Home Health Best practices for environmental health : environmental pollution, protection, quality and sustainability
Food Security and Protection
STATEMENT OF PROBLEM AND SPECIAL INFORMATION
Food security and protection is: the prevention of contamination of the food flow process by biological, chemical, physical agents, or radionuclear materials, intentionally or unintentionally; the prevention and control of the growth of microorganisms causing foodborne disease once the food stream has become contaminated; and the prevention and control of the spread of foodborne disease when it has occurred. This chapter will bring together considerable information about how to prevent and mitigate these problems by using a systems approach to the flow of the products and a determination of the hazardous points of contact and how to create appropriate interventions. It will not give you all of the technical details which may be found in Handbook of Environmental Health—Biological, Chemical, and Physical Agents of Environmentally Related Diseases, Volume 1. (See endnote 1.)
Food protection has been a concern for at least the last 12,000 years when people came together to plant crops and grow sufficient food to keep the clan from starving. Communities grew and society developed along with the increased quantity of food available. The unintended consequence of this action was the increase in disease potential and the spread of microorganisms from animals to people, since the animals shared habitats with the people. Disease then spread from people to people. The movement of people and resources, throughout recorded time and from place to place, has always resulted in increased levels of disease within the population, sometimes of a pandemic nature. In modern times, even more than in previous times, the flow of food from production to consumption to disposal has led to a substantial increase in the numbers of individuals exposed to foodborne disease, other infectious diseases, and severe environmental concerns related to the air, water, land, and a variety of chemicals.
It is estimated that yearly 48 million Americans became ill with foodborne disease and it was reported that 28,000 of these people were hospitalized and 3000 died. (See endnote 2.) Norovirus is the most frequent organism involved in foodborne disease followed by non-typhoidal Salmonella. (See endnote 2.) It is only because of chance that the numbers are not far higher than estimated yearly. Further, in the last 20-30 years, there has been an increased failure to control the classic zoonoses, such as Brucellosis caused by a bacterium which frequently comes from animals, increased foodborne infections, and livestock pollutants in rapidly growing urban and suburban areas. A potential emergence of new zoonoses, such as bovine spongiform encephalopathy, increasing globalization and trade in livestock and livestock products, greater livestock concentrations in production areas, more varied and intensive feed sources, and a growing interest in raising market animals in suburban and urban lots has developed and poses potentially new hazards to people.
Then add recent major veterinary public health problems as they relate to animals and people including: Nipah virus in Malaysia resulting in human deaths caused by direct contact with infected bats, infected pigs, or people infected with the Nipah virus through close contact; RVF virus causing Rift Valley fever, a mosquito-borne viral zoonotic disease in Egypt causing 200,000 human cases and 600 deaths in 1977; Crimean-Congo hemorrhagic fever, caused by the bites from infected ticks of the Hyalomma species, affecting workers in abattoirs (although this is not a food-transmitted disease, it is an occupational hazard to people working in the food industry); anthrax among domestic and wild animals and causing human disease and death; avian influenza with epidemics affecting poultry flocks and humans with disease and death; and Salmonella Enteritidis, verotoxigenic Escherichia coli and listeriosis, however, most of the human infections come from direct or indirect contact with the blood or organs of infected animals (See endnote 4). Although many of these diseases are appearing more frequently in poor countries of the Third World, it is only a matter of time before they arrive in the United States. (See endnote 3.) In fact, the current H1N1 influenza virus has both avian and pig elements in its genetic code.
In the last 20-25 years, the food supply chain has become increasingly global in nature. In many foreign countries, there is: a lack of awareness of food safety concerns; a lack of integration of food safety into the primary care system; inadequate information and ability to diagnose potential disease and contamination problems; inadequate food laws; and inexperienced and poorly trained personnel to evaluate food safety activities. All of these have led to an increased potential for food- borne and waterborne disease.
