We must focus on food safety as well as nutrition to feed the hungry — but there are many barriers to safe eating, writes the WHO's Jørgen Schlundt.
Most scientists agree that the world's farmers produce enough food to cater for the Earth's six billion people. The fact that more than one billion people suffer from hunger and undernutrition is widely thought to be a result of inadequate distribution.
But we will never eliminate global hunger by simply improving our capacity to spread agricultural produce among all inhabitants unless we can also guarantee the quality of supplies.
The concept of nutrition security — ensuring access to food that is nutritious as well as sufficient — is increasingly being used to stress the importance of the quality of food for people of all ages.
Poor nutrition weakens immune systems and contributes to half the deaths associated with infectious disease among children aged under five in developing countries. Undernutrition in the early years of life can also impair long-term cognitive development and productivity at work.
Micronutrient deficiencies also have severe health impacts — vitamin A deficiency is the leading cause of blindness in children, affecting up to half a million children each year. Iodine deficiency causes brain damage and iron deficiency is responsible for anaemia in two billion people worldwide.
Safety and nutrition links
But there is another aspect of food quality that is equally important — safety.
Nutrition and food safety are inextricably linked, particularly in places where food supplies are insecure. When food becomes scarce, hygiene, safety and nutrition are often ignored as people shift to less nutritious diets and consume more 'unsafe foods' — in which chemical, microbiological, zoonotic and other hazards pose a health risk.
Unsafe food, whether arising from poor quality supplies or inadequate treatment and preparation, increases the risk of foodborne infections such as diarrhoea. These infections have a much higher impact on populations of poor nutritional status, where diarrhoea can easily lead to serious illness and death.
Indeed, poor nutrition and foodborne disease often join hands in a vicious cycle of worsening health. For example, poor nutritional status weakens resistance against diarrhoea, which, in turn, leads to the uptake of fewer nutrients and poorer nutritional status.
Food safety must be systematically integrated into policies and interventions to improve nutrition and food availability.
Rolling out food standards
Arguably, the first stepis for all countries to adopt and adhere to international standards on food safety, such as those developed by the WHO and Food and Agriculture Organization through the Codex Alimentarius Commission.
Efficient food safety interventions often require coordinated action throughout the food safety chain. For example, if chickens are infected with salmonella at a farm, how they are then treated at the slaughterhouse, in the shop or market and in the kitchen all determine the number of bacteria that reach consumers, and so the number of people getting sick (or dying).
Likewise, if we can follow the level of a hazardous chemical in the different stages of food production we will also learn where to introduce the most efficient prevention measures.
Importantly, international standards are non-negotiable and should apply equally to populations — an acceptable level of food contamination is not higher for starving people than for others.
There should not be one framework for food that is exported and another for food consumed locally as has previously been the case even in some developed countries. By the same token, there should not be one framework for populations with sufficient nutrition and another for hungry ones.
Coherent and holistic national food safety systems would not only improve health in countries with insecure food supplies — they would also help development and boost food trade. A national system that can live up to international standards will ensure that local products can be exported to other markets.
But there are many obstacles to building efficient food safety systems, not least the lack of political awareness. Food safety as a local health and development problem is still rarely acknowledged by decision makers in many developing countries, and is often given little priority by major donors.
Recent food safety scandals and a growing knowledge base are slowly making a change. When the BSE (bovine spongiform encephalopathy) scandal hit Europe in the 1990s, it led to a major overhaul of the system. Likewise, new data on antimicrobial resistance has led to the discontinuation of antimicrobial growth promoters in some countries.
It is also clear that one major obstacle to improving food safety systems, particularly in developing countries, is the lack of data on the burden of foodborne diseases both globally and within nations. Such data are critical to establishing evidence-based national and international food safety policies.
The WHO, guided by an external expert group,is now working to address this gap by collecting data on foodborne diseases across the world by age, sex and region. It hopes to publish a global foodborne disease burden report and atlas in 2011–12.
We have little hope of achieving the Millennium Development Goal of reducing child mortality by two-thirds by 2015 unless developing countries — in collaboration with donor agencies — recognise the need for, and invest in, improvements in water and food safety, and nutrition security.
We need an integrated approach to food where food safety and nutrition are systematically introduced into mainstream food system policies and interventions across the world.
Producing safe food is not simply a tool for boosting agriculture or trade — it is an essential ingredient for public health.
Jørgen Schlundt is director of the Department of Food safety, Zoonoses and Foodborne Diseases at the WHO in Geneva, Switzerland.