T. Kolodnitska 1,2, V. Seleznova 1,2
1 HSEE of Ukraine “Bukovinian State Medical University”, Chernivtsi, Ukraine,
2 L.I. Medved’s "Research Center of Preventive Toxicology, Food and Chemical Safety, Ministry of Health, Ukraine"(State Enterprise), Kyiv, Ukraine
ABSTRACT. Introduction. The burden of foodborne diseases is increasingly attracting WHO attention and heightening the necessity of international global public health commitments.
The aim of the study is to analyze and summarize the existing national and international experience in reducing the burden of foodborne diseases on the basis of studying legislative and regulatory documents, sources of statistical data, scientific publications and materials of the First FAO/WHO/AU International Food Safety Conference Addis Ababa, 12-13 February 2019.
Materials and methods. The bibliosemantic and analytical methods have been used.
Results and discussion. It is established that today, the lack of data about the burden of foodborne diseases not only does not allow to get an accurate picture of the current situation, but also complicates the evaluation of the effectiveness and resulting quality of preventive measures and strategies. In recent years, Ukraine has witnessed a sharp deterioration in the food safety and quality situation due to the demonopolization of the food industry, increased volumes of supplies from abroad, weakening of the control over the production and sale of food products. Unresolved issues remain regarding the level of harmonization of Ukrainian legislation with European norms, which is currently insufficient. According to our belief, the issue of food safety should occupy a more prominent place in the development strategy.
Conclusions. In order to reduce the burden of foodborne diseases, the basic principles recommended by the WHO should be taken into consideration: orientation of the measures being implemented to the future, their preventive character, capacity-building in foundational spheres, the integrating efforts and the stimulation of private investment.
Key Words: the burden of foodborne diseases, food safety, DALY.
Introduction. Ensuring access of population to sufficient amounts of safe and nutritious food products (FPs) is one of the fundamental conditions for the strengthening of human health. Alimentary risk factors include a vast array of bacterial pathogens, viruses and parasites, toxins and chemical substances, which all may cause a plethora of disease. In 2015, the WHO presented their first report with assessment of global burden of foodborne diseases (FBD), reporting 600 million FBD cases globally and 420,000 associated deaths. Overall, 40% of FBD burden was in children younger than 5 years. It is likely that the real scale of the problem is underestimated, and that the above figures were obtained from conservative estimates based on modelling and expert review of the role of FPs in disease. It is expected that in the future the global burden of FBD will increase even more, stimulated by such factors as international trade, changing food habits and methods of agricultural work, as well as by climate change. In addition to adverse human health implications of unsafe food products, the latter impede socio-economic development, put an excessive burden on public health systems and harm the economy, trade and tourism [7, 9].
The objective of the study. To review the existing national and international experience on reducing FBD burden based on evaluation of literature sources.
Materials and methods. The information pool of the study included legislation and regulatory documents, sources of statistical data, scientific publications and electronic resources. This work has employed a biblio-semantic method and an analytical method.
Results and discussion. At The First International Food Safety Conference sponsored by the FAO, the WHO and the African Union in Addis Ababa, 12-13 February 2019, the WHO reference group on epidemiology for FBD burden reported that global FBD burden induced a loss of 33 million years of healthy life due to disease or death, with adjustment for disability: Disability-Adjusted Life Year, DALY (ІН 95 %, 25-46 Mio). The most common causes of FBD included norovirus, Campylobacter spp, Salmonella enterica, Salmonella typhi, Taenia solium, hepatitis A virus and aflatoxin. It was especially difficult to assess the burden of illness caused by chemicals and toxins, since manufacture and logistics of FPs may contaminate them with thousands of chemical substances and various toxics of natural origin. For most low- and middle-income countries, there is no data on the extent of contamination of food products with chemicals. Of the 31 causes of FBD reviewed in the report, only three chemicals were considered: aflatoxin, dioxin and cyanide [6]. There are literature reports that metals in FPs cause 9 Mio DALY. According to estimates, the greatest number of cases of such diseases worldwide is due to exposure to lead [5].
