The rapid transformation of food systems is creating unintentional infectious disease risks that will need to be addressed through effective coordination between agricultural and public health sectors, a new review study says.
A food system includes all the aspects of feeding and nourishing people: growing, harvesting, packaging, processing, transporting, marketing and consuming food.
The review, published in Lancet Planetary Health (Sept 2022), explored how intensification of agricultural production and increasing complexity of food supply chains, particularly in low-income and middle-income countries, change the risks and relative burdens of infectious diseases.
The review covered four case studies:
vector-borne disease in irrigated agriculture;
zoonotic diseases in livestock value chains;
food safety; and
antimicrobial resistance associated with food systems.
For each case study, the authors asked three questions:
What aspects of food system transition are creating unintentional infectious disease risks?
What solutions might exist for these problems?
How would they require better coordination of agricultural and public health policy and practice?
Food systems in transition are characterized by intensification and diversification of food production, as an increasingly urban and more wealthy population demands different diets.
The review showed that successfully addressing the challenges of evolving food systems calls for constructive dialogue between agricultural and public health sectors.
Such a cross-sectoral approach recognises the costs and benefits of disease-reducing interventions and seeks win–win solutions that are most likely to attract broad policy support and uptake by food systems.
For areas such as antimicrobial resistance, it is important to identify the potential agricultural and health outcomes of agricultural interventions to reduce health risks.
Effective communication and constructive dialogue on inclusive ways forward between policy-makers and informal milk vendors can help to bridge the gap between policy and reality in Kenya’s informal milk sector, according to a new research study published in Development Policy Review (May 2022).
Around 80% of milk in Kenya is sold informally, providing livelihoods and contributing to the food security and nutrition of low-income consumers. Government policy, however, is focused on formalization—primarily through licensing and pasteurization—with enforcement via fines, confiscation of milk or closing the premises of informal actors.
The study, which was carried out by researchers from the International Institute for Environment and Development (IIED) and the International Livestock Research Institute (ILRI), sought to better understand if, and why, Kenya’s informal milk sector and regulatory system are disconnected from one another and how the policy–reality gap might be better bridged.
To understand the nature and performance of Kenya’s informal milk markets and their governance, the authors used surveys with informal market players and key informant interviews. Fieldwork was carried out in Nairobi in late 2018.
The study found that milk safety and quality matters to all actors in informal milk value chains. The trust-based system used is effective in moderating behaviour and assessing and prioritizing quality and safety.
However, government policy was found not to accomplish the stated goal of formalization, with low levels of licensing among informal actors. Pasteurization was not rewarded in the market and there was some evidence of sub-optimal pasteurization processes being undertaken to satisfy regulators.
These findings point to a gap between the reality of Kenya’s informal milk sector and its policy and regulatory system.
This gap is seen in the form of adversarial relationships between regulators and informal actors, and unnecessary transaction costs, missing opportunities for enhancing livelihoods, food safety, and food security.
The authors of the study therefore recommend that new approaches build on and consider existing approaches taken by actors in informal food markets to ensure food safety and quality.
The Tokyo Nutrition for Growth Summit 2021 takes place on 7–8 December 2021. The summit comes at a critical time, midway through the United Nations Decade of Action on Nutrition, with only five years left to achieve the World Health Assembly targets on maternal, infant and young child nutrition, and 10 years to reach the Sustainable Development Goals.
Ahead of the summit, on 2 December 2021, the International Institute for Environment and Development (IIED) and the International Livestock Research Institute (ILRI) hosted a side event on the role of informal markets within future food systems.
The purpose of the side event was to derive a set of principles to help national policymakers develop risk-based policies that reward positive food safety as opposed to criminalization and marginalization. Such policies will improve the governance, operations and future of informal markets to ensure their continued contribution to livelihoods, health and nutrition.
A panel discussion featured the following speakers:
Delia Grace, professor of food safety systems, Natural Resources Institute, University of Greenwich and joint appointed scientist, ILRI
Jane Battersby, senior lecturer, Department of Environmental and Geographical Science, University of Cape Town
Vivian Maduekeh, managing principal, Food Health Systems Advisory
Emma Blackmore, research associate, IIED
Stella Nordhagen, senior technical specialist, Global Alliance for Improved Nutrition
Utpal Kumar Sharma, director, Dairy Development Department, Government of Assam, India
The health impacts of climate change are getting worse, exposing communities around the world to greater risks of food and water insecurity, heatwaves and the spread of infectious diseases, according to a new report by the Lancet Countdown.
The Lancet Countdown is an international, multidisciplinary collaboration of leading researchers from 43 academic institutions and United Nations agencies that independently monitors the health consequences of a changing climate and publishes its findings in an annual report.
climate change impacts, exposures and vulnerability;
adaptation planning and resilience for health;
mitigation actions and health co-benefits;
economics and finance; and
public and political engagement.
