Introduction: Food safety is the assurance that food and food products when consumed in the usual way does not pose a threat to human health and well-being. More than 200 known foodborne diseases or illnesses are transmitted as a result of eating or drinking contaminated food (1). The causes of foodborne illnesses include viruses, bacteria, parasites, toxins, metals and prions. Some of the common symptoms of foodborne illnesses range from mild gastroenteritis to life-threatening neurological, hepatic and renal syndromes. According to the Caribbean Epidemiology Center (CAREC), foodborne diseases have been reported to double over the past three years in Trinidad, with the highest incidence occurring in 2005 (2). The World Health Organization has reported that 1.8 million people from developing countries die each year as a result of foodborne diseases.

In the United States, foodborne diseases have been estimated to cause 6 million to 81 million illnesses and up to 9,000 deaths each year (3-6). However, ongoing unexpected changes in the food supply, the identification of new foodborne diseases and the re-emergence of dormant or existing foodborne diseases have made these figures obsolete and have unnerved the need for fresh insights into food safety.

It is undisputable fact that foodborne disease takes a major toll on human health and well being, especially on fragile health care systems in the Caribbean and other developing countries. Thousands of millions of people are afflicted with foodborne diseases, fall ill and many die as a result of eating unsafe food. In a response to this concern, the Fifty-third World Health Assembly (May, 2000) adopted a resolution calling upon the World Health Organization (WHO) and its Member States including Trinidad and Tobago to recognize food safety as an essential public health function with the aim of reducing the burden of foodborne disease globally (3-6).

Food Safety: A Basic Human Right The United Nations and WHO have deemed the availability of safe food a basic human right (7). Safe food contributes to health, which in turns translates into economic productivity that may serve to alleviate poverty. The poor and the underprivileged persons in communities, societies, populations and countries are the most vulnerable to ill health. Food and waterborne diarrhoeal diseases, for example, are leading causes of illness and death among the poor and unprivileged, killing an estimated 1.8-2.2 million people annually, most of whom are children (7). Diarrhea is the most common symptom of foodborne illness, but other serious consequences may include kidney, liver failure, brain and neural disorders often resulting in death. The debilitating long-term complications of foodborne diseases may have a devastating effect on families, communities, populations and countries often leading to decreased productivity, increased economic burden on fragile economies and health care systems.

Economic Consequences of Foodborne Diseases: There are only limited data on the economic consequences of food contamination and foodborne disease in developing countries. In studies in the USA in 1995, it was estimated that the annual cost of the 3.3-12 million cases of foodborne illness caused by seven pathogens was US $6.5-35 billion. The medical costs and the value of the lives lost during just five foodborne outbreaks in England and Wales in 1996 were estimated at UK£ 300-700 million. The cost of the estimated 11, 500 daily cases of food poisoning in Australia was calculated at AU$ 2.6 billion annually (7).

Causes of Increased Incidence of Foodborne Diseases: The increased incidence of foodborne diseases due to microbiological hazards and other physical and chemical hazards is the result of a multiplicity of factors, all associated with our fast-changing world.

 Demographic profiles are being altered, with increasing proportions of people who are more susceptible to microorganisms in food.

 Changes in farm practices, more extensive food distribution systems and the increasing preference for meat and poultry in developing countries all have the potential to increase the incidence of foodborne illness. Extensive food distribution systems raise the potential for rapid, widespread distribution of contaminated food products.

 Changes in food production result in new types of food that may harbour less common pathogens. Intensive animal husbandry technologies, introduced to minimize production costs, have led to the emergence of new zoonotic diseases, which affect humans.

 Safe disposal of manure from large-scale animal and poultry production facilities is a growing food safety problem in much of the world, as manure frequently contains pathogens.

 Changes in eating patterns, such as a preference for fresh and minimally processed foods, the increasingly longer interval between processing and consumption of foods and the increasing prevalence of eating food prepared outside the home all contribute to the increased incidences of foodborne illness ascribed to microbiological organisms.

 The emergence of new pathogens and pathogens not previously associated with food is a major public health concern. E. coli O157:H7 was identified for the first time in 1979 and has subsequently caused illness and deaths (especially among children) owing to its presence in ground beef, unpasteurized apple cider, milk, lettuce, alfalfa and other sprouts, and drinking-water in several countries. Salmonella typhimurium DT104 has developed resistance to five commonly prescribed antibiotics and is a major concern in many countries because of its rapid spread during the 1990s (7).

 New technologies, such as genetic engineering, irradiation of food, ohmic heating and modified atmosphere packaging, may be used to increase agricultural production and extend shelf life. Their potential benefit for public health is great: for example, genetic engineering of plants has the potential to increase the nutrient content of foods, decrease their allergenicity and improve the efficiency of food production. However, the potential long-term public health effects of these technologies are questionable and have raised concerns globally during the past decade (7).

References: 1. Bryan FL. Diseases transmitted by foods. Atlanta: Centers for Disease Control; 1982. 2. CAREC. Communicable Disease Feedback Report. Port of Spain: Trinidad; 2001. 3. Archer DL, Kvenberg JE. Incidence and cost of foodborne diarrheal disease in the United States. J Food Protect 1985;48:887-94. 4. Bennett J, Holmberg S, Rogers M, Solomon S. Infectious and parasitic diseases. In: Amler R, Dull H, editors. Closing the gap: the burden of unnecessary illness. New York: Oxford Univ Press; 1987: 102-14. 5. Todd ECD. Preliminary estimates of costs of foodborne disease in the United States. J Food Protect 1989;52:595-601. 6. Foodborne pathogens: risks and consequences. Ames, IA: Council of Agricultural Science and Technology; 1994. 7. WHO global strategy for food safety: safer food for better health. Geneva: WHO; 2002.





About the author:

Dr Pattron is a Public Health Scientist, Ministry of Health Trinidad