One Health:
A Critical Pathway to
Ensuring
Global Food Safety
Marguerite Pappaioanou, DVM, PhD
CDC Liaison to FDA for Food Safety
The findings and conclusions in this presentation are those of the author and do
not necessarily represent the views of the Centers for Disease Control and
Prevention or the Food and Drug Administration
Several Current Complex Health Problems
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Feeding 7 billion people (and growing numbers) with
nutritious, accessible, affordable food
Impacts of climate change
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Floods, droughts
Changes in reservoir hosts, vectors of disease
Natural and human-made disasters
Urbanization; Land Use and Agricultural Practice
Changes
Access to clean air and drinking water
Non-communicable diseases
Poverty
Biodiversity
Risk of emerging infectious diseases, pandemics
Why One Health?
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Health problems today are complex; caused by
multiple drivers, factors
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No single discipline or sector can do it alone
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Opportunities for prevention, mitigation along a
continuum– multiple sectors and disciplines
essential to solutions
One Health
Is the Collaborative Effort of Multiple
Disciplines
– working locally, nationally, and globally–
to attain optimal health for people, animals,
and our environment.
AVMA-AMA One Health Task Force
Implementing One Health
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Policies
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Impacting on drivers, process, outcome, impact;
resource allocation, communications
Multisectoral /disciplinary health programs
 Providers/treatment/care
 Disease prevention, surveillance, response,
control, treatment
Multisectoral/disciplinary Research
 Multi/Inter Professional Education
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Why Implement One-Health ?
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Achieve improved health for humans, animals, and the
environment– all interconnected-- more effectively and
efficiently
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More efficient use of limited resources
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Cost effectiveness of infrastructure to carry out prevention
Achieve overall good for nation, region, world
Opportunities for One Health
Food Security
Food Safety
Emerging/
Zoonotic
Diseases
Bio- AgroTerrorism
Emergency
Response
Biomedical
Research
Disability
Antibiotic
Resistance
Mental Health
Environmental
Health
Injuries
Occupational
Health
Obesity
Physical Activity
Health
Education
Millenium Development Goals
Source:
UNDP
Goal 8: Develop a Global Partnership for Development
Food Security
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Exists “when all people at all times have access to
sufficient, safe, nutritious food to maintain a healthy
and active life”.
Includes both physical and economic access to food
that meets people's dietary needs and food
preferences.
Three pillars:
 Food availability: sufficient quantities of food available consistently.
 Food access: having sufficient resources to obtain appropriate
foods for a nutritious diet.
 Food use: appropriate use based on knowledge of basic nutrition
and care, as well as adequate water and sanitation.
Food Security
Globalization of the
Food Supply
Global Poultry Exports
Air Routes
Imported Foods and Entry Lines to the US
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Imported food entry lines has doubled
 4.4 M in 2002
 8.6 M in 2010
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As of 2011, ~ 15% of all food products consumed in
the US were imported
 20% of fresh vegetables
 50% of fresh fruit
 80% of seafood
Food Supply and Globalization
Food Safety
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Assurance that food will not cause harm to the consumer
when it is prepared and/or eaten according to its
intended use (WHO).
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Causes of illness– contamination of food with bacteria,
viruses, parasites toxins, metals, prions
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Symptoms range from mild to severe and life threatening
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Range of food related activities with respect to foodborne
illness -- from prevention and surveillance to detection
and control
Ensuring Food Safety and
Defense
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Surveillance
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Detection
Assessing magnitude of
the problem
Outbreak investigation
 Response/mitigation
 Prevention
 Regulatory Systems
 Capacity Building
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Estimates of Burden of Foodborne Illness
(Morbidity, Mortality, Economic Costs
2011 Estimates)
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Canada (32.5 M people)
 1 in 8 Canadians (4 Million people) domestically acquired/yr
 Cost ~ $12-14 B annually
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The United States (300 M people)
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1 in 6 Americans (48 M people) with foodborne illness
~ 128,000 hospitalized
~3,000 people die
Cost ~ $77.7 B (individual costs) annually
Globally (WHO) (7 B people)
 1/3 of global population (2 billion people)
 1.5 billion cases of diarrhea in children < 5 yrs/year,
 > 3 M premature deaths
Scallan, et al, EID 2011; Thomas et al, Foodborne pathogens and disease 2013
International Costs of Foodborne Illness
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Loss of trade (commodities– produce, livestock, etc.)
