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      World Health Organization Global Estimates and Regional Comparisons of the Burden of Foodborne Disease in 2010

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          Abstract

          Illness and death from diseases caused by contaminated food are a constant threat to public health and a significant impediment to socio-economic development worldwide. To measure the global and regional burden of foodborne disease (FBD), the World Health Organization (WHO) established the Foodborne Disease Burden Epidemiology Reference Group (FERG), which here reports their first estimates of the incidence, mortality, and disease burden due to 31 foodborne hazards. We find that the global burden of FBD is comparable to those of the major infectious diseases, HIV/AIDS, malaria and tuberculosis. The most frequent causes of foodborne illness were diarrheal disease agents, particularly norovirus and Campylobacter spp. Diarrheal disease agents, especially non-typhoidal Salmonella enterica, were also responsible for the majority of deaths due to FBD. Other major causes of FBD deaths were Salmonella Typhi, Taenia solium and hepatitis A virus. The global burden of FBD caused by the 31 hazards in 2010 was 33 million Disability Adjusted Life Years (DALYs); children under five years old bore 40% of this burden. The 14 subregions, defined on the basis of child and adult mortality, had considerably different burdens of FBD, with the greatest falling on the subregions in Africa, followed by the subregions in South-East Asia and the Eastern Mediterranean D subregion. Some hazards, such as non-typhoidal S. enterica, were important causes of FBD in all regions of the world, whereas others, such as certain parasitic helminths, were highly localised. Thus, the burden of FBD is borne particularly by children under five years old–although they represent only 9% of the global population–and people living in low-income regions of the world. These estimates are conservative, i.e., underestimates rather than overestimates; further studies are needed to address the data gaps and limitations of the study. Nevertheless, all stakeholders can contribute to improvements in food safety throughout the food chain by incorporating these estimates into policy development at national and international levels.

          Abstract

          An overview of foodborne diseases worldwide; part of the World Health Organization’s investigation into the incidence, mortality, and disease burden of foodborne hazards.

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          Most cited references19

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          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          The Lancet, 380(9859), 2224-2260
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            Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study.

            Prevention and control of disease and injury require information about the leading medical causes of illness and exposures or risk factors. The assessment of the public-health importance of these has been hampered by the lack of common methods to investigate the overall, worldwide burden. The Global Burden of Disease Study (GBD) provides a standardised approach to epidemiological assessment and uses a standard unit, the disability-adjusted life year (DALY), to aid comparisons. DALYs for each age-sex group in each GBD region for 107 disorders were calculated, based on the estimates of mortality by cause, incidence, average age of onset, duration, and disability severity. Estimates of the burden and prevalence of exposure in different regions of disorders attributable to malnutrition, poor water supply, sanitation and personal and domestic hygiene, unsafe sex, tobacco use, alcohol, occupation, hypertension, physical inactivity, use of illicit drugs, and air pollution were developed. Developed regions account for 11.6% of the worldwide burden from all causes of death and disability, and account for 90.2% of health expenditure worldwide. Communicable, maternal, perinatal, and nutritional disorders explain 43.9%; non-communicable causes 40.9%; injuries 15.1%; malignant neoplasms 5.1%; neuropsychiatric conditions 10.5%; and cardiovascular conditions 9.7% of DALYs worldwide. The ten leading specific causes of global DALYs are, in descending order, lower respiratory infections, diarrhoeal diseases, perinatal disorders, unipolar major depression, ischaemic heart disease, cerebrovascular disease, tuberculosis, measles, road-traffic accidents, and congenital anomalies. 15.9% of DALYs worldwide are attributable to childhood malnutrition and 6.8% to poor water, and sanitation and personal and domestic hygiene. The three leading contributors to the burden of disease are communicable and perinatal disorders affecting children. The substantial burdens of neuropsychiatric disorders and injuries are under-recognised. The epidemiological transition in terms of DALYs has progressed substantially in China, Latin America and the Caribbean, other Asia and islands, and the middle eastern crescent. If the burdens of disability and death are taken into account, our list differs substantially from other lists of the leading causes of death. DALYs provide a common metric to aid meaningful comparison of the burden of risk factors, diseases, and injuries.
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              From “one medicine” to “one health” and systemic approaches to health and well-being☆

