Food safety in a social context
Delia Grace,
Professor Food Safety Systems, Natural Resources Institute, Chatham, UK
Scientist International Livestock Research Institute, Nairobi, Kenya
Co-authors: Bernard Bett, Theo Knight-Jones, Florence Mutua, Hung Nguyen, Himadri Pal,
Kristina Roesel
Understanding the social context of One Health
World One Health Congress, Singapore 7-11 November 2022

Overview
1. Why study food safety in a OH
2. What have we learned?
3. The missing middle – incentives & institutions
4. Way forward

Context
“Quadripartite Launches Joint Action
Plan to Promote One Health
Approach”
The five-year plan outlines six action tracks:
– enhancing One Health capacities to strengthen health systems;
– reducing the risks from emerging and re-emerging zoonotic epidemics and
pandemics;
– controlling and eliminating endemic zoonotic, neglected tropical, and vector-
borne diseases;
– strengthening the assessment, management, and communication of food safety
risks;
– curbing the silent pandemic of antimicrobial resistance; and

Years of life lost annually for FBD
FERG: Havelaar et al., 2015; Gibb et al., 2019
Health impact of FBD comparable to
that of malaria, HIV/AIDs or TB
31 hazards
• 600 mio illnesses
• 480,000 deaths
• 41 million DALYs
zoonoses
non zoonoses
FBD occurs at the intersection of human health,
animal health, agro-food systems

The public health and domestic economic costs
of unsafe food may be 20 times the trade-
related costs for developing countries
Cost estimates 2016 (US$ billion)
Productivity loss 95
Illness treatment 15
Trade loss or cost 5 to 7
‘Productivity Loss’ =
Foodborne Disease DALYs x Per Capita GNI
Based on WHO/FERG & WDI Indicators Database Illness treatment =
US$27 x # of Estimated foodborne illnesses
Trade loss or costs =
2% of developing country high value food exports

6
Systematic literature review – Food safety
interventions in SS Africa
Along the
value chain
Technologies Training &
information
New processes Organisational
arrangements
Regulation Infrastructure
Farmer +++ +++ + +++ + ++++
Processor
&
transporter
+++ +++ +++ ++ ++ +++
Retailer + ++ + ++ ++ +++
Consumer + +++ + + + +++
Govt +++ ++ ++ +++
Population level:
 Incorporating food safety into other health programs such as mother and child care or HIV
treatment
 Medical interventions such as vaccination for cholera or norovirus or binders for aflatoxins
 Dietary diversity to reduce exposure and vulnerability to toxins
 Water treatment

• Donor investment since 2010 less than $40 million a year. Small in
relation to burden and investments in other health areas
• Substantial focus on –
• National control systems
• Exports and other formal markets
• Chemical hazards
•
• Little focus on –
• Market-based and demand-led approaches
• Informal sector where most foods are sold
• Biological hazards and risks to human health
Desk study– Food safety investments in SS
Africa

Reliance on regulations without institution
building
 100% of milk in Assam doesn’t meet standards
 98% of beef in Ibadan, 52% pork in Ha Noi, unacceptable
bacteria counts
 92% of Addis milk and 46% of Nairobi milk had aflatoxins
over EU standards
 36% of farmed fish from Kafrelsheikh exceed one or more
MPL
 30% of chicken from commercial broilers in Pretoria
unacceptable for S. aureus
 24% of boiled milk in Abidjan unacceptable S. aureus

9

Promoting transformation without behaviour
change
 Supermarketisation is slower than thought.
 Formal sector food is risker than thought.
 Modern business models have often run into problems
– Co-ops, abattoirs, market upgrades

11
0
10
20
30
40
50
60
70
80
90
100
Poor total bacteria Unacceptable total
bacteria
Unacceptable
faecal bacteria
Unaccpetable
Staph
Unacceptable
listeria
Any unacceptable
Supermarket
Wet market
Village
Compliance : Formal often worse than informal
ILRI, 2013

Knowledge & awareness is not enough
 Many actors are well intentioned but ill informed
 Small scale pilots show short term improvements
 Smallholders have been successfully integrated into export
chains
 But domestic GAP has limited effect
– In 4 years VietGAP reached 0.06%
– In Thailand GAP farmers have no better
pesticide use than non-GAP
No behaviour change without change
in incentives or choice architecture!

Incentives
Technology
& training
ENABLING
ENVIRONM
ENT
Moral, Social,
Material
Capacitate VC actors
Inform, monitor &
legitimize VC actors
Build capacity &
motivation of
regulators
Nudges
Three legged stool
Policy,
infrastructure
Motivate & facilitate
behaviour change
Innovation

Technology + training
savings on firewood / month
= 900,000 UGX (260 US$) + >100 trees
Reach:
50% of all pork butchers and
their 300,000 customers in Kampala

Gumboots (6US$)
Tippy tap (1US$)
Bar of soap (0.50US$)
250mL bleach (0.70US$)
Laminated poster and certificate (6
US$)
= ca. 15 US$ per kit

16
+ Missing ingredient: Nudges
3 bucket cleaning system

+ Missing ingredient: Enabling
Environment

Take home messages
 FBD is important for health, wealth and development
 Huge health & economic burden: most is due to microbes &
worms in fresh foods sold in wet markets in LMICs
 Interventions: training very easy, technologies quite easy,
infrastructure moderate difficulty, authority buy-in moderate
difficulty, motivation almost never addressed
 Currently no proven approaches for mass markets in LMIC
that are scalable and sustainable
 The 3-legged stool (pull-push) most promising approach:
capacity, enabling environment, motivation for behaviour
change

Acknowledgements and Further Reading

20

THANK YOU