1
The U.S. Food System

OVERVIEW

Aside from the prospect of terrorism, the U.S. food supply is vulnerable to myriad threats. As Dr. Michael Osterholm observes in the first contribution to this chapter, unintentional foodborne illness kills thousands of people each year in this country and sickens millions more. The vastness and complexity of modern food production provides abundant opportunity for contamination; consider, for example, the intricate path from farm to table taken by processed food products, comprising multiple ingredients from around the world. At the same time, the breadth and swiftness of modern food distribution networks make outbreaks of foodborne illness difficult to detect and all but impossible to contain, as illustrated by the histories of several recent foodborne outbreaks.

Intentionally adulterated food could be delivered to thousands, perhaps millions, of Americans within days. Osterholm notes that such an outright attack on the food supply could cause higher morbidity and mortality, and a far greater economic impact, than is associated with all-too-common outbreaks of accidental foodborne illness. Although most previous acts of foodborne terrorism have involved local attacks staged by lone perpetrators, Osterholm argues that the relative ease by which food could be used to harm societies and economies, as well as individuals, necessitates the development of effective measures to prevent, detect, and respond to potential bioterrorist attacks to the food system. In the course of this process, policy makers will need to assess the risks and benefits of possible safeguards and consider how the costs of safer foods will be borne by the food industry and, ultimately, the public.



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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary 1 The U.S. Food System OVERVIEW Aside from the prospect of terrorism, the U.S. food supply is vulnerable to myriad threats. As Dr. Michael Osterholm observes in the first contribution to this chapter, unintentional foodborne illness kills thousands of people each year in this country and sickens millions more. The vastness and complexity of modern food production provides abundant opportunity for contamination; consider, for example, the intricate path from farm to table taken by processed food products, comprising multiple ingredients from around the world. At the same time, the breadth and swiftness of modern food distribution networks make outbreaks of foodborne illness difficult to detect and all but impossible to contain, as illustrated by the histories of several recent foodborne outbreaks. Intentionally adulterated food could be delivered to thousands, perhaps millions, of Americans within days. Osterholm notes that such an outright attack on the food supply could cause higher morbidity and mortality, and a far greater economic impact, than is associated with all-too-common outbreaks of accidental foodborne illness. Although most previous acts of foodborne terrorism have involved local attacks staged by lone perpetrators, Osterholm argues that the relative ease by which food could be used to harm societies and economies, as well as individuals, necessitates the development of effective measures to prevent, detect, and respond to potential bioterrorist attacks to the food system. In the course of this process, policy makers will need to assess the risks and benefits of possible safeguards and consider how the costs of safer foods will be borne by the food industry and, ultimately, the public.

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary The benefits of modern food production and distribution, which balance the aforementioned risks, are considered in the second paper in this chapter. Dr. Craig Henry demonstrates that increasingly globalized and sophisticated food supply chains have afforded cheaper food for much of the world’s population. He also discusses consumer and demographic trends that affect the food supply, including growing global demand for products that are not only tasty, convenient, and inexpensive, but safe as well. THE FOOD SUPPLY AND BIODEFENSE: THE NEXT FRONTIER OF THE FOOD SAFETY AGENDA Michael T. Osterholm, Ph.D.1 University of Minnesota The interface between the international food supply system and terrorism has the potential to produce a catastrophic impact on both the health of consumers and the availability of and confidence in specific food products. Former Secretary of Health and Human Services Tommy Thompson observed upon his resignation in 2004, “I, for the life of me, cannot understand why the terrorists have not, you know, attacked our food supply, because it is so easy to do” (Branigin et al., 2004). A few months later, Michael Chertoff, Secretary of Homeland Security, said that he “didn’t want to get up in public and say the sky is falling if it is not falling,” and stated that he was going to be “realistic and sensible and serious about the kinds of trade-offs that we have to consider when we are making decisions about protecting ourselves.” Although superficially contradictory, I would argue that these two remarks are consistent. They reflect the recognition that, four years after September 11, 2001, we cannot guarantee the safety of everyone and everything within our borders. We have to make critical decisions about which critical components of our everyday world to accord priority in protection or in response should an attack occur. I believe that the security of our food supply must be at the top of such a list. Lester Crawford, a former commissioner of the Food and Drug Administration (FDA), said in 2002, “To conclude that the use of food as an instrument of terror is unlikely would be looking at the world of today through the prism of the past. The terror of these times is based on a different note on a different scale.” The occurrence of unintentional foodborne illness already kills thousands of people each year in this country and sickens millions more. However, an inten- 1 Director, Center for Infectious Disease Research and Policy; Associate Director, Department of Homeland Security National Center for Food Protection and Defense; Professor, University of Minnesota.