The report notes that key trends are getting worse across every indicator, affecting people in all corners of the world.
For example, the potential for outbreaks of dengue, chikungunya and Zika is increasing most rapidly in countries with a very high human development index, including European countries.
Suitability for malaria infections is increasing in cooler highland areas of countries with a low human development index.
Coasts around northern Europe and the United States of America are becoming more conducive to bacteria which produce gastroenteritis, severe wound infections and sepsis. In resource-limited countries, the same dynamic is putting decades of progress towards controlling or eliminating these diseases at risk.
The report also notes that there are 569.6 million people living less than five metres above current sea levels, who could face rising risks of increased flooding, more intense storms, and soil and water salinification. Many of these people could be forced to permanently leave these areas and migrate further inland.
In light of these and other growing climate-related risks, the authors of the report call for urgent, globally coordinated action to mitigate climate change and build a healthier, sustainable future for all.
Among the report’s co-authors is Delia Grace, professor of food safety systems at the Natural Resources Institute, University of Greenwich on joint appointment at the International Livestock Research Institute.
One Health is a concept that recognizes that the health of people is linked to the health of animals and their shared environment. A One Health approach in preventing and controlling diseases therefore involves the collaborative efforts of multiple disciplines and sectors. This approach is especially useful for managing zoonoses, diseases that are transmitted between animals and people.
According to the World Health Organization, at least 61% of all human pathogens are zoonotic and have represented 75% of all emerging pathogens during the past decade. There are more than 200 known zoonotic diseases. The health and economic cost of these diseases falls largely on poorer countries which bear 98% of the global burden of zoonoses.
Additionally, in poorer countries, zoonoses comprise 25% of the human burden of infectious diseases. Just 13 of over 200 zoonotic diseases cause 2.4 billion cases of illness and 2.2 million deaths annually (not including COVID-19).
Most zoonotic diseases are endemic in nature. Apart from emerging zoonoses like severe acute respiratory syndrome, highly pathogenic avian influenza and now COVID-19, many endemic zoonoses such as brucellosis and cysticercosis are not prioritized by national and international health systems and are therefore termed neglected zoonoses.
The impact of neglected zoonoses is most severe on poor households in low-resource settings as most people living in rural areas depend on livestock for food, transport and farm work. People living in urban slums are also affected as the rise in urban livestock agriculture brings people and animals into closer contact.
The ongoing COVID-19 pandemic has brought into sharp focus the interconnectedness of people, animals and the environment, and the need for multi-disciplinary approaches such as One Health to tackle the challenge. Preventing and controlling zoonoses in domestic and wild animal populations is a cost-effective way to ensure such diseases do not spread to human populations.
The International Livestock Research Institute (ILRI) has a wealth of research expertise on zoonoses and One Health. The institute recently launched a set of seven research briefs that highlight the benefits of One Health in sustainable livestock production towards improving the health of people, animals and the environment.
For example, innovative community disease surveillance programs can help health experts to detect disease outbreaks rapidly and identify the specific disease hotspots for more timely and targeted interventions.
A research study on the business case for One Health shows that every one dollar invested in One Health generates five dollars’ worth of benefits. Now is the time for governments, investors and policymakers to increase investment in One Health to prevent and control neglected zoonoses and safeguard the health of millions of people and animals and their shared ecosystem.
The COVID-19 pandemic and climate change represent converging challenges to which no continent, country or community is immune. Aligning the global recovery from COVID-19 with our response to climate change offers a triple win: protect public health, promote a sustainable economy and preserve our planet.
This is according to a new report by the Lancet Countdown initiative, an international, multi-disciplinary research collaboration that tracks the evolving public health impacts of climate change and publishes its findings annually in The Lancet medical journal ahead of the United Nations climate change negotiations.
The Lancet Countdown 2020 report, launched on 3 December 2020, tracks the links between health and climate change across 43 indicators in five domains:
climate change impacts, exposures and vulnerabilities;
adaptation, planning and resilience for health;
mitigation actions and health co-benefits;
economics and finance; and
public and political engagement.
The report represents the findings and consensus of the 35 leading academic institutions and United Nations agencies that make up the Lancet Countdown initiative, and draws on the expertise of climate scientists, geographers, engineers, experts in energy, food and transport, economists, social and political scientists, data scientists, public health professionals and doctors.
Among the report’s co-authors is Delia Grace, professor of food safety systems at the Natural Resources Institute, University of Greenwich and contributing scientist at the International Livestock Research Institute.
Visit the Lancet Countdown 2020 website to read thematic summaries and key findings of the report. The full text of the report is available for free via The Lancet (you will need to create a free account with The Lancet).
