WHO Initiative to Estimate The Global Burden Of Foodborne ... · for ongoing exchange and communication are few. It is like two people trying to assemble a jigsaw puzzle, each with
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WHOWHOWHOWHOInitiative to EstimateInitiative to EstimateInitiative to EstimateInitiative to EstimateThe Global BurdenThe Global BurdenThe Global BurdenThe Global Burden
Of Foodborne DiseasesOf Foodborne DiseasesOf Foodborne DiseasesOf Foodborne DiseasesMilestones Milestones Milestones Milestones ––––
Year Four of the InitiativeYear Four of the InitiativeYear Four of the InitiativeYear Four of the Initiative
Claudia SteinClaudia SteinClaudia SteinClaudia SteinTanja KuchenmTanja KuchenmTanja KuchenmTanja Kuchenmüüüüllerllerllerller
Food Safety and ZoonosesFood Safety and ZoonosesFood Safety and ZoonosesFood Safety and Zoonoses
Foodborne Diseases Stakeholder DayFoodborne Diseases Stakeholder DayFoodborne Diseases Stakeholder DayFoodborne Diseases Stakeholder Day11 November 201011 November 201011 November 201011 November 2010
• Discuss: 10'
What are your key expectations for this meeting?
• Reporter:Person who has the next birthday!
Two Expectations
Your expectations for TodayGroups of 10
"Diseases commonly transmitted through food":
Bacteria, viruses, parasites, chemicals, bio-toxins
"Burden" = Morbidity, Disability, Mortality & more!
Foodborne Diseases –a global development issue
UN Millennium Development Goals (MDGs)
• 4 out of 8 MDGs –
affected directlyby foodborne diseases
UN Millennium Development Goals (MDGs)
Diseases of poverty:
• Poor food storage & preparation ���� contamination
• Poor food regulatory systems and enforcement
• Diseases may have short duration but frequent ���� high rates of absenteeism and medical expenses
UN Millennium Development Goals (MDGs)
Contributing to child mortality:
• Children particularly vulnerable to contaminated environments, incl. food
• 1.5 million child deaths from diarrhoeal diseases annually
• 'Tip of iceberg' of foodborne diseases
• Diarrhoeal diseases exacerbate malnutrition ����vicious cycle of morbidity & mortality
Food safety is just as important as food security
Food security withoutfood safety can cause
great harm
• Malnourished people are morevulnerable to foodborne diseases & more likely to die
• Contaminated food is rarely discarded in famine situations
2006 WHO Consultation to Develop a Strategy to Estimate the
Global Burden of Foodborne Diseases –
"What doesn't get "What doesn't get "What doesn't get "What doesn't get measured, doesn't measured, doesn't measured, doesn't measured, doesn't
get done"get done"get done"get done"
"How else to "How else to "How else to "How else to assess assess assess assess
effectiveness of effectiveness of effectiveness of effectiveness of food safety policies food safety policies food safety policies food safety policies & interventions?"& interventions?"& interventions?"& interventions?"
Recommendation 10Recommendation 10Recommendation 10Recommendation 10: : : : WHO to lead efforts & WHO to lead efforts & WHO to lead efforts & WHO to lead efforts &
appoint appoint appoint appoint Foodborne Foodborne Foodborne Foodborne Disease Burden Disease Burden Disease Burden Disease Burden
Epidemiology Epidemiology Epidemiology Epidemiology Reference Group Reference Group Reference Group Reference Group
(FERG)(FERG)(FERG)(FERG)
GoalGoalGoalGoal of Initiative: Provide of Initiative: Provide of Initiative: Provide of Initiative: Provide data & tools to enable data & tools to enable data & tools to enable data & tools to enable policypolicypolicypolicy----makers & other makers & other makers & other makers & other
stakeholders to set stakeholders to set stakeholders to set stakeholders to set evidenceevidenceevidenceevidence----based priorities in based priorities in based priorities in based priorities in food safety at country levelfood safety at country levelfood safety at country levelfood safety at country level
What is the FERG?
FERG = scientific expert group appointed by & advising the WHO Director General
• transparent selection process after public call for experts
• representing all regions of the world (North & South)• multi-disciplinary and multi-sectoral
• To provide estimates on the global burden of all relevant foodborne diseases, according to age, sex and regions
• To assist WHO to strengthen the capacity of countries to conduct burden of foodborne diseases studies & policy situation analyses
• To assist WHO in bridging the gap between collection of scientific evidence and food safety policy making.
What are the objectives of FERG?
