This document discusses food safety in the context of One Health and summarizes the key learnings from studying food safety interventions. It finds that: 1. Foodborne diseases impose a large health and economic burden worldwide, especially in developing countries where most foods are sold in wet markets. 2. Existing interventions have had limited impact because they often focus on regulations, exports, and formal sectors without addressing the incentives and behaviors of actors in informal domestic markets. 3. A more effective approach incorporates technology, training, incentives, and nudges to change behaviors, supported by an enabling policy environment. This "three-legged stool" approach shows promise for improving food safety at scale.

1. 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

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

3. 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

4. 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

5. 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. 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

7. • 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

8. 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. 9

10. 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. 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

12. 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!

13. 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

14. 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

15. 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. 16
+ Missing ingredient: Nudges
3 bucket cleaning system

17. + Missing ingredient: Enabling
Environment

18. 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

19. Acknowledgements and Further Reading

20. 20

21. THANK YOU