Loss of food
Loss of tourism
Public Health Surveillance costs
Outbreak investigations
Clean-up
Global Food System – “Farm to Fork”
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Food production systems to feed growing human
population at affordable cost (produce, nuts, meat,
aquaculture, processed foods)
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Land, Water, Climate change
Animal feed, fertilizers, pesticides, antibiotics?
Markets – local, national, international, role of small holders, women
Livestock housing, animal welfare considerations
Genetics, genomics, seeds, animal and plant health, emerging food
pathogens
Transportation: To Processers, Distributers, Retailers,
Food Stores, Marketing
Agricultural investments
Economic crises, Rising Food Prices, Political turmoil
and unrest
Supply chain risks
How contamination of foods occurs
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Fields fertilized with untreated manure, watered with unclean
water
Animals fed contaminated feed
Many bacteria– i.e., Salmonella spp., Campylobacter spp.,
Yersinia enterocolitica, E. coli STEC, can reside in healthy food
animals showing no signs of illness.
These animals can spread the bacteria to other healthy animals
on the farm and during transportation to processing facilities
During processing, the bacteria may cross-contaminate other
foods being processed at the same location.
Food is stored at too high a temperature and for too long
Many different countries supply foods to other countries.
Consumers should also be alert to the potential for crosscontamination in the home.
Challenges for Food Safety Authorities
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Increasing burden of foodborne illness and new
emerging foodborne hazards (healthy animals)
Rapidly changing technologies in food production,
processing and marketing
Developing science-based food control systems with
a focus on consumer protection
International food trade and need for harmonization
of food safety and quality standards
Changes in lifestyles, including rapid urbanization
Growing consumer awareness of food safety and
quality issues and increasing demand for better
information
Source: Assuring Food Safety and Quality: Guidelines for strengthening
national food control systems. FAO/WHO Publication
Food Safety Challenges of
Developing Countries
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Differ by region-- differences in income level, diets, local
conditions, and government infrastructures.
Food producer and the consumer often have a close
connection.
Fewer processed and packaged foods
Most fresh food is traded in traditional markets; street
vendors supply much of the food consumed outside the
home.
Perishable food often prepared and consumed
immediately
Minimal storage of prepared foods.
Food Safety Concerns - Developing Countries
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Inappropriate use of agricultural chemicals
Use of untreated or partially treated wastewater
Use of sewage or animal manure on crops
Absence of food inspection, including meat inspection
Lack of infrastructure, such as adequate refrigeration
Poor hygiene, including a lack of clean water supplies
Roles and Responsibilities-Surveillance, Outbreak
Investigation,
Mitigation/Response, Regulatory
Systems, Prevention
Food Safety
Non-Regulatory Agencies (U.S.)
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HHS/Centers for Disease Control and Prevention
 Foodborne illness surveillance– PulseNet, FoodNET,
FoodCORE, National Outbreak Reporting System (NORS),
National Antimicrobial Resistance Monitoring System (NARMS),
Foodborne Outbreak Online Database (FOOD)
 Epidemiologic outbreak investigations, special studies on
attribution, outbreaks
 EHS-NET (food service establishments, NVEAIS)
 Integrated Food Safety Centers of Excellence
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USDA/Animal and Plant Health Inspection Service,
Veterinary Services
 On the farm food animal disease surveillance, prevention,
control
Food Safety-- Regulatory Agencies (U.S.)