FERG FERG FERG FERG –––– composition & processcomposition & processcomposition & processcomposition & process
WHO SecretariatWHO SecretariatWHO SecretariatWHO SecretariatCore or Core or Core or Core or
Steering groupSteering groupSteering groupSteering group Thematic Thematic Thematic Thematic Task ForcesTask ForcesTask ForcesTask Forces
1.1.1.1. Burden of Disease expert (Chair)Burden of Disease expert (Chair)Burden of Disease expert (Chair)Burden of Disease expert (Chair)2.2.2.2. Food & Agriculture OrganizationFood & Agriculture OrganizationFood & Agriculture OrganizationFood & Agriculture Organization3.3.3.3. Epidemiologists & expert scientists in:Epidemiologists & expert scientists in:Epidemiologists & expert scientists in:Epidemiologists & expert scientists in:
Microbiology/enteric diseasesMicrobiology/enteric diseasesMicrobiology/enteric diseasesMicrobiology/enteric diseasesChemicals/ToxicologyChemicals/ToxicologyChemicals/ToxicologyChemicals/ToxicologyParasitic diseasesParasitic diseasesParasitic diseasesParasitic diseasesZoonotic diseases Zoonotic diseases Zoonotic diseases Zoonotic diseases Cause attributionCause attributionCause attributionCause attributionDisease modelingDisease modelingDisease modelingDisease modeling
Ad-hoc resource experts
1. Enteric diseases2. Parasitic diseases3. Chemicals & toxins4. Source attribution5. Country Studies
• Burden of disease• Knowledge translation
External expertsExternal expertsExternal expertsExternal experts
Spot the FERG members!
FBD Burden - Action framework
Strategic framework
Assembling Assembling Assembling Assembling existing evidenceexisting evidenceexisting evidenceexisting evidence
Country studiesCountry studiesCountry studiesCountry studiesCountry Country Country Country BoDBoDBoDBoDcapacity builtcapacity builtcapacity builtcapacity built
Tools for countries to Tools for countries to Tools for countries to Tools for countries to assess effectivenessassess effectivenessassess effectivenessassess effectiveness
Burden of FBD Burden of FBD Burden of FBD Burden of FBD Country Study ProtocolsCountry Study ProtocolsCountry Study ProtocolsCountry Study Protocols
Capacity building Capacity building Capacity building Capacity building Modules Modules Modules Modules
for conducting studiesfor conducting studiesfor conducting studiesfor conducting studies
Food Safety Policy Food Safety Policy Food Safety Policy Food Safety Policy Situation AnalysesSituation AnalysesSituation AnalysesSituation Analyses
Capacity building Capacity building Capacity building Capacity building Modules Modules Modules Modules
Tools for systematicTools for systematicTools for systematicTools for systematicburden of FBD studiesburden of FBD studiesburden of FBD studiesburden of FBD studies
Tools & mechanisms Tools & mechanisms Tools & mechanisms Tools & mechanisms facilitating facilitating facilitating facilitating
research upresearch upresearch upresearch up----taketaketaketake
for using for using for using for using BoDBoDBoDBoD datadatadatadata
ExchangeExchangeExchangeExchange
How to bridge the gap between researchers and policy-makers ?
WHO‘s Mission
„…shall be the attainment by all peoples of the highest possible level of health.“
Source: WHO‘s Consitution
WHO‘s Mission
It is responsible for:
• providing leadership on global health matters,
• shaping the health research agenda,
• setting norms and standards,
• articulating evidence-based policy options,
• providing technical support to countries, and
• monitoring and assessing health trends.
ResearchersResearch production
Policy-makersResearch utilisation
How to integrate research into policy ?
Linear Process
Peer-reviewed article
Global Atlas & Report
Two distinct communities
•‘Scientific’ (context free)
• Colloquial (contextual)
• Proven empirically
• Anything that seems reasonable
• Theoretically driven
• Policy relevant
• As long as it takes
• Timely
• Caveats
• Clear Message
Evidence
Evidence
Researchers'
Policy-makers'
Two distinct communities
•‘Scientific’ (context free)
• Colloquial (contextual)
• Proven empirically
• Anything that seems reasonable
• Theoretically driven
• Policy relevant
• As long as it takes
• Timely
• Caveats
• Clear Message
Evidence
Evidence
How to integrate research into policy ?
Researchers'
Policy-makers'
"...efforts by researchers and by decision makers seem to proceed largely independently.
Both have their own (often misplaced) ideas about the other's environment. Opportunities
for ongoing exchange and communication are few.
It is like two people trying to assemble a jigsaw puzzle,
each with half the pieces but each working in a separate
room."
Lomas J. Research and evidence-based decision making. Aust N Z J Public Health. 1997;21:439–441.