Food safety has never featured prominently on Africa’s development agenda. When it is an issue, typically the focus has been on high-value food items produced for export, while food safety in domestic markets has been largely neglected, both by governments and development partners. This must change. Recent research has shown that the health and economic consequences of foodborne diseases in Africa are significant and growing, as urbanization and income growth prompt dietary changes that increasingly expose consumers to food safety hazards.
The coming decade is critical. A ‘business as usual’ approach to food safety, involving a combination of post-outbreak firefighting and fragmented regulatory and ad hoc interventions, will do little to check the threats posed by unsafe food in many African countries. The good news is that many of these problems can be controlled and their costs reduced. A combination of incremental and systematic measures, well within the capacity of most governments, can flatten the curve of foodborne illness.
Until recently, research on foodborne diseases was mostly limited to high-income countries. Research and public health interventions in poorer countries largely focused on the so-called big three—tuberculosis, HIV/AIDS and malaria—and on maternal and child mortality. Yet, recent epidemiological research from the World Health Organization shows the costs of neglecting foodborne diseases in developing countries. Worldwide, the global health burden of foodborne diseases is on par with the big three. The young, old, malnourished and poor are disproportionately impacted and children under five years of age are especially vulnerable.
Globally, Africa south of the Sahara and emerging Asia have the highest incidence of and death rates from foodborne diseases. Yet while the incidence rates of the two regions are comparable, Africa’s estimated death rate is nearly four times higher. The reasons for that difference are not fully understood, but the prevalence of endemic ailments and poor diagnostic and treatment options probably account for much of it. Drawing on data from the World Health Organization and other recent sources, we estimate that Africa experiences around 135 million cases of foodborne diseases and 180,000 foodborne disease-related deaths per year. Microbial pathogens—especially Salmonella spp., toxigenic Escherichia coli, norovirus and Campylobacter spp.—account for about 80% of Africa’s foodborne disease burden.
The economic consequences of foodborne diseases in Africa are correspondingly severe. A recent World Bank study estimated the productivity losses alone attributed to unsafe food within Africa at $20 billion in 2016 and the cost of treating these illnesses at an additional $3.5 billion. These costs are heaviest in larger, middle-income countries such as South Africa, Nigeria and Egypt, yet are also significant elsewhere. Overall, the relative economic burden of foodborne diseases is higher for African countries than for developing countries elsewhere.
Both the health and economic consequences of foodborne diseases in Africa are likely to grow as the continent develops. In low-income countries, food is typically produced close to the point of consumption and undergoes limited transformation. Starchy staples such as cassava, maize and rice predominate. Traditional processing techniques dominate and are often fairly effective at reducing risk. As they develop and urbanize, countries experience rapid shifts in diet and towards more intensified agriculture. Such transitions typically lead to increased consumption of fresh produce and animal-sourced foods and a lengthening of food supply chains. Yet much of this perishable food continues to be handled and distributed through informal channels, creating potentially multiple points for food hazards to develop. In these transitioning food systems, the official regulatory apparatus is often overwhelmed by the breadth and depth of emerging challenges.
Until very recently, domestic food safety programs in Africa have been few and poorly funded. By contrast, literally hundreds of projects supported by trade partners or development agencies have sought to address international trade-related food safety problems. These have been beneficial and have helped to push Africa’s trade in safety-sensitive foods such as fish, fresh fruit and vegetables from $3.8 billion in 2001 to $16.1 billion in 2017. But overall, the available evidence suggests that the trade-related costs associated with unsafe food in African countries are small compared to the domestic public health costs and productivity losses. In fact, we estimate the ratio between domestic and trade-related costs is likely to be on the order of 40 to 1, suggesting that the predominant attention of policymakers on the trade impacts of food safety has been deeply misguided.
African countries must implement better domestic food safety policies and support them with needed investment. But this, in itself, will not be enough to give them the upper hand against foodborne diseases. What they need is nothing less than a food safety paradigm shift. The traditional regulatory model, imported from high-income countries, centres on enforcement through regular inspection of food facilities and product testing, with set legal and financial penalties. This model is ill-suited to food systems in Africa, where smallholder farmers, micro- and small enterprises and informal food channels predominate, surveillance and inspection mechanisms can be weak and court procedures challenging and slow. It introduces an antagonistic and often unproductive relationship between government and the private sector as regulator versus regulated.
A better approach is to think of food safety as a shared responsibility between food business operators, consumers and the government. In this model, governments set forth a vision, convene stakeholders and offer a diverse set of policy instruments to involve, incentivize and leverage the actions of key value chain actors. Instead of being the ‘official food control’ authority, governments should act as facilitators encouraging investments and behaviour change. Experimentation and flexibility will be critical.
