Food Borne Diseases emanate from a variety of reasons, mostly concentrated around compromised standards of food safety. FBD are infections of the gastrointestinal tract caused by consumption of harmful toxin (bacteria, parasites, viruses, or chemicals) contained in foods or beverages.
The World Bank recently assessed that food borne diseases (FBD) cost India about $28 billion (Rs 1,78,100 crores) or around 0.5% of the country’s gross domestic product every year. There were about 100 million FBD cases in 2011 which are projected to rise to 150-177 million by 2030.
Food Borne Diseases emanate from a variety of reasons, mostly concentrated around compromised standards of food safety. FBD are infections of the gastrointestinal tract caused by consumption of harmful toxin (bacteria, parasites, viruses, or chemicals) contained in foods or beverages. The toxins or pathogens which spoil the food and cause FBD usually come from unhygienic environments, improper/inadequate storage temperature and duration, poor water quality used for meal preparation etc.
About 37% Indians live in poverty and do not have a separate designated kitchen. This increases the chance of inducing toxins in our foods. Also, about half of our population (600 million people) face severe water scarcity each year. Using unsafe water for cooking or drinking is another risk factor for FBD.
In view of the above conditions, earmarking and celebrating 7 June, 2019 as the first World Food Safety day is a welcome gesture. This day is bound to have a special relevance for countries like India which bear the brunt of being food insecure (15% or 196 million people are undernourished in India) on one hand, and largely depending on poorly regulated network of unorganized (dubious quality) sellers on the other.
A significant proportion of our people (more than 50% in rural and 30.7% in urban areas) access the Public Distribution System (PDS), which is one of the largest government subsidized safety net programmes in India. Similarly, the government aided Mid-Day Meal (MDM) programme fed to more than 120 million children daily in government schools also caters to growing children who need to be protected against sub-optimal food quantity and quality.
Issues like adulterated oils, pulses, grains, dairy products, sweets etc, unhygienic Mid-Day Meals (problems of insect and rodent infestation), contamination of heavy metals and other toxic compounds in packaged ready-to-eat food etc are often reported by media. We know about these but may not be aware that all these fall under the purview of food safety. Of course, the regulators need to ensure and facilitate access to safe food, but consuming it and staying alert to avert FBD is our responsibility too.
Mass awareness programmes are a must in India, especially at community levels. As per the National Institute of Nutrition reports, about 80% households cook food twice a day, and more than half serve food hot; many reheat leftover foods. Fewer than 10% of Indian homes have refrigerators, and hence campaigns borrowing heavily from Western countries may not work in our settings. Issues like cross-contamination, reheating, or thawing might be of little relevance in our socio-economically challenged households. We need programmes catering to local issues and providing local pragmatic solutions.
Several niche initiatives, programmes and policies by Food Safety and Standards Authority of India (FSSAI) have been rolled out like the Safe and Nutritious Food campaign, Indian Food Sharing Alliance, banning the use of unsafe packaging material, including newspapers, non-biodegradable plastics, Prevention of Food Adulteration Act etc. But their coverage, quality and regular monitoring for rigorous implementation need to be enhanced by leaps and bounds.
The National Nutrition Strategy 2017 prepared by the Niti Aayog as well as the Poshan Abhiyaan also endorse that food safety, clean water and sanitation need to be dovetailed with other aspects of food security. The trained capacity to handle the workload needs to be strengthened. Even the WHO’s ‘Five keys for safer food’ campaign comprising of personal hygiene, adequate cooking, avoiding cross-contamination, keeping food at safe temperatures, and avoiding food from unsafe sources, exists but implementation in our country by all food manufacturers and/or sellers is questionable. In fact, India needs to strengthen training, education and capacity building across all levels of the value chain, and embed food safety in all nutrition programmes.
Another area of concern is on the rising trends of antibiotic resistance in food borne bacteria. India is one of the largest exporters of animal food products. In 2009, more than 1.6 lakh livestock were affected by bacterial infections. There are high levels of antibiotic resistance in veterinary sectors. This spreads in several ways -- including through consumption of animal products, exposure to raw meat products, and direct contact between animals and humans. Our animal husbandry industry needs to be motivated and regulated to stop overuse of antibiotics to boost the size and growth of animal products. These antibiotics leach into our bodies when we consume the animal products and make us resistant to drugs. Many of the commonly occurring infections are increasingly becoming untreatable. Again, laws exist but stronger enforcement of those could help slow down this menace.
All the above issues become graver when we note that a huge proportion of our population is also food and nutrition insecure. If we ensure food safety, then a lot of the people in that bucket could be prevented from falling in and many others could be pulled out too. Thus, several overlapping and symbiotic components, including but not limited to physical, economic and social access to nutritious balanced diet, clean drinking water, safe environment, and healthcare have a role to play in ensuring food safety and security jointly.
This also therefore creates a need for a stronger coherent inter-sectoral (animal husbandry, human resource development, health, agriculture, women and child development, environment, food processing etc) dialogue, action plan and implementation of accountability. Food safety guidelines and policies should aim to address the entire farm-to-fork consumption continuum using locally acceptable, culturally sensitive and innovative approaches.
Role of research and development in creating evidence based, cost effective strategies for promoting safe and nutritious food at all stages of life is also very critical. Committed resources for encouraging formation and nurturing of multi-disciplinary teams including food technologists, agriculture scientists, economists, public health and nutrition professionals, etc will go a long way in making foods safe and masses food secure in India.
(Dr Shweta Khandelwal, is Head, Nutrition Research and Additional Professor, Public Health Foundation of India (PHFI). Views are personal.)