The Least Developed Economies: “The Cold Spots” In the least developed economies, foodborne dis- ease is probably common but largely underreported. We know that diarrhea is the third most important cause of disease burden in low income countries,12 most of which is associated with contaminated food and water. 13 Te exact contribution of foodborne disease to the burden of gastrointestinal disease in developing countries is unknown but will likely increase as communities rapidly gain access to safe water while most of their food remains contami- nated. However, the poorest consumers are to some degree protected from foodborne disease by their limited access to the foods most oſten implicated as the source of foodborne disease (such as livestock products, fish, and leafy vegetables), the short value chains for these products, and indigenous practices (such as fermentation and lengthy cooking) that mitigate risk. Conversely, the poorest are more at risk from


contaminants associated with staple foods, such as aflatoxins (fungal toxins that are especially prob-


Marked by both a high absolute burden of foodborne disease and a high level of concern, middle income countries are what can be called the foodborne disease ‘hot spots.’


lematic in maize, sorghum, and groundnuts). While around 4 billion people in tropical countries have uncontrolled exposure to aflatoxins, most of the known burden (hepatic carcinoma compounded with high rates of hepatitis B infections) is seen in the minority of countries (mainly African) where dietary diversity is low and reliance on staples, par- ticularly maize, is high. Moreover, in the poorest countries it is diffi-


cult to disentangle foodborne disease from the complex of waterborne, vector-borne, contagious,


44 REDUCING AND MANAGING FOOD SCARES


filth-associated, and other diseases of neglect and poverty. In the least developed countries, food safety is apparently not a dominant concern of either the public or policymakers, and atempts to impose food safety regulation may on occasion create more harm (such as by increasing transaction costs and reducing food availability) than benefit.14


The Emerging Economies: “The Hot Spots” Te third and arguably most important set of food safety concerns is seen in emerging economies. Tey are characterized by rapidly growing demand for the riskiest foods (animal source foods and vegeta- bles), rapidly intensifying agriculture to meet these demands, but lagging food governance systems. Marked by both a high absolute burden of foodborne disease and a high level of concern, these coun- tries are what can be called the foodborne disease


“hot spots.” Emerging economies have rapidly changing food


systems, with urbanization creating bigger markets and longer and more complex food chains. In coun- tries where infrastructure is lacking, the growth of cities stimulates urban and peri-urban production of perishable foods, including livestock products and vegetables. Indeed, to promote food security China has actively encouraged agricultural production within city limits.15 Predictably, placing large, dense human populations in close proximity to large, dense livestock populations brings both public health and environmental hazards—risks that are compounded by poor agricultural practices (such as lack of trace- ability and reliance on veterinary drugs to mask poor husbandry) and lack of effective regulation. Te avian influenza pandemic revealed the gen-


erally low levels of biosecurity on farms, as well as the unsanitary conditions in slaughter, processing, and retail facilities in South Asia and Southeast Asia. Other major concerns are farming where industrial pollution is high, the use of gray water (domestic wastewater excluding sewage) is widespread, and management of livestock waste is poor. As a result, biological and chemical hazards are widespread in these systems, as well as the food emerging from them. Most studies of the farms and wet markets of emerging countries reveal high levels of pathogens and contaminants.


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