54082_CH1_0001_0012 7/8/08 10:45 AM Page 1 © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. CHAPTER 1 IS AMERICA AT RISK? Sari Edelstein, PhD, RD Chapter Objectives After reading the chapter and reflecting on the contents, you should be able to: 1. Identify the concern for food safety and the presence of food- borne illness in the United States. 2. Articulate an understanding of the term “biotechnology” as it relates to genetically modified food. 3. Determine that food insecurity is a growing problem in the United States. 4. Recognize that the threat of agroterrorism/bioterrorism exists in the United States Key Terms agroterrorism: Includes purposeful adulteration/poisoning of agri- cultural crops and the food supply to cause illness or death. biotechnology: Includes a gene slicing technique that enables sci- entists to insert genes into foods for the purpose of dealing with the environmental stresses the world now poses. bioterrorism: Includes purposeful adulteration/poisoning of food or food sources to cause illness or death. food insecurity: Relates to the access to wholesome, healthy foods. food safety: The pursuit of uncontaminated, unadulterated, clean, wholesome food that is fit for healthy consumption. foodborne illness: A disease that is carried or transmitted to people by food. Pathogens in food can generate infection, intoxication, or intoxification. 1 54082_CH1_0001_0012 7/8/08 10:45 AM Page 2 © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 2 Chapter 1: Is America at Risk? genetically modified foods: Foods that have undergone gene slic- ing or gene replacement. Introduction This book, Food and Nutrition at Risk in America: Food Insecurity, Biotechnology, Food Safety, and Bioterrorism, addresses the strengths and weaknesses of four paramount issues in America’s struggle to provide safe and adequate food and nutrition for all those living within its borders. As we leap into the second decade of the 21st century, we find that providing US inhabitants with “safe and adequate” food has become a daunting task. So daunting, in fact, that we might be on the verge of “crisis management” in our ability to protect our population from pathogens and chemicals that invade our food supply as well as our capability to supply enough affordable food to feed our people. Food and Nutrition at Risk in America takes a four-pronged approach to expose those areas in the food and nutrition domain that have become increasingly vulnerable to the provision of safe and adequate food and nutrition in the United States. These four areas of concern are: food safety, biotechnology and genetically modified foods, food insecurity, and agro/bioterrorism. Food Safety Food safety includes the pursuit of uncontaminated, unadulterated, clean, wholesome food that is fit for healthy consumption. To feed the population safe food, the food should not cause illness upon ingestion or during the hours following ingestion. In short, safe food should not cause a foodborne illness, which is a disease that is carried or transmitted to people by food (FDA, 2006). Food safety can be threatened by biological, chemical, or physical hazards. In Section One of this book, biological foodborne pathogens, their eti- ology, and emerging pathogens in the US food system will be high- lighted for the reader. Disease-causing pathogens in food can generate infection, intoxication, or intoxification for unwitting con- sumers. These illnesses can cause morbidity and mortality at alarm- 54082_CH1_0001_0012 7/8/08 10:45 AM Page 3 © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. Food Safety 3 ing rates. Table 1.1 indicates illness rates from biological foodborne illness in the United States. Table 1.2 gives an account of the current dollars spent by the United States in three of its major governmental offices—US Depart- ment of Agriculture (USDA), US Department of Health and Human Services (HHS), and Environmental Protection Agency (EPA)—on food safety programs. Table 1.3 lists the percentage of respondents who identified various pathogens as the top three causes of food- borne illnesses and the estimated percentage of US foodborne ill- nesses that were actually caused by those pathogens. Figure 1.1 depicts the surveillance rates from 1996 to 2004 of five major foodborne illnesses, and Figure 1.2 indicates the five types of Salmonella infection rates from those years. Chemical hazards in food are linked to paint, lubricants, clean- ing agents, and pesticides while physical hazards include broken glass, metal shavings, and plastic ties. These hazards should not be minimized in their importance of control in the food supply. Food and Nutrition at Risk in America will focus on biological hazards as the major source of foodborne illness in the United States. Table 1.1 Average Annual Hospitalizations and Deaths for