Since food, its ingredients, and the water used to process it may reach a mass audience, it is a perfect vehicle for terrorists to disseminate biological, chemical, or physical agents, or radionuclear materials. (Water in bottles is included as a food.) It seems logical that purposely contaminated food could lead to massive illness and death. An example of a bioterrorist attack in the United States occurred in 1984 when followers of the Indian guru Bhagwan Shree Rajneesh were in conflict with local people politically and caused a food poisoning outbreak affecting 751 people in Dallas, Oregon, by introducing Salmonella contamination into salad bars at 10 local restaurants, to keep people away from the polls.
Unintentional contamination of food has led to massive outbreaks of disease, such as Salmonella typhimurium contamination of milk causing over 150,000 illnesses in 1985 in the United States (See endnote 5) and E. coli O157:H7 contamination of radish sprouts in Japan causing 8000 illnesses with several children dying. Toxic chemicals including pesticides, mycotoxins, heavy metals, and other toxic substances can cause severe reactions and death. Physical agents such as glass, needles, metal fragments, etc. can cause disease or injury. Radionuclear agents are typically radioactive chemicals capable of causing injury or death when present at hazardous levels or lower levels over a period of time.
Such contamination could also cause enormous financial costs and panic in a given population, thereby spreading fear locally, regionally, nationally, and globally. Public health systems would then be inundated and have great difficulty in functioning in an effective manner.
In addition, it is estimated that 20% of the population is over the age of 60. These people are more susceptible to certain types of infections because of chronic illness and a reduced immune response due to the use of certain prescription drugs, radiation, therapy and existing infections.
The public is consuming far more prepared foods outside the home in restaurants and other facilities. New microorganisms will be found in the global food supply. Further, there is a greater emphasis on the use of fruits and vegetables than in prior years and they are apparently becoming more contaminated.
There is a constant turnover of personnel in many food facilities because these are minimum- wage jobs that require low-level skills and education. Workers are not given paid sick leave and therefore come to work when they could infect the food supply. Individuals with little training or understanding of the intricacies of food production and preparation can easily contaminate various parts of the food process including preparation and serving, since some of the workforce may not be trained effectively to prevent disease and injury.
The problems identified by the Food and Drug Administration (FDA) in a recent report on food manufacturing establishments and similar to the ones found in retail food establishments are basically the same as those that the author encountered when he first started in the environmental health field as a practitioner in the state of Pennsylvania and then the City of Philadelphia in 1955 and 1956. The major differences are concerns about allergens affecting people and a sharp increase in the globalization of raw foodstuffs and finished products entering the country and the food supply. There has also been increased concern about the use and abuse of a variety of chemicals including pesticides, fertilizers, etc. Other problems include condensate on pipes and other equipment; contamination of reused products; contamination of raw materials; contamination of the food process line and equipment; use of contaminated water for processing and cooling; hard-to-clean equipment; improper cooling, heating, and time control; improper cleaning and storage of containers; improper or totally lacking regular maintenance and cleaning and sanitization schedules; improper or inadequate cleaning and sanitization materials and techniques; improper design and use of aged equipment; improper pest control; poor facility design; poor ventilation system design and maintenance; improper plumbing, and submerged inlets and back flow; contamination of the finished products; poor personnel hygiene; lack of necessary training and retraining of personnel; lack of adequate supervision and management training for first-line supervisors and managers; inadequate numbers of and training for individuals who need to respond to outbreaks of foodborne disease to contain them; etc. The two leading causes of foodborne illness are the abuse of time and temperature activities and improper hand washing. (See endnotes 6, 7.)
A potentially extremely serious problem revolves around protecting the food supply during temporary events which have massive audiences. This includes football games, baseball games, other sporting events, state fairs, etc. There are a large number of eating facilities in areas where there may be very poor control of refrigeration, water supply, preparation, and serving by temporary staff, insect, and rodent problems, and sewage problems from a substantial amount of human waste produced in a short period of time or, in the event of a fair, the use of portable toilets, and solid waste disposal.
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