ACTA VET. BRNO 2004, 73, : 151-153
Book Review
Foodborne disease: a focus for
health education - 2000. World Health Organization,
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
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.