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary tional terrorist attack on the food supply is likely to have very different ramifications in terms of morbidity and mortality, and a far greater economic impact than unintentional foodborne illness. The Food System Figure 1-1, which depicts key global trends between 1850 and the present, places our food system in a historical context. The right vertical axis shows the number of days required to circumnavigate the globe; in 1850 it took approximately one year to accomplish an around-the-world trip; by 1950 that same feat could be accomplished in less than 48 hours. Although the time to circumnavigate the world has been essentially the same since 1950, we now move substantially more people and goods around the world today than we did even 30 years ago. The left vertical axis shows the world’s population in billions; in the past century the world population has grown from less than 1 billion to more than 6.5 billion people. The commensurate growth in need for protein and carbohydrate has important implications for the origins of food and its patterns of consumption. FIGURE 1-1 Speed of global travel in relation to world population. SOURCE: Murphy and Nathanson (1994). Reprinted with permission from Elsevier.

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary Today’s global food system constitutes the world’s most complicated industrial infrastructure. The following framework identifies the major components of the food supply and highlights their vulnerability to intentional harm: Pre-farm inputs include cattle feed, agricultural chemicals such as fertilizers and pesticides, and water supplied for irrigation. Farming practices include intensive animal production (zoonoses2), the raising of animals and crops in close proximity (fecal contamination of plant products), and corporate farming (products are widely distributed). The recent introduction of foot-and-mouth disease in Great Britain serves as an example of the severe effects upon the food supply that can result from a disease that is limited to livestock. Transportation is critical to maintaining the U.S. food supply. This was clearly illustrated when, in response to Hurricane Katrina, the Federal Emergency Management Agency (FEMA) requested that private fleet refrigerated trucks locate themselves in several holding areas in the impacted states of Louisiana and Mississippi so they could be used if needed for cold storage of human bodies and food and ice. Although a limited number of independent truckers—the main movers of goods from wholesale to retail grocery stores—answered the call, a major shortage of overland transportation occurred, resulting in an interruption of the food supply when food failed to be delivered from processors to retail locations. Processing encompasses the preparation of myriad foods in thousands of locations around the globe, any of which represents potential targets for sabotage. Wholesale distribution occurs with such rapidity and over such great distances that the process resembles an aerosol release. In the case of some products, a terrorist could assume overnight delivery of an adulterant to many thousands, if not millions, of people—a product that would be difficult to detect and remove from market before considerable harm was done. Retail includes both groceries and prepared food: a huge and complex system of outlets for an equally vast array of foods, provided by a largely low-paid and transient workforce. This is particularly the case in restaurants, which account for nearly half of all U.S. food expenditures. Most foodborne attacks to date have occurred at this level, or thereafter at the point of consumption. The Global Food Supply The global nature of the U.S. food supply adds further layers of complication to the farm-to-table framework, thereby magnifying concerns for its safety. The U.S. agricultural sector annually produces more than $1 trillion dollars in eco- 2 Zoonoses is defined as “diseases of non-human animals that may be transmitted to man or may be transmitted from man to non-human animals.” (http://cancerweb.ncl.ac.uk/cgi-bin/omd?zoonoses).