Gastrointestinal Illness by Diagnostic Category, National Hospital Discharge Survey, 1992 to 1996 First diagnosis All diagnoses Cause of enteritisa Hospitalizations Deaths Hospitalizations Deaths Bacterial (001–005, 27,987 148b 54,953 1,139 008–008.5) Viral (008.6–008.8) 82,149 0b 132,332 194b Parasitic (006–007) 2,806 82b 5,799 127b Unknown etiology 186,537 868b 423,293 5,148 (009, 558.9) Total 299,479 1,098 616,377 6,608 aICD-9-CM code. bEstimate unreliable due to small sample size. Source: Mead, P.S., Slutsker, L., Dietz, V., McCaig, L.F., Bresee, J.S., Shapiro C., et al. (1999). Food-related illness and death in the United States. Emerging Infectious Diseases Newsletter, Vol. 5, No. 5. Retrieved October 12, 2007, from http://www.cdc.gov/ncidod/eid/vol5no5/ mead.htm. © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 54082_CH1_0001_0012 7/8/0810:45AMPage4 4 Table 1.2 Summary of Inventory for Federal Food Safety Research Fiscal Year 2000, Dollars in 1,000s (Estimated) Research focus HHS USDA EPA Totala Projects Dollars Projects Dollars Projects Dollars Projects Dollars Detection of foodborne hazards 54 23,365 19,846 900 Control of foodborne hazards 8 3,700 51,325 0 Pathogenicity of foodborne microbes 16 7,400 0 0 Antimicrobial/antibiotic resistance/ 8 3,900 8,115 0 susceptibility of foodborne microbes Epidemiology of food-associated 5 200 7,000 2,000 organisms/illness Risk assessment: methods/data 7 3,177 10,011 600 Food handling, distribution, and storage 0 0 12,791 0 Chapter 1: Is America atRisk? Chapter 1:Is Economic analysis 0 0 3,230 0 Total 123,099a 112,318 3,500b 238,917 aThis number includes $81,357 million for National Institutes of Health (NIH), whose research dollars are not allocated until after grant awards are actually made; splits reflect only Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) dollars, and no totals are given by category. bFunding levels for the EPA competitive grants program in fiscal year 2000 that is specifically targeted to drinking water pathogen research have not been determined at this time. Source: USDA Food Safety Research Information Office. (2005). Retrieved September 20, 2007, from http://fsrio.nal.usda.gov/. 54082_CH1_0001_0012 7/8/08 10:45 AM Page 5 © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. Biotechnology and Genetically Modified Foods 5 Table 1.3 Percentage of Respondents Identifying Each Pathogen as among the Top Three Causes of Foodborne Illness and Estimated Percentage of Foodborne Illnesses in the United States Actually Caused by Those Pathogens Percentage of Estimated percentage of respondents listing it foodborne illness in United Pathogen among top three causes States caused by pathogen Salmonella 90 9.7 Escherichia coli 56 1.3 Staphylococcus 36 1.3 Shigella 32 0.6 Campylobacter 18 14.2 Listeria 16 Ͻ0.1 Hepatitis A virus 8 Ͻ0.1 Clostridium 8 1.8 perfringens Norwalk-like virus 5 66.7 Virusesa 467.2 Giardia lamblia 3 1.4 Streptococcus 2 0.4 aThis represents respondents who wrote in “viruses” only; it does not include those who specified Norwalk-like virus. Source: Jones, T.F., & Gerber, D.E. (2001). Perceived etiology of foodborne illness among public health personnel. Emerging Infectious Diseases Newsletter, Vol. 7, No. 5. Retrieved October 12, 2007, from http://www.cdc.gov/ncidod/eid/vol7no5/jones.htm. Biotechnology and Genetically Modified Foods Biotechnology includes a gene slicing technique that enables scien- tists to insert genes into foods for the purpose of dealing with the environmental stresses the world now poses (Bren, 2003). Figure 1.3 illustrates gene slicing. The result is a genetically modified food that should be better able to withstand environmental stresses and pro- vide people with higher quality and quantity of food. More than 50 genetically modified food products have been evaluated by the FDA and were found to be as safe as conventional foods, including canola oil, corn, cottonseed oil, papaya, potatoes, soybeans, squash, sugar beets, sweet corn, and tomatoes. Figure 1.4 depicts the percentage of 54082_CH1_0001_0012 7/8/08 10:45 AM Page 6 © Jones and Bartlett Publishers, LLC. NOT FOR SALE OR DISTRIBUTION. 6 Chapter 1: Is America at Risk? FIGURE 1.1 Relative Rates Compared with 1996 to 1998 Baseline Period of Laboratory-Diagnosed Cases of Infection with Campylobacter, Escherichia coli O157, Listeria, Salmonella, and Vibrio, by Year—Foodborne Diseases Active Surveillance Network, United States, 1996 to 2004 2.0 Vibrio Salmonella Campylobacter Listeria E. coli O157 1.0 0.8 Relative rate Relative 0.7 0.6 0.5 1996–1998 1999 2000 2001 2002 2003 2004 Year Source: CDC. (2005). Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food—10 sites, United States, 2004. (MMWR, Vol. 54, No. 14, pp. 352–356.) Retrieved September 20, 2007, from http://www.cdc.gov/mmwr/preview/ mmwrhtml/mm5414a2.htm#tab.