There are no quick fixes to Africa’s food safety challenges. They require a comprehensive approach that focuses on improving food safety awareness, practices and governance. Foundational investments will be needed in people, infrastructure and institutions. Addressing these issues will require sustained attention from technical agencies and government ministries as well as donors. It will require broader interventions to improve access to quality public health services, clean water and sanitation and improved agricultural productivity. It will require, in short, a commitment commensurate to the scale of the problem. It is also likely, as in other parts of the world, that improvements will ultimately be driven by better-aware consumers demanding food safety and eliciting responses from public sector and food suppliers. Recognizing that is a good place to start.
This article by Steven Jaffee and Delia Grace was originally posted on the International Food Policy Research Institute website. It is based on a chapter they and others co-authored in the 2020 Annual Trends and Outlook Report: ‘Why Food Safety Matters to Africa: Making the Case for Policy Action’ by Steven Jaffee, Spencer Henson, Delia Grace, Mateo Ambrosio and Franck Berthe.
Steven Jaffee is a lecturer at the University of Maryland. Delia Grace is a professor of food safety systems at the Natural Resources Institute, University of Greenwich and a contributing scientist at the International Livestock Research Institute.
A new research report (Oct 2020) by scientists from the International Institute for Environment and Development (IIED) and the International Livestock Research Institute (ILRI) reviews the status and policy contexts of informal milk markets in Kenya, Tanzania and Assam (India) to better understand the opportunities for a policy innovation based on training and certification to overcome market access barriers for sellers of informal milk by improving the health and safety practices of informal milk traders, thereby addressing policymakers’ concerns. It is based on an extensive review of available literature and a small number of expert interviews and contributions.
The Alliance for a Green Revolution in Africa launched its 2020 Africa Agriculture Status Report during the African Green Revolution Forum virtual summit hosted in Kigali, Rwanda on 8-11 September 2020.
This year’s report focuses on the challenges of feeding Africa’s cities and the opportunities available to smallholder farmers and agribusinesses to meet the needs of the continent’s fast growing urban food markets.
The report features a chapter on food safety and public health in urban food markets in Africa. Currently, Africa suffers from the highest per capita rate of foodborne illnesses in the world. The riskiest foods from a health perspective are animal-source foods, fruits and fresh vegetables. Consumption of these food products is rising rapidly in African cities.
Improving food safety in Africa’s urban food markets — both the dominant informal markets and the growing formal markets — will go a long way to safeguard the health of consumers and reduce the economic and health burden of foodborne illnesses.
Interventions include improving domestic market infrastructure, training of food handlers and increasing awareness of the shared responsibility of regulators and value chain actors to provide safe food.
Unsafe food directly undermines human health and jeopardises the attainment of national, continental and global development goals. For this reason, African governments urgently need to prioritize food safety and adopt policies and strategies that will ensure the delivery of adequate and safe food to urban markets.
The Lancet Countdown: tracking progress on health and climate change is a multidisciplinary, international research collaboration that provides a global overview of the relationship between public health and climate change. Publishing its findings annually in The Lancet, the initiative generates research evidence to inform an accelerated policy response to climate change.
The Lancet Countdown 2018 report presents the work from leading academics and technical experts from 27 partner academic and United Nations institutions around the world, including the International Livestock Research Institute (ILRI), Tehran University of Medical Sciences, University of Sydney and the World Health Organization. The study was funded by the Wellcome Trust.
Among the report’s co-authors are Delia Grace, veterinary epidemiologist and co-leader of the Animal and Human Health program at ILRI, and Paula Dominguez-Salas, assistant professor in nutrition-sensitive agriculture at the London School of Hygiene and Tropical Medicine on joint appointment at ILRI.
The Lancet Countdown initiative brings together climate scientists and geographers, mathematicians and physicists, transport and energy experts, development experts, engineers, economists, social and political scientists, and health professionals, reporting on 41 indicators across five key thematic groups:
climate change impacts, exposures and vulnerability;
adaptation planning and resilience for health;
mitigation actions and health co-benefits;
economics and finance; and
public and political engagement.
Below are the four key messages of the Lancet Countdown 2018 report:
Present day changes in heat waves, labour capacity, vector-borne disease and food security provide early warnings of the compounded impacts on public health that are expected if temperatures continue to rise. Trends in climate change impacts, exposures and vulnerabilities show an unacceptably high level of risk for the current and future health of populations across the world.
A lack of progress in reducing emissions and building adaptive capacity threatens human lives and the viability of the national health systems they depend on, with the potential to disrupt core public health infrastructure and overwhelm health services.
A number of sectors have seen the beginning of a low-carbon transition; the nature and scale of the response to climate change will shape the health of nations for centuries to come.
Ensuring a widespread understanding of climate change as a central public health issue will be crucial in delivering an accelerated response, with the health profession beginning to rise to this challenge.
In addition to organizations recognized for specific projects and outputs, we thank all donors which globally supported the work of ILRI and its partners through their contributions to the CGIAR system
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