April 10, 2015

Guest Commentary - Healthy Foods Must Be Nutritious, Safe, and Fair

By John McDermott and Delia Grace

Food safety is a growing concern locally and globally. High-profile food scares in recent years, in rich and emerging countries, have raised awareness that healthy eating must be safe eating.

Unfortunately, the most nutritious foods are often the least safe.  Vegetables and fruits are often grown with highly contaminated wastewater; when eaten raw, the risks are high. Livestock and fish products are common causes of foodborne illness, yet are also critical for children’s cognitive development and growth. Developing countries are seeing a boom in the production and consumption of fresh foods, with most of the world’s milk now drunk in India and pork eaten in China. But could this boom in fresh food consumption bring a boom in foodborne disease?Foodborne infections currently cause millions of illnesses, many of them not reported. One study found that for every additional 10kg of meat eaten per person per year, deaths from food borne disease went up by 6 percent (Henson et al., 2012).

Different solutions for different contexts 

In an increasingly globalized world, there are dramatic differences in food systems. Policymakers and the public often assume that one universal system should apply everywhere. But what is good for the rich may be bad for the poor and vice versa: we argue that to provide nutritious, safe, and fair food to all, food safety systems must be tailored for different national and sub-national contexts.  

High-income countries – the worried well

In high-income countries, consumers may worry about food safety but the most serious health problems from food are now syndromes linked to overconsumption rather than infections. As the incidence of infectious diseases in high-income countries has declined, concern about food safety has grown, with both experts and consumers increasingly averse to the mass-produced, mass marketed, heavily processed foods that dominate markets. Food systems need to supply food that continues to be safe but is better at supporting a healthy diet and respecting human values such as local production and animal welfare.

Middle-income countries – dynamic food safety hot spots

In the emerging middle-income countries, there is unprecedented growth in food production. This all too often leads to heavy reliance on chemicals—whether antimicrobials in intensifying livestock production or pesticides for vegetables and fruits—to compensate for poor practice. Many food businesses take shortcuts to make profits; a notorious example being the milk scandal in China when dangerous melamine was added to infant food (Grace and McDermott, 2015). Consumers in countries such as China have little faith in the food safety system and consistently cite food safety and environmental pollution as two of their greatest concerns. In these countries, food systems can lever consumer demand to force businesses to impose private standards, which the public sector can oversee. Where trust is low, verification must be high. Effective standards will require greater transparency in the food system and would be greatly helped by inexpensive tests for direct verification of food safety.

Low-income countries – working with traditional wet markets

In low-income countries (and large parts of emerging economies), most fresh foods are produced by smallholders and sold in wet markets. The millions of farmers and thousands of market agents who participate in these markets are difficult to monitor and regulate.  Rules and regulations are often seen as barriers to be avoided or taxes to be paid. In fact, regulations may paradoxically worsen food safety, as vendors are forced into more informal markets to avoid them (Grace et al., 2008).

This challenge has led to innovative approaches to planning and implementing food safety in informal markets such as the Safe Food Fair Food program which we were involved in. This program focused on livelihood opportunities as well as food safety. For example, milk sold in the traditional sector in Kenya often did not meet microbial standards, but because it was consumed quickly or boiled, the risk of diseases was low. By marshaling evidence on the high economic benefits of the traditional milk sector as well as the low health risks, policymakers agreed to support this sector (Kaitibie et al., 2010).

Lessons for safer food systems

Three principle lessons for adapting food safety systems come from our experience. The first is that incentives matter and must be aligned with policy objectives. Where people are paid on test results, there will be temptation to game these rather than meet the standards so that rewards follow genuinely safer food.

The second lesson is that risk management, not hazard avoidance, must guide food safety systems. There will always be some hazards in foods, but where health risks are low, the nutritional and livelihood benefits of traditional food systems often warrant their support.

Thirdly, developing capacity is critical. Food safety governance, management, and routine practices are weak in much of the world. As food systems become more complex, the capacities of actors in supply chains will need to change.

Creating the policy, regulatory, and enabling environment for balancing nutrition, safety, sustainability, and fairness for truly healthier food systems is both critical and challenging.

Considering incentives, risk, and capacity can help governments facilitate the development of food systems that are safer, fairer, and more nutritious for their people.   

John McDermott is director, CGIAR Research Program on Agriculture for Nutrition and Health (A4NH), International Food Policy Research Institute, Washington, DC. Delia Grace is lead, Program on Food Safety and Zoonoses, International Livestock Research Institute (ILRI), Nairobi, Kenya.
  • Grace D. and McDermott J. Chapter 6 - Food Safety Reducing and Managing Food Scares. Global Food Policy Report, IFPRI 2015. 
  • Grace D. et al., 2008. City dairying in Kampala: integrating benefits and harms. In: Cole D., Lee-Smith D., Nasinyama G. (Eds) Healthy city harvests: Generating evidence to guide policy on urban agriculture. International Potato Center (CIP) and Makerere University Press.
  • Hanson, L.A. et al., 2012. Estimating global mortality from potentially foodborne diseases: an analysis using vital registration data. Population health metrics, 10(1), p.5
  • Kaitibie, S. et al., 2010. Kenyan dairy policy change: influence pathways and economic impacts. World Development 38(10):1494-1505.


The Global Food and Agriculture Program aims to inform the development of US policy on global agricultural development and food security by raising awareness and providing resources, information, and policy analysis to the US Administration, Congress, and interested experts and organizations.

The Global Food and Agriculture Program is housed within the Chicago Council on Global Affairs, an independent, nonpartisan organization that provides insight – and influences the public discourse – on critical global issues. The Council on Global Affairs convenes leading global voices and conducts independent research to bring clarity and offer solutions to challenges and opportunities across the globe. The Council is committed to engaging the public and raising global awareness of issues that transcend borders and transform how people, business, and governments engage the world.

Support for the Global Food and Agriculture Program is generously provided by the Bill & Melinda Gates Foundation.


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