              Faced with complex patterns of global change, the inextricable interconnection of humans, pet animals, livestock and wildlife and their social and ecological environment is evident and requires integrated approaches to human and animal health and their respective social and environmental contexts. The history of integrative thinking of human and animal health is briefly reviewed from early historical times, to the foundation of universities in Europe, up to the beginning of comparative medicine at the end of the 19th century. In the 20th century, Calvin Schwabe coined the concept of “one medicine”. It recognises that there is no difference of paradigm between human and veterinary medicine and both disciplines can contribute to the development of each other. Considering a broader approach to health and well-being of societies, the original concept of “one medicine” was extended to “one health” through practical implementations and careful validations in different settings. Given the global health thinking in recent decades, ecosystem approaches to health have emerged. Based on complex ecological thinking that goes beyond humans and animals, these approaches consider inextricable linkages between ecosystems and health, known as “ecosystem health”. Despite these integrative conceptual and methodological developments, large portions of human and animal health thinking and actions still remain in separate disciplinary silos. Evidence for added value of a coherent application of “one health” compared to separated sectorial thinking is, however, now growing. Integrative thinking is increasingly being considered in academic curricula, clinical practice, ministries of health and livestock/agriculture and international organizations. Challenges remain, focusing around key questions such as how does “one health” evolve and what are the elements of a modern theory of health? The close interdependence of humans and animals in their social and ecological context relates to the concept of “human-environmental systems”, also called “social-ecological systems”. The theory and practice of understanding and managing human activities in the context of social-ecological systems has been well-developed by members of The Resilience Alliance and was used extensively in the Millennium Ecosystem Assessment, including its work on human well-being outcomes. This in turn entails systems theory applied to human and animal health. Examples of successful systems approaches to public health show unexpected results. Analogous to “systems biology” which focuses mostly on the interplay of proteins and molecules at a sub-cellular level, a systemic approach to health in social-ecological systems (HSES) is an inter- and trans-disciplinary study of complex interactions in all health-related fields. HSES moves beyond “one health” and “eco-health”, expecting to identify emerging properties and determinants of health that may arise from a systemic view ranging across scales from molecules to the ecological and socio-cultural context, as well from the comparison with different disease endemicities and health systems structures.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                PLoS Med
                PLoS Med
                plos
                plosmed
                PLoS Medicine
                Public Library of Science (San Francisco, CA USA )
                1549-1277
                1549-1676
                3 December 2015
                December 2015
                : 12
                : 12
                : e1001923
                Affiliations
                [1 ]National Institute for Public Health and the Environment, Bilthoven, The Netherlands
                [2 ]University of Florida, Gainesville, Florida, United States of America
                [3 ]Utrecht University, Utrecht, The Netherlands
                [4 ]The Australian National University, Canberra, Australia
                [5 ]University of Zurich, Zurich, Switzerland
                [6 ]Gibb Epidemiology Consulting, Arlington, Virginia, United States of America
                [7 ]Danish Technical University, Copenhagen, Denmark
                [8 ]Institute of Environmental Science and Research, Christchurch, New Zealand
                [9 ]Institute of Tropical Medicine, Antwerp, Belgium
                [10 ]Boston Children's Hospital, Boston, Massachusetts, United States of America
                [11 ]University of Kelaniya, Ragama, Sri Lanka
                [12 ]Hikma Pharmaceuticals, Amman, Jordan
                [13 ]Université catholique de Louvain, Brussels, Belgium
                [14 ]World Health Organization, Geneva, Switzerland
                [15 ]World Health Organization, Regional Office for Europe, Copenhagen, Denmark
                [16 ]Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
                [17 ]Ghent University, Merelbeke, Belgium
                Mahidol-Oxford Tropical Medicine Research Unit, THAILAND
                Author notes

                AHH, MDK, PRT, HJG, TH, RJL, NP, FJA, DB, NdS, NG, NS, and BD serve as members of the World Health Organization advisory body—the Foodborne Disease Burden Epidemiology Reference Group—without remuneration. The authors declare no competing interests.

                Wrote the first draft of the manuscript: AHH BD. Contributed to the writing of the manuscript: AHH MDK PRT HJG TH FJA RJL NP DB NdS NG NS AC CM CS BD. Agree with the manuscript’s results and conclusions: AHH MDK PRT HJG TH RJL NP FJA DB NdS NG NS AC CM CS BD. All authors have read, and confirm that they meet, ICMJE criteria for authorship.

                ¶ Membership of the World Health Organization Foodborne Disease Burden Epidemiology Reference Group is provided in the Acknowledgments.

                Article
                PMEDICINE-D-15-02427
                10.1371/journal.pmed.1001923
                4668832
                26633896
                58def9c2-fd2c-4712-a6f3-b7bfcd509350

                2015 World Health Organization. This is an open access article distributed under the Creative Commons Attribution IGO License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/3.0/igo/. This article should not be reproduced for use in association with the promotion of commercial products, services or any legal entity.

                History
                Page count
                Figures: 5, Tables: 4, Pages: 23
                Funding
                This study was commissioned and paid for by the World Health Organization (WHO). Copyright in the original work on which this article is based belongs to WHO. The authors have been given permission to publish this article.
                Categories
                Collection Review

                Medicine
                Medicine

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