"...efforts by researchers and by decision makers seem to proceed largely independently.
Both have their own (often misplaced) ideas about the other's environment. Opportunities
for ongoing exchange and communication are few.
It is like two people trying to assemble a jigsaw puzzle,
each with half the pieces but each working in a separate
room."
Lomas J. Research and evidence-based decision making. Aust N Z J Public Health. 1997;21:439–441.
Various factors
influencing policy-making
Re se a rch
Pro
ble
ms
How to increase research up-take?
Pol
icy
Pol
icy
Research
Research
Capacity building Capacity building Capacity building Capacity building ModulesModulesModulesModules
for conducting studiesfor conducting studiesfor conducting studiesfor conducting studies
Tools for systematicTools for systematicTools for systematicTools for systematicburden of FBD studiesburden of FBD studiesburden of FBD studiesburden of FBD studies
Tools to increase reTools to increase reTools to increase reTools to increase re----search impact search impact search impact search impact
on policyon policyon policyon policy
ResearchersResearchersResearchersResearchers PolicyPolicyPolicyPolicy----makersmakersmakersmakers
Efforts to increase the up-take of evidence in policy-making
TrustTrustTrustTrust
UnderstandingUnderstandingUnderstandingUnderstanding
Need to institutionalisedialogue and exchange
Facilitate useFacilitate useFacilitate useFacilitate use
Within the CSTF
(KTPG)
Country level
(Platforms)
Capacity building Capacity building Capacity building Capacity building ModulesModulesModulesModules
for conducting studiesfor conducting studiesfor conducting studiesfor conducting studies
Tools for systematicTools for systematicTools for systematicTools for systematicburden of FBD studiesburden of FBD studiesburden of FBD studiesburden of FBD studies
Tools to increase reTools to increase reTools to increase reTools to increase re----search impact search impact search impact search impact
on policyon policyon policyon policy
ResearchersResearchersResearchersResearchers PolicyPolicyPolicyPolicy----makersmakersmakersmakers
Efforts to increase the up-take of evidence in policy-making
TrustTrustTrustTrust
UnderstandingUnderstandingUnderstandingUnderstanding
Need to institutionalisedialogue and exchange
Facilitate useFacilitate useFacilitate useFacilitate use
Within the CSTF
(KTPG)
Country level
(Platforms)
Mandate of the FERG 'Knowledge Translation and Policy Group'
Goal
improve global public health by making
food safety policies and practices more
evidence informed.
Strategies1. advise and support the FERG in (i) conceptualizing
and designing policy-relevant tools and methods, and (ii) engaging with global stakeholders to foster their commitment to food safety;
2. advise and support FERG selected country research teams in producing, accessing, packaging, and communicating evidence required for influencing food safety policies and practices; and
3. advise and support FERG selected national teams of food safety stakeholders in demanding, accessing and using evidence required for food safety policies and practices.
Capacity building Capacity building Capacity building Capacity building ModulesModulesModulesModules
for conducting studiesfor conducting studiesfor conducting studiesfor conducting studies
Capacity building Capacity building Capacity building Capacity building Modules Modules Modules Modules
Tools for systematicTools for systematicTools for systematicTools for systematicburden of FBD studiesburden of FBD studiesburden of FBD studiesburden of FBD studies
Tools for increasing reTools for increasing reTools for increasing reTools for increasing re----search impact search impact search impact search impact
on policyon policyon policyon policy
for using for using for using for using BoDBoDBoDBoD datadatadatadata
ResearchersResearchersResearchersResearchers PolicyPolicyPolicyPolicy----makersmakersmakersmakers
Efforts to increase the up-take of evidence in policy-making
ReliableData
Improving “usability”(Relevance,
time and simplicity)
Effective access to
Data
Effective & targeted
communication
Increase BoD
understanding and use
TrustTrustTrustTrust
UnderstandingUnderstandingUnderstandingUnderstanding
Need to institutionalisedialogue and exchange
Facilitate useFacilitate useFacilitate useFacilitate useIncentives to use Data
Expected Results(among others)
Global Programme on Evidence for Health Policy
Quoted in Cook, E.T. (1913), The Life of Florence Nightingale, (London: Macmillan), volume 2, p.396, and cited by
J.Maindonald and A.M.Richardson, This Passionate Study: a Dialogue with Florence Nightingale, Journal of Statistics
Education ,Volume 12, Number 1 (2004).