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HHS/Food and Drug Administration (produce, dairy,
eggs, seafood)
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Regulations, MFRPS, Food Code
Compliance and enforcement
Facility / Food service inspections, investigations
Tracebacks, trace-forwards
Sampling and testing foods
Environmental assessments
Root cause analyses, industry relations
Regulatory science
Subject matter experts, relationships with industry
Food defense
Rapid Response Teams
USDA/Food Safety and Inspection Service (meat)
Tools to Stop Foodborne Outbreaks
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Trace back and trace forward– food vehicles
Communications/sharing information/alerting
consumers
Inspections, sampling, testing
Voluntary Recall
Mandatory Recall
Food Detention
Seizure
Administrative warning letter
Import alerts
Injunction
Criminal Prosecution
Preventing Foodborne Outbreaks
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Healthy animals and crops
Sanitation, clean facilities, equipment
Safe agricultural/food production practices, safe food
processing
Best practices / Educating restaurant managers, food
workers, grocers on food safety and sanitation
measures
Educating consumers, proper food handling at home,
hand washing, cooking
Public/private sector partnerships
Evidence-based, strong regulatory systems
Capacity Building
Farm-to-Table Prevention
Production
Processing
Preparation
and
Cooking
Farmers, Industry, Fishermen,
University Extension, Engineers,
Sanitarians, Veterinarians
Food industry, Food Scientists,
FSIS and FDA (SME, food
inspectors, consumer safety
officers, compliance officers),
State agriculture
Grocers, restaurant owners,
food handlers/preparers, home
cooks, preparers, FDA,
City/County, State Government
Food Safety Legislation - US
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Federal Food, Drug, Cosmetic Act (1938)
Food Safety Modernization Act (FSMA) (2011)
 Recognizes primary responsibility and capacity of food industry to
make food safe
• What the food industry does every day– producers, distributors,
suppliers
• Highlights need for gov’t collaboration with food industry in getting
standards right and providing assurances that standards are met
 Spells out essential and complementary role of government
 Government, Industry Collaboration Key to Success
FDA’s International Food Safety Capacity Building
Plan (FSMA- 305)
• Enhance efficiency across
FDA/FVM Program
• Increase effectiveness
through evidence-based
decision making
• Support exchange of
information between FDA and
foreign government agencies
or other entities
• Enhance technical assistance
and capacity building in food
safety
INTERNATIONAL
ORGANIZATION, ORGANIZATIONS
FOR FOOD SAFETY
International Organizations – Food Safety
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FAO, WHO, OIE
Codex Alimentarius
World Trade Organization
International Organization for Standardization (ISO)
Alliance for Food Security and Nutrition (G8)
Ministries of Health, Agriculture, Commerce
Academia/ Universities – Research, training, extension
Parastatal organizations– NAS/IOM/NRC (US)
Associations -- Not for profit and for profit
 Pew Charitable Trust, Center for Science in the Public Interest,
Institute for Food Technologists, International Association for
Food Protection
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Global Food Safety Initiative
Food producers, processors, retail market
WHO Department of Food Safety and Zoonoses
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Provides evidence-based scientific options for policy
development to protect consumer's health and
managing food safety
Develops mitigation strategies to prevent, control
and contain risks
Sets international standards and promotes their
implementation
Coordinates international efforts to food-related
outbreak surveillance, detection and response
Ensures clear risk communication in support of
foodborne and zoonotic disease prevention
Provides technical support to assist Member States
building sustainable capacity.
WHO Global Foodborne
Infections Network (GFN)
• Capacity-building program
• Promotes integrated,
laboratory-based
surveillance
• Promotes intersectoral
collaboration among
human health, veterinary
and food-related
disciplines
• 184 Member States and
territories; 1062 members
FAO
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Achieving food security for all
 Ensure regular access to high-quality food
for active, healthy lives.
 Improve nutrition, increase agricultural
productivity, raise the standard of living in
rural populations
 Contribute to global economic growth.
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194 Member Nations, two associate
members and one member
organization, the European Union.