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary nomic activity. Agriculture accounts for 13 percent of the U.S. gross domestic product and employs more than 16 percent of the nation’s workforce (USDA, 2005a). In 2004, the nation’s agricultural exports, at $62.3 billion, exceeded agricultural imports by $9.6 billion. The United States is also a major importer of food. Currently, the number of foreign food facilities that have registered with the FDA as required under the Biopreparedness Act of 2002—more than 130,000—outnumbers the number of domestic registrations. Figure 1-2 shows the main regions from which the United States imports significant amounts of several key foods. The supply of these foods may be disrupted by a variety of factors, including variables rarely considered in the United States, such as political instability or the interruption of electrical power. It is also important to note that domestically produced food is no less vulnerable to adulteration than imported products. As Figure 1-3 demonstrates, sanitary standards at some U.S. food production facilities are vastly inferior to others in foreign sites. The global food supply exemplifies cost containment, with the result that food in the United States and throughout much of the world has become increasingly cheaper. Figure 1-4 shows that while the United States spent an increasing amount of money on food over the past two decades, the percentage of disposable income represented by food expenditures has fallen dramatically over the same period. The expectation of inexpensive food as part of the global just-in-time economy means that there is little resiliency in our food supply, however. Food once stored in warehouses for weeks or months is now shipped overnight, around the world, a situation that makes it difficult to detect a contaminated product and remove it from commerce before it is widely consumed; thus today’s food recall typically documents last week’s outbreak. For a terrorist, the number of foods that move from “farm to fork” within days to weeks represents an opportunity. In many instances, an adulterated food could be guaranteed overnight delivery to thousands, if not millions, of Americans. Previous Outbreaks and Attacks The single largest outbreak of salmonellosis documented in the United States to date stands as an example of the potential of a foodborne illness to occur among many thousands of consumers before it is detected. In 1994, ice cream mix produced in a Minnesota plant was shipped before final freezing and packaging as a pasteurized product in trucks that had previously carried raw egg mix without being adequately cleaned. There were more than 200,000 cases of illness among those who ate the ice cream (Hennessy et al., 1996). As is typical in foodborne outbreaks, humans serve as the bioassay for contamination. Routine enteric disease surveillance conducted by the Minnesota Department of Health identified an increased occurrence of cases of Salmonella

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary FIGURE 1-2 The problem: Global food systems. SOURCE: Osterholm (2005).

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary FIGURE 1-3 Identifying the source of food in a global system is challenging. SOURCE: Sholl (2005).

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary FIGURE 1-4 Food expenditures as a share of disposable personal income, United States, 1974–2003. SOURCE: Adapted from USDA (2004). serotype enteritidis infection. An epidemiologic investigation led to the identification of Salmonella serotype enteritidis contamination in selected lots of ice cream. Epidemiologic data provided the only indication that ice cream was the vehicle, as the bacterium was found in less than two percent of samples tested. Nevertheless, despite the low attack rate, a large number of people were sickened because of the large volume of contaminated ice cream. An intentional attack would probably feature higher concentrations of such an agent, with predictably devastating consequences. To date intentional foodborne attacks have not produced a major catastrophe. Instead, they have been largely localized events, staged by individuals. For example, a postgraduate student in parasitology scattered his roommate’s food with the roundworm Ascaris suum; four persons became seriously ill, and two suffered respiratory failure (Phills et al., 1972). Although Ascaris is not an agent of particular concern, this example reminds us that many individuals have access to infectious and noninfectious adulterants that could easily be added to many foods. A well-known incident occurred in Oregon, in 1984, when members of the Rajneesh religious cult contaminated a salad bar with Salmonella, causing 751 illnesses (Torok et al., 1997). This attack was actually a limited “trial run” of a plan to sway an election by incapacitating voters. In 1996, a disgruntled Texas lab worker intentionally contaminated pastries

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary with Shigella dysenteriae and left them for her coworkers to eat. Twelve people became infected (Kolavic et al., 1997); the culprit was ultimately sentenced to 20 years in prison (Ex-lab worker, 1998). As the following examples illustrate, chemical contamination of the food supply may pose an even much greater risk than many biologic agents: In Holland and Germany, in 1978, a dozen children were hospitalized after citrus fruit from Israel was intentionally contaminated with mercury (Khan et al., 2001). In China, in 2001, 120 people became ill after specific food products were laced with rat poison by makers of competing products (Death sentence, 2002a). In 2002, a similar rat poisoning incident killed at least 38 people and made more than 300 seriously ill (Death sentence, 2002a, 2002b). In Michigan, the contamination of 200 pounds of ground beef with insecticide containing nicotine by a disgruntled employee in a supermarket sickened 111 people, including 40 children (CDC, 2003). Foodborne Attack Scenarios Terrorists could achieve mass human casualties by adding a class A bioterrorism agent such as botulinum toxin during the processing or transportation of a variety of vulnerable foods. This is not an artificial scenario, given the previously described account of milk adulteration. It is of grave concern to analysts who have researched its possibility and projected consequences, some of whom feel that such attack scenarios should not be publicly discussed. Economic disruption is a likely outcome of any foodborne attack, and it could be achieved without directly harming humans by spreading pathogens specific to livestock (e.g., foot-and-mouth disease) or crops (e.g., soybean rust). Such diseases could have critical implications for the food supply system. Economic consequences would also likely result from mass anxiety, which could be generated with a credible hoax that targeted popular food products or a popular restaurant. Previous incidents have shown that consumers react intensely to the mere suggestion that a food has been or will be contaminated and may extrapolate an isolated incident of contamination to a nationwide scale. An ideal food or beverage vehicle for a foodborne terrorism attack would have the following characteristics: It would be produced in such a way that a perpetrator would have the ability to adulterate it beyond control steps that would eliminate or disable the potential agent. Although food processes such as heat treatment are designed to deactivate pathogens, most do not specifically target chemical contaminants. It would be a large volume of a widely distributed product, allowing the agent to be disseminated to the largest possible population.