I collected my figures with a purpose in mind, with the idea that they could be used to argue for change. Of what use are
statistics if we do not know what tomake of them? What we wanted at that time was not so much
an accumulation of facts, as to teach the men who are to govern the country the use of statistical
facts. (Florence Nightingale)
Alliance of current partners & collaborators
• US Department of Agriculture, FSIS (technical & $ support)
• US Food and Drug Administration, CFSAN (technical & $ support)
• Netherlands Ministry of Health, Sports & Welfare ($ support)
• Japanese Ministry of Health, Labour and Welfare ($ support)
• US Centers for Disease Control & Prevention (technical & $ support)
• Government of the Federal Republic of Germany (JPO to Secretariat)
• Government of the UK, Department of Health (3 secondments to Secretariat)
• Government of the Republic of Ireland (2 secondments to Secretariat)
• UN & other internationals (FAO, OIE, IARC, UNEP, WTO, World Bank)
• Multiple topic-relevant networks & institutes (e.g GFN, Med-Vet-Net, Int Collab of BoI studies, European CDC, Institute for Health Metrics and Evaluation)
In discussion process with:• Bi-laterals, multi-laterals, Foundations etc
Alliance of current partners & collaborators
• US Department of Agriculture, FSIS (technical & $ support)
• US Food and Drug Administration, CFSAN (technical & $ support)
• Netherlands Ministry of Health, Sports & Welfare ($ support)
• Japanese Ministry of Health, Labour and Welfare ($ support)
• US Centers for Disease Control & Prevention (technical & $ support)
• Government of the Federal Republic of Germany (JPO to Secretariat)
• Government of the UK, Department of Health (3 secondments to Secretariat)
• Government of the Republic of Ireland (2 secondments to Secretariat)
• UN & other internationals (FAO, OIE, IARC, UNEP, WTO, World Bank)
• Multiple topic-relevant networks & institutes (e.g GFN, Med-Vet-Net, Int Collab of BoI studies, European CDC, Institute for Health Metrics and Evaluation)
In discussion process with:• Bi-laterals, multi-laterals, Foundations etc
US$ 4.3 million raised to
date
Further US$ 3.5 million
required
Is this really necessary….?
• A lot of ground work never tackled before
• Many causes to be quantified
• Need to make link between causes and food
Chemicals and Toxins
Elemental contaminants
Lead, mercury, cadmium, manganese, arsenic
Mycotoxins
Aflatoxins, ochratoxin, fumonisin, trichothocenes
Food additives
Sulphites, nitrites/nitrates, benzoic acid
Pesticides
Organophosphates, carbamates, DDT, pyrethrins
Organic industrial contaminants
POPs, e.g. Aldrin, Dieldrin, Heptachlor, dioxins, PCBs, perchlorate, perfluorinated compounds
Veterinary drugs/residues
Antibiotics, hormones - but not antimicrobial residues
Seafood toxins
Tetrodotoxin, ciguatera, shellfish toxins, DSPs, PSPs, histamines in tuna
Process contaminants
Acrylamide, PAHs, choropropanol
Allergens
Peanuts
Natural toxicants
Cyanide in cassava, aminoglycosides
Radionuclides and depleted uranium
Is this really necessary….?
• A lot of ground work never tackled before
• Many causes to be quantified
• Need to make link between causes and food
Chemicals and Toxins
Elemental contaminants
Lead, mercury, cadmium, manganese, arsenic
Mycotoxins
Aflatoxins, ochratoxin, fumonisin, trichothocenes
Food additives
Sulphites, nitrites/nitrates, benzoic acid
Pesticides
Organophosphates, carbamates, DDT, pyrethrins
Organic industrial contaminants
POPs, e.g. Aldrin, Dieldrin, Heptachlor, dioxins, PCBs, perchlorate, perfluorinated compounds
Veterinary drugs/residues
Antibiotics, hormones - but not antimicrobial residues
Seafood toxins
Tetrodotoxin, ciguatera, shellfish toxins, DSPs, PSPs, histamines in tuna
Process contaminants
Acrylamide, PAHs, choropropanol
Allergens
Peanuts
Natural toxicants
Cyanide in cassava, aminoglycosides
Radionuclides and depleted uranium
Enteric pathogens
Adenovirus
Aeromonas
Astrovirus
Bacterial toxins (Bacillus ceerus)
Bacterial toxins (C perfringens)
Bacterial toxins (S aureus)
Brucella sp.
Campylobacter sp.
Clostridium botulinum
Cryptosporidium sp.
Cyclospora sp.
EAggEC
Entero-pathogenic E. coli (EPEC)
Entero-toxigenic E. coli (ETEC)
Enterovirus
Giardia sp.