More than 70% of all pollutants enter the human body with food products. Recently, Ukraine has experienced a sharp deterioration in safety and quality of FPs due to demonopolization of food industry, increasing imports and relaxed regulatory control of manufacture, logistics and retail of food products [2]. According to the rating made by The Economist Intelligence Unit, Ukraine took the 44th place among the 105 countries studied for access of population to and the quality of FPs, with 8.4 points on a 100-point assessment scale [1]. According to official data, approximately 133,000 cases of intestinal infections have been registered in Ukraine in 2017 [3].
It should also be noted that food production may contribute to human disease via mechanisms completely unrelated to direct intake of pathogens with food [6]. The FBD burden is a multifactorial concept, related not only to exogenous pathogens and toxins, but also to suboptimal and/or inadequate nutrition. Noncommunicable disease (NCD) contribute to increasing fractions of morbidity and mortality. The most important risk factors include excess body weight and obesity, which are becoming increasingly more prevalent in low- and middle-income countries, notably more among their poor residents. According to the World Health Organization, in 2016, the global prevalence of obesity was 1.9 billion adults and 340 million children. There is accumulating evidence that inadequate nutrition potentially resulting in FBD is conducive to obesity and obesity-associated disease. As a result, there is a situation that can be described as a “triple burden of gastrointestinal disease”: children with growth delays and gastrointestinal infections are subject to the increasing risk for obesity and obesity-associated disease. Another risk factor, which affects the safety of FPs and the incidence of noncommunicable disease, is seen in countries where FBD outbreaks are caused by consumption of contaminated raw foods: the population seeks to buy highly processed food, which often contains much fat, sugar and salt. Consumption of such products triggers excess weight and obesity [4].
Metabolic disorders originate from childhood. The worst situation with obesity is seen in Greece, Portugal, Ireland and Spain. However, Ukraine has nothing to brag about: 58% of Ukrainians have excess body weight. In 2017, an average Ukrainian citizen began to use more bread, meat and fruit but less milk, cheese and vegetables; the consumption of fish, potatoes and eggs remained at previous levels. Monthly consumption of one person includes 8.4 kg of bread, 4.8 kg of meat and sausages, 1.2 kg of fish, 20 eggs, 200 g of potatoes, 300 g of vegetables, etc. According to nutritionists, such diet provides sufficient caloric value; however, it is not balanced by the main nutrients. On an average, each Ukrainian consumes approximately 14.0 kg of fish per year; this is almost half the FAO-recommended target level (20.0 kg) [3].
Whereas DALY is an integral qualitative index of FBD burden for healthcare purposes, the economic burden is another important factor to consider when making decisions of national and international scale [6]. The safety of FPs largely depends on government policies, public and private investment and other actions, since they define both basic provisions for activity of involved parties and the level of their awareness and expertise, the opportunities and the practice of their work at all stages of the “from lawn to table” chain. Food safety is only possible with safety of main dietary ingredients and with recognition of this fact by consumers [8].
The regulatory bodies of many developing countries view food safety primarily as a key to international market and as a clearance for trade. However, these issues are not domestically viewed as strategically or politically important; this is why the costs allocated for these purposes are usually more than modest. Such an approach is hardly beneficial for development of national systems for FP safety management [8].
In the recent years, there is increasing evidence of increasing disease burden and economic burden, which bears upon the consumers buying FPs (especially perishables with high nutritional value) in informal outlets and through informal sales channels. This calls for a large-scale FP safety strategy, equally targeting the needs of traders and the needs of the domestic market. In part, such strategy should address the risks of FP safety in the organized and unorganized sectors [9].
Usually, the problem of ensuring FP safety at the domestic level falls into the spotlight only in times of crisis, such as FBD outbreaks with fatalities and high-profile cases against deliberate FP falsification, which cause dissatisfaction and anger in the population, forcing politicians to react quickly. In such cases, as a rule, the authorities use multiple measures aimed at eliminating harm, etc. Sometimes these measures may cope with the immediate cause of the problem, but in most cases, they cannot ensure neither stable improvement of the situation in terms of incentives, practical actions and potential, nor make a difference in FP safety. Thus, crisis management is an ineffective substitution strategy; it is not an effective alternative to a coordinated, evidence-based and proactive risk management. The only result of this strategy is increasing healthcare expenditures and the expenses aimed at solving socio-economic issues [8].