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary It would be able to preserve the agent’s potency until it is consumed. It would be a product that is rapidly distributed and consumed, thus unlikely to be detected until considerable damage is done. The product would be consumed disproportionately by high-risk populations (e.g., children or the elderly). In addition to Clostridium botulinum (botulism) and its toxin, biological agents for such attacks could include Bacillus anthraces (anthrax) and other enteric bacterial species. Gastrointestinal anthrax represents a relatively effective foodborne weapon; while not as deadly as its aerosol counterpart, it can result in significant morbidity, mortality, and economic disruption. Although only 22 cases of anthrax occurred in this country in 2001, those cases resulted in a dramatic impact on the U.S. postal system; even a few cases of food-related anthrax in a single food commodity would do the same, if not more. At the same time, common enteric bacterial species, such as Salmonella, could produce mass illness, as demonstrated by the previous example of the Rajneesh cult attack Such an outbreak may not be recognized as an attack, and therefore fail to cause panic and fear. Chemical adulterants pose an even greater risk to the food supply than many biologic agents. A vast number of potentially deadly chemicals could be introduced into a number of widely distributed foods, to devastating effect. Food Biosecurity In recent years in the United States, food biosecurity has traditionally been defined as the development of effective measures to prevent, detect, and respond to potential bioterrorist attacks to the food system. However, it is important to recognize a more essential, global definition of food biosecurity: the availability of sufficient food. While the United States attempts to protect its food supply from bioterrorism, we must also bear in mind that security for much of the world is compromised by the lack of an adequate food supply. The World Health Organization (WHO) in a 2002 document entitled Terrorist Threats to Food (WHO, 2002) concluded that the early detection of disease resulting from covert food terrorism requires sensitive surveillance systems for communicable disease at the local and national levels, with close cooperation and communication among clinicians, laboratories, and public health officials. These conclusions apply to food safety in general, not just protection against deliberate attacks, reinforcing the need for a comprehensive system for foodborne disease surveillance. Detecting and responding to an act of foodborne terrorism will depend on the type of agent, the efficiency of the attack, and the geographic distribution of cases. If an attack produces a few unusual, distinctive cases, it is more likely to be

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary detected than one that sickens many people with a common foodborne illness. A large number of acute cases of foodborne illness, clustered by time and location, will trigger an immediate response. However, it may take weeks to recognize an epidemic of foodborne disease: from the time the contaminated food is eaten until symptoms appear; from the time a person seeks medical attention until the results of a stool sample can be interpreted; from the time public health officials receive laboratory results until case interviews can be conducted. Improving systems for food defense requires us to decide how we determine what constitutes acceptable risk, as well as what measures best serve the public good. Today, the U.S. food industry emphasizes food safety, which is not the same thing as food biosecurity. For example, a standard tool for identifying potential sources of foodborne illness, called Hazard Analysis and Critical Control Point (HACCP) (FDA, 2006), focuses on exposures that are reasonably likely to occur, regardless of impact. Bioterrorism, while an extremely rare event, would be expected to have a severe impact. Should food producers be required, or merely encouraged, to invest resources in protecting their products against the risk of terrorism? Are food defense systems public goods that warrant public support? They are unlikely to yield measurable benefits to a company. Representatives from the food industry have stated that they would prefer legislative requirements for such safeguards, so that every company bears the same burden as its competitors. Under such conditions, food defense would be treated as a cost of doing business. No such regulation has yet been formally proposed, nor has the level of “tolerable risk” been defined, except to note that risk cannot be entirely eliminated. However, it is clear that an effective response to the threat of foodborne terrorism requires collaboration and greater efficiency among the federal agencies responsible for food safety and for transportation, as well as among state and local health departments. Despite all we know about the potential for various agents to cause foodborne illness, we do not know the identity of tomorrow’s terrorist today. He or she could be a member of an animal liberation group who is working in a food-processing plant, waiting for an opportunity to act. An unbalanced individual with expertise in microbiology could be planning to stage a small-scale attack with an infectious agent just to see what happens. An international terrorist organization could be readying an attack. That is why Paul Wilkinson, from the Centre for the Study of Terrorism and Political Violence, said more than a decade ago, “Fighting terrorism is like being a goalkeeper. You can make a hundred brilliant saves, but the only shot that people remember is the one that gets past you” (Wilkinson, 1992).

