emerging contaminants posed by EMA and other threats. The food safety testing market is dominated by pathogen testing due to the high prevalence of pathogens in food contamination, with meat and poultry accounting for the major share in food testing by type. Experts say that, because of time and resource constraints, the traditional regulatory practices and existing detection methods for food contaminants will not be feasible to test for all potential contaminants that could make their way into food sources.

Chapter 2 | How Food Gets Contaminated

Chapter Contents

Section 2.1—The Food Production Chain

Section 2.2—Origin and Nature of Food Risks

Section 2.1 | The Food Production Chain

This section includes text excerpted from How Food Gets Contaminated—the Food Production Chain, Centers for Disease Control and Prevention (CDC), September 5, 2017. Reviewed May 2022.

It takes several steps to get food from the farm or fishery to the dining table. We call these steps the food production chain (see Figure 2.1). Contamination can occur at any point along the chain—during production, processing, distribution, or preparation.

Production

Production means growing the plants we harvest or raising the animals we use for food. Most food comes from domesticated animals and plants, and their production occurs on farms or ranches. Some foods are caught or harvested from the wild, such as some fish, mushrooms, and game.

Examples of Contamination in Production

If a hen’s reproductive organs are infected, the yolk of an egg can be contaminated in the hen before it is even laid.

If the fields are sprayed with contaminated water for irrigation, fruits and vegetables can be contaminated before harvest.

Fish in some tropical reefs may acquire a toxin from the smaller sea creatures they eat.

Processing

Processing means changing plants or animals into what we recognize and buy as food. Processing involves different steps for different kinds of foods. For produce, processing can be as simple as washing and sorting, or it can involve trimming, slicing, or shredding. Milk is usually processed by pasteurizing it; sometimes, it is made into cheese. Nuts may be roasted, chopped, or ground (such as with peanut butter). For animals, the first step of processing is slaughter. Meat and poultry may then be cut into pieces or ground.

Figure 2.1. Food Production Chain

They may also be smoked, cooked, or frozen and may be combined with other ingredients to make a sausage or entrée, such as a potpie.

Examples of Contamination in Processing

If contaminated water or ice is used to wash, pack, or chill fruits or vegetables, the contamination can spread to those items.

During the slaughter process, germs on an animal’s hide that came from the intestines can get into the final meat product.

If germs contaminate surfaces used for food processing, such as a processing line or storage bins, germs can spread to foods that touch those surfaces.

Distribution

Distribution means getting food from the farm or processing plant to the consumer or a food service facility like a restaurant, cafeteria, or hospital kitchen. This step might involve transporting foods just once, such as trucking produce from a farm to the local