Helicobacter pylori
Hepatitis A
Hepatitis E
Leptospirosis
Listeria monocytogenes
Mycobacterium bovis
Non cholera Vibrios
Norovirus
Prions
Rotavirus
Salmonella (non-typhoidal) sp.
Salmonella (typhoid)
Shiga-toxin producing Escherichia coli (STEC)
Shigella sp.
Vibrio cholerae O1/ O139
Yersinia sp.
Parasites
Ancylostoma duodenale
Angiostrongylus cantonensis
Angiostrongylus costaricensis
Anisakis simplex
Ascaris lumbricoides
Blastocystis hominis
Capillaria philippinensis
Clonorchis sinensis
Cryptosporidium spp
Cyclospora spp
Dicrocoelium dendriticum
Dientamoeba fragilis
Diphyllobothrium latum
Echinococcus spp.
Echinostoma spp.
Entamoeba histolytica
Fasciola spp.
Fasciolopsis buski
Gastrodiscoides hominis
Giardia intestinalis
Gnathostoma spinigerum
Heterophyes heterophyes
Hymenolepis nana
Isospora belli
Linguatula serata
Metagonimus yokogawai
Nanophytes salmincola
Opisthorchis felineus
Opisthorchis viverrini
Paragonimus spp.
Sarcocystis hominis (LOW priority)
Taenia saginata
Taenia solium
Toxocara spp
Toxoplasma gondii
Trichinella spp.
Trichostrongylus spp
Trichuris trichiura
Achievements to date –first results presented last year (2009)
Could be 1 Could be 1 Could be 1 Could be 1 miomiomiomio
higher than higher than higher than higher than
previously estimated
previously estimated
previously estimated
previously estimated
~18,000 deaths~18,000 deaths~18,000 deaths~18,000 deaths
~30% of epilepsy
~30% of epilepsy
~30% of epilepsy
~30% of epilepsy
1111----2% of 2% of 2% of 2% of populationpopulationpopulationpopulation
Achievements to date – burden resultsin peer-reviewed literature
Stakeholder recommendations 2009:implementation by WHO
• Aims– Provide overall verdict of progress made
– Identify what is going well (and must continue)
– Identify what would benefit from improvements or change
• Methods– Obtain views of FERG experts and stakeholder groups
• Questionnaire survey of FERG experts (46)
• Semi-structured interview of FERG experts (15) and stakeholders (5)
External mid-term evaluation
Thank you very much for your participation!
Results are truly anonymous to Secretariat
• Overall verdict
– Initiative progressing very well
– Initiative extremely important
– Leadership and management by WHO Secretariat exceptional
– Some threats identified which should be addressed (e.g.
Secretariat staffing, administrative processes)
– Some areas could potentially be enhanced (comms media,
travel service, revision of time frames)
Preliminary results
Enter the stakeholders
• WHO member states
• Bi/multi-lateral donors
• NGOs
• Consumer groups
• Industry
• Public & scientific media
What is the purpose of this stakeholder
meeting?
• Actively engage with the research conducted & FERG
• Open new channels for multi-sectoral technical cooperation
• Provide direct input into relevance of country studies
Stakeholder roles
at the meeting
• Suggest how country studies best meet
stakeholder needs
• Suggest how WHO
can bridge the
evidence-policy gap
• Suggest how collaboration in this
area can be improved
• Other suggestions!
For consideration inFor consideration inFor consideration inFor consideration inFERG plenaryFERG plenaryFERG plenaryFERG plenary12 November12 November12 November12 November
Extending the alliance of partners –get involved!
• Consider whether and how the Initiative is relevant to your work
• Consider how and to what extent you wish to engage with WHO and contribute to the outcome of the Initiative
• Expert scientific/technical input into Initiative
• Expansion of expert network & raising awareness of FERG
• Peer-review feedback on work of FERG
• Other practical inputs:
• Human resources to Initiative
• Funding for Initiative
What kind of input could be provided?
Global Programme on Evidence for Health Policy
ThankThankThankThank You.You.You.You.
Now would youNow would youNow would youNow would youplease closeplease closeplease closeplease closemy fridge my fridge my fridge my fridge ––––my food will my food will my food will my food will otherwise beotherwise beotherwise beotherwise beunsafeunsafeunsafeunsafe…………
Round 2:Round 2:Round 2:Round 2:Burden resultsBurden resultsBurden resultsBurden results
of selected causesof selected causesof selected causesof selected causes
1.1.1.1. AflatoxinAflatoxinAflatoxinAflatoxin contaminationcontaminationcontaminationcontamination2.2.2.2. Foodborne Foodborne Foodborne Foodborne TrematodesTrematodesTrematodesTrematodes
(parasites)(parasites)(parasites)(parasites)
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