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary THE U.S. FOOD SUPPLY—HOW CHANGING DEMOGRAPHICS AND CONSUMER DEMAND POSE NEW CHALLENGES FOR FOOD SAFETY Craig W. Henry, Ph.D.3, 4 Food Products Association Summary When purchasing food, U.S. consumers consider a variety of product attributes, including taste, convenience, cost, and safety. Increasingly, this is true around the world, as consumers seek to purchase high-quality, safe foods. Regardless of income, families in countries around the world are spending less on food as a percentage of total expenditures, as they benefit from the lower cost of food production and increased competition in the retail marketplace. However, the fact remains that lower-income families, on average, spend approximately 2.5 times more on food as a percent of total expenditures than do higher-income families. Conversely, higher-income families spend more on meat and seafood products than do lower-income families. Process attributes related to the manner in which a food is grown, raised, processed, and marketed are becoming increasingly important to consumers globally. For example, there is a growing demand for “organically” grown food products, particularly in the United States and Europe. The food purchased and consumed in the United States increasingly is imported. From 2000 to 2004, food imports into the United States increased substantially, with meat, fresh fruit, and vegetables leading in sales growth. Demographic changes in the United States are reflected by the marketplace. For example, the number of single-parent households in the United States continues to grow. By 2030, it is anticipated that only 17 percent of U.S. households will be single-earner married couples, with almost 30 percent of households headed by unmarried individuals. With more households where both parents work and more single-parent households in the future, less time will be available for meal preparation. Clear, concise, and accurate information must be communicated among the United States and countries around the world to help ensure compliance with regulatory requirements. Additionally, stakeholders must coordinate the approach to addressing threats such as mad cow disease and avian influenza. Only through 3 Senior vice president of Scientific and Regulatory Affairs. 4 The Food Products Association (FPA) is the largest trade association serving the food and beverage industry in the United States and worldwide. FPA’s laboratory centers, scientists, and professional staff provide technical and regulatory assistance to member companies and represent the food industry on scientific and public policy issues involving food safety, food security, nutrition, consumer affairs, and international trade.

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary a collaborative effort and the proper allocation of resources can the United States and other countries meet the challenge of ensuring a safe, abundant, and nutritious world food supply. Global Consumption Trends Gathering accurate and up-to-date statistics on global food consumption trends is challenging. However, using statistics from a number of sources—in particular, information compiled and published by the Food Marketing Institute (FMI)—allows us to examine some emerging trends regarding global food consumption (Tables 1-1 through 1-3). It is clear that some “health-oriented” foods—such as soy-based drinks and yogurt beverages—have enjoyed substantial growth during this period. Demographics certainly play an important role in food expenditures. The U.S. Department of Agriculture (USDA) report for March 2005 provided excellent insight into global buying habits. First, we see the predominant income groups in a variety of countries (Table 1-2). Following the breakdown of income groups, we see the food expenditure patterns among the selected countries (Table 1-3). Although food expenditures have declined for all income groups, the decline is more pronounced for the low-income group. Tables 1-4 through 1-9 provide more insight into the type of foods being purchased by the various levels of income (see Annex 1-1). If we look at the trends as far as a summary of this is concerned, between 1997 and 2003 there is a clear decline of 2.5 percent of income spent on the major food groups. However, the question remains, why are the costs of food expenditures declining? More efficient production, leading to lower food prices, and/or increased competition in the retail food marketplace likely have had an impact. Certainly, the global food industry has done an excellent job of enhancing efficiencies related to farming practices and food production. TABLE 1-1 Food Categories with the Fastest Growing Global Sales and Growth Rate Between 2003 and 2004 Categories with Fastest Growing Sales Growth Rate 2003–2004 (%) Soy-based drinks 31 Drinkable yogurts 19 Eggs 14 Cereal, muesli, fruit bars 10 Sports energy drinks 10 All others 6–9 SOURCE: Nielson (2004).

