ACTA VET. BRNO 2004, 73, : 151-153


  Book Review


Foodborne disease: a focus for health education - 2000. World Health Organization, Geneva. 198 p.ISBN 92 4 156196 3.


   The publication has been prepared by Dr Yasmine Motarjemi, Scientist, Food Safety programme, WHO with contribution from Dr A. Moarefi and Mr. M. Jacob. Further 18 international specialists reviewed the book and provided comments and suggestions. The book is the result of collaboration between WHO's Food Safety and Health Education and Health Promotion programmes.

   The book is subdivided in 5 chapters and 2 annexes. The text is accompanied by 13 tables, 12 figures, 27 instructive boxes.

   The book starts with Preface and Introduction justifying the reason for publishing such a book. WHO identified public education and community participation as essential pillars of strategies for improving food safety and for intervening to prevent foodborne diseases. One of the factors contributing to the scant attention to this subject is the insufficient awareness of health-policy makers and medical and health personnel of the health consequences of food contamination and the links between many diseases and food. The purpose of this book is therefore to: raise the awareness of health policy makers of the importance of foodborne diseases for public health and outline the scope of food safety problems; highlight the importance of the education of food handlers and consumers for the prevention of foodborne illnesses; describe approaches used to select health education messages and key behaviour that need to be changed or reinforced; suggest possible partners or channels for implementation and communication, drawing on past experiences and initiatives or existing material as example of how objectives can be achieved.

   On page V the WTO "Agreement on the Application of Sanitary and Phytosanitary Measures" is declared as one of the basic international documents for food safety. This Agreement is in  contradiction with the concept of the book. Obviously, the authors do not know in full the text and implementation documents that have already caused catastrophic and often irreparable consequences due to diseases, including foodborne ones, spreading through international trade. WTO policy is based upon the principle "business first" admitting explicitly a negative effect of the trade, in our case also at the expense of sanitary quality, i.e. food safety. These documents do not recognize words such as "pathogen-free" food or "healthy" animals. Importing countries cannot reject food animals or foodstuffs which are not epidemiologically healthy - not pathogen-free or to ask for the guarantee for foodborne diseases-free status without "scientific justification" !?. For example, they cannot request salmonella-free food import when these agents exist in importing country !

   Chapter 1 demonstrates the task that is before the health sector and describes the extent of the problem of foodborne diseases. It outlines the nature of foodborne diseases, trends, economic implications, emerging pathogens and factors that affect prevalence.

   Chapter 2 gives the reasons why health education in food safety is both necessary and effective. It calls for systematic education and training of professional food handlers, and for increased consumer information. It stresses that food preparation represents the critical stage in the food chain. It describes the experience in industrialized and developing countries. On page 48 there is a following formulation: "Experience has shown that, despite all efforts in agriculture, the production of food of animal origin free from pathogens (first line of defense) is not yet possible, and a large proportion of foodstuffs reaching consumers is contaminated." Unfortunately, this "first line of defence" is dealt with very poorly, almost as non-existent. The whole concept of the book is underestimating the decisive factor of food safety, i.e. preventive and control measures where etiological agents of foodborne diseases start, i.e. at the origin of food production process and of the particular food chain. The education and training at this decisive level is much more demanding and probably therefore they have been left out.

   Chapter 3 explains the complexity of behaviours that have an influence on food safety and describes approaches that have been used in selecting behaviours as the focus for change. Particular emphasis is given to the Hazard Analysis Critical Control Point (HACCP) system, which also has applications for health education about food safety. Again, this chapter is leaving out the "first line of defense" similarly as the above-mentioned system. The approach reminds of "fire brigade" procedures and not the solution of key problems at the primary origin of foodborne diseases.

  Chapter 4 suggests strategies and partners for educational programmes and draws on initiatives from different countries as examples. It describes activities in health, education and tourism sectors as well as the role of food and health inspectors, mass media, food industry and community. In Box 17 on page 105 entitled "WHO recommendations on health surveillance and management procedures for food-handling personnel" there is following sentence: "Pre-employment or routine medical and laboratory examinations of food-handling personnel are not recommended. Instead, resources should be directed towards education and training". There is difficult to understand why world organization responsible for health policy is recommending something that is against professional logic and responsibility. How can education and training prevent and solve the occurrence of persons - subclinical carriers of foodborne disease agents in food processing or manipulating enterprises who are contaminating foodstuffs destined for mass distribution and consumption ? I cannot believe that also WHO is giving the priority to economic aspects at the expense of human health.

  Chapter 5 gives guidance in implementing educational programmes and the infrastructure needed for the design and planning of such programmes, without extending to behavioural sciences and educational methods, for which references to appropriate publications are provided.

  Annex 1 contains a series of tables on the characteristics of following diseases: Aeromonas enteritidis, Bacillus cereus gastroenteritis, botulism, brucellosis, campylobacteriosis, cholera, Clostridium perfringens enteritis,  Escherichia coli infections, listeriosis, salmonellosis, shigellosis (bacillary dysentery), Staphylococcus aureus intoxication, typhoid and paratyphoid fevers, Vibrio parahaemolyticus gastroenteritis, Vibrio vulnificus infection, yersiniosis, viral gastroenteritis, viral hepatitis A, poliomyelitis, amoebiasis (amoebic dysentery), cryptosporidiosis, giardiasis, toxoplasmosis, anisakiasis, ascariasis, trichinellosis, taeniasis (Taenia solium, Taenia saginata), clonorchiasis, fascioliasis, opisthorchiasis and paragonimiasis. The list is not complete (e.g. bovine tuberculosis is missing). This annex represents the most useful part of the book.

  Annex 2 describes the issue of risk communication as an element of health education.

  The Bibliography part consists of 486 literature sources supporting the text and giving hundreds (mainly from the richest countries) of examples related to food safety and education  It is a pity that the authors probably do not know that food safety policy, education and training exist also in Central and Eastern Europe (e.g. in Czech Republic is a unique Veterinary Faculty of Food Hygiene in the world). This misrepresentation reduces international value of this book.

  According to the authors the primary target audience of this book are health policy-makers, the managers of food safety and health education programmes in both public and private sectors, and consumer bodies. The book is also intended for those working in cooperation and development agencies, national and international organizations, academic institutions, non-governmental organizations and all who have responsibility for public health protection and promotion.

  In conclusion, in spite of critical comments, I appreciate that WHO has published this book rich of useful information. It would be desirable to produce a similar book for health education and training dealing with the decisive problems of foodborne diseases, i.e. with so called "first line of defense" - supporting preventive and control measures at field level with the aim to produce healthy, pathogen-free food.     


                                                                                                                Prof.MVDr Vaclav  K o u b a, DrSc.