Headquarters - Rome
Codex Alimentarius Commission
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Established by FAO and WHO in 1963
Develops harmonized international food standards,
guidelines and codes of practice to protect the
health of the consumers and ensure fair practices in
the food trade.
Promotes coordination of all food standards work
undertaken by international governmental and nongovernmental organizations
185 Member Countries and 1 Member Organization
(EU)
220 observers– 50 IGOs, 154 NGOs, 16 UN
Committees, Task Forces
CODEX Standards
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Codes of Practice (46)
Guidelines (69)
Maximum Residue Limits (MRLs)
Standards (330)
OIE- World Organization for Animal Health
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Intergovernmental organization responsible for
improving animal health worldwide (est. 1924).
 In 2013 -- total of 178 Member Countries
 Maintains permanent relations with 45 other international &
regional organizations; has Regional and sub-regional Offices on
every continent.
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Reference organization of the WTO
 Sanitary Phyto-Sanitary Standards
 Establishes standards (Terrestrial- ; Aquatic Animal Codes,
Biological standards, etc.; veterinary services, competencies)
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2002-- Established permanent Working Group on
Animal Production Food Safety (APFSWG)
 Membership includes internationally recognized experts from
FAO, WHO, Codex Alimentarius Commission (CAC), reflects a
broad geographical basis.
World Trade Organization
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Organization for trade opening
Forum for governments to negotiate trade
agreements
Operates a system of trade rules
Place for governments to settle trade disputes.
Place where member governments try to sort out the
trade problems they face with each other.
Established 1995
159 countries
WTO Agreements
Organization of International
Foodborne/FoodSafety Surveillance
Looking to the Future
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Globalization -- Domestic IS Global; export and
import of foods will only increase
Food Security, Food Safety, Food Defense
Antibiotic Resistance, Food producing animal –
welfare
Impacts of Climate Change
Public-private sector collaboration
Need for Strong Regulatory Systems – all countries
Capacity Building – Applied epidemiology, laboratory
methods (whole genome sequencing, culture
independent methods), regulatory science/systems
One Health!
Multi-Disciplinary Teams– Disciplines, Sectors
• Food Scientists
•
• Environmental Health
•
Specialists/Engineers
• Public health nurses
•
• Physicians
•
• Microbiologists, Toxicologists
• Epidemiologists
•
• Veterinarians
• Consumer Safety Officers
•
• Food and Drug
Investigators/inspectors
• Biostatistitians
•
• Public Health Educators
• Information/communication officers
• Legal/lawyers
Health sector;
National reference
laboratories;
Agriculture, fisheries;
Food/feed safety
sectors;
Local authorities;
Sectors that liaise
with industry, trade
and academia
Other agencies
One Health Core Competencies
Building on technical skills and knowledge of individual disciplines,
sectors
• Systems analysis/thinking (understanding bigger picture,
determinants of illness/disease/health, how multiple sectors are
involved)
• Strong leadership and management skills
• Understanding self-limitations and need for experts from
different fields
• Teams and teamwork- Understanding roles and responsibilities
• Communication for collaboration
• Conflict resolution
• Values and ethics
• Creating an enabling environment and advocating change
One Health Education for a One Health Workforce
POLICIES that Create Enabling Environments and Resources
RESEARCH AND EVALUATION
PRACTICE/PERFORMANCE
EDUCATION
What is
Practiced
in any
Setting
What is
Learned
and
Taught
Adapted from D’Amour D. &
Oandasan I. 2005. J
Interprofessional Care Suppl. 1:820.
And further enhancements by Tufts
University and DAI, Inc. of the
USAID/Respond Project
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Prevention
Early detection/DX
Early effective response/mitigation
Stop/control transmission
Effective treatment, care
Efficient use of limited resources
Better Health and Well-Being
Thank you
Questions?
Comments?
The findings and conclusions in this presentation
are those of the author and do not necessarily
represent the views of the Centers for Disease
Control and Prevention