The deepening of crisis in Ukraine after the events of spring 2014 is due to a whole set of reasons, such as: low living standards of the overwhelming majority of the population, crisis in the public health system secondary to socio-economic transformations in the country and depreciation of human health both by the State and by its citizens. Therefore, based on results of recent mortality predictions by domestic and international experts, it can be argued that under current crisis conditions of the Ukrainian state, no significant improvements of DALY trends can be expected in Ukraine in the short term. Such improvements may only become possible once political and socio-economic situation in the country stabilizes [3].
Theoretically, the population of Ukraine does have the reserves to reduce DALY and these reserves are quite substantial. All social dimensions at all levels of management should be directed at improvement of living conditions, everyday life and working conditions in particular, to create a public environment that stimulates the population to adopt and assimilate healthy lifestyle behavioural patterns, including rational nutrition. Health improvement should be the ultimate goal of any socio-economic reforms. Practical implementation of state policies to reduce mortality and DALY in Ukraine should be performed with a mechanism of targeted programs that use national budget subsidies and local budgets [3]. Regulatory organs should provide support to activities aimed at FP safety, since introduction of necessary changes would require appropriate institutional reforms (for example, introduction of required standards and regulatory requirements). That said, however, one should not put too much trust in institutional enforcement of any such requirements. The experience of the developed countries has shown that command-and-control methods (involving audits and sanctions for non-compliance) are less effective and more costly than creating an environment where all parties involved, motivated by appropriate stimulation, would act based on self-regulation [4]. Therefore, a major role in improving health belongs to directing the public policy to teaching the people how to own their health and to improve its quality, to attaining high levels of self-preservation culture, especially under contemporary reality in Ukraine, when public health expenditures have been dramatically reduced [3].
Taking into account the European bearings of our country, the signing of the political part of the Association Agreement with the EU and the readiness of the European Union to open their market for Ukrainian goods unilaterally, a current objective of paramount importance is that Ukraine completes harmonization of its legislation with European requirements and norms. Thus, a number of guidance documents have been adopted recently, namely the national DSTU Standard 4161:2003 “Food Safety Management Systems. Requirements”, the national DSTU Standard ISO 22000:2007 (identical to the international ISO 22000:2005 standard), Resolution of the MoH of Ukraine “On improvement of state sanitary and epidemiological surveillance of НАССР system implementation” No. 20 dated 30 June 2010 and others. However, there are still unresolved issues with the level of harmonization of Ukrainian legislation with European norms, which is currently insufficient. Thus, the level of harmonization is 64% in agriculture (58 of 90 standards have been adopted) and 40% in food industry (63 of 157 standards have been adopted). Overall, Ukraine will need to harmonize its legislation with the requirements of 59 Regulations and Directives of EU [1].
Recent studies have shown that even in cases where the achievement of a goal in the area of development is impossible without a certain level of FP safety, the associated issues are addressed inefficiently and the results obtained are not measured. The practitioners should clearly define results and outcomes in the area of FP safety, invest in their achievement and measure the results in terms of reducing the risk of morbidity or reducing susceptibility to disease [8].
In the author’s understanding, the issues of food safety in Ukraine should have a prominent place in the strategy of national development. In order for food safety initiatives to be maximally people-oriented, the following principles should be kept:
- Integration of food safety issues into development strategies.
- Strengthening the sanitary control of food-borne diseases.
- Solving the problems of food safety in domestic markets.
- Holistic analysis preceding the development of food safety strategies and programs.
- Completion of harmonization of Ukrainian legislation according to European norms.
- Using the technologies and approaches that would promote safety and transparency of manufacture and sales & distribution chains.
- Motivation and stimulation of all parties involved in various links of the food chain, from the manufacturer to the customer [4].
Conclusions
- The FBD burden attracts progressively greater attention of the WHO and increases the need for global commitments of international communities in the realm of public health.
- Lack of data on the FBD burden not only impedes a clear understanding of current situation, but also complicates assessment of efficacy and outcomes of preventive interventions and strategies.
- In Ukraine, there are still problems concerning the degree of harmonization of Ukrainian legislation with European standards, which is currently insufficient.
- In order to relieve the burden of FBD, it is essential to implement the following WHO guiding principles: proactive interventions, the preventive nature of interventions, empowering the potential in fundamental realms, fostering collaboration and stimulation of private investments [8].
REFERENCES
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Надійшла до редакції 18.04.2019 р.