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary TABLE 1-2 Food Expenditure Patterns Among Selected Countries High Upper Middle Lower Middle Low Income Japan Mexico Colombia Ukraine United States Czech Republic Russia Indonesia United Kingdom Hungary Romania India Germany Chile Bulgaria Vietnam France Brazil Morocco   Singapore South Africa Philippines   South Korea Turkey China   SOURCE: USDA (2005b). Data indicates that growing wealth in countries around the world is creating a growing demand for food attributes beyond taste and cost. Worldwide, we see growth in consumer demand for foods with various attributes, such as the increased demand for soy-based drinks. Convenience and safety are another two key attributes that are having a growing effect on consumer buying habits. According to the FMI’s Grocery Shopper Trends for 2005, single men and women without children, account for 25 percent of the 81.9 million working households in the United States. Since 1940, single-parent families have doubled and now account for 16 percent of the households in the United States. The issue is: who is buying and who is preparing meals in our domestic economy? Married couples with and without children account for 37 percent of U.S. households. By 2030 it is expected that 17 percent of households with married couples will have a single earner. Forty-five percent will be dual-earner married couples, and 30 percent will be unmarried individuals. Single-parent households will exceed 18 percent (FMI, 2005). In the United States, female “bread winners” are far more common today than in the past. Twenty percent of U.S. households currently are supported by a single female earner. This equates to close to 3.6 million or 8 percent of all the total current working households. This results in fewer adults at home with a primary focus on family care and meal preparation. In turn, this creates a change in how meals are prepared and, subsequently, creates time constraints for meal TABLE 1-3 Food Expenditure Patterns Among Selected Countries, Food Share of Total Expenditures   1997 (%) 2003 (%) High-income average 11.7 11.1 Upper-middle income average 22.2 19.5 Lower-middle income average 35.4 32.0 Low-income average 41.7 38.3 SOURCE: USDA (2005b).

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary preparations. Let’s consider how meals are actually sourced and prepared within the home. Surprisingly only 1.5 evening meals per week are consumed away from home. Thirty-nine percent of the shoppers, on a weekly average, eat out less than once per week. On the weekly average, 15 percent of single mothers eat at fast food restaurants at least three times a week. Let us look at the various sources of food for the U.S. household (Table 1-10). Ninety-two percent of households eat home-cooked meals one or more times a week; 79 percent eat home-cooked meals at least three times a week. This indicates that a significant percentage of the time, people are preparing their meals at home. An equal number, 22 percent, eat at least one meal a week at either a fast-food or full-service restaurant. And nearly a quarter of U.S. households eat at least one “ethnic” meal at home or at a restaurant each week; Chinese and Mexican cuisine have become part of the mainstream America diet. Grocery Shopper Trends for 2005 also indicates that income, age, region, residence, and ethnicity affect food buying decisions. The NPD Group recently released findings from its 20th Annual Report on Eating Patterns in America (NPD Group, 2006). It is interesting to see what has changed over the past 20 years. Today, 53 percent of consumers say they try to avoid snacking as opposed to 71 percent in 1985. The annual number of main meals skipped per person rose from 102 in 1985 to 114 in 2005. Meals cooked in microwave ovens doubled from 10 percent in 1985 to 20 percent today. To me, this is surprising, in that I would have expected it would have been a much higher increase than just a doubling. Clearly, saving time is important for most consumers. What has the food industry done to respond to consumer demand for more convenient but still good-tasting foods? Joy Zacharia, associate editor of Cooking Light magazine, says consumers are taking advantage of prewashed salads, precut and washed vegetables, pork tenderloins and boneless, skinless chicken breast and thighs. Consumers in developed countries around the world increasingly look for convenient, high-quality foods that are safe. There is also a growing market for foods perceived to support healthy lifestyles. The food industry continues to develop and market new products to meet evolving consumer demands. TABLE 1-10 Grocery Shopper Trends for 2005   1 or More Times/Week (%) At Least 3 Times/Week (%) Eat home-cooked meals at home 92 79 Eat out at fast-food establishments 22 5 Dine out at full-service restaurants 22 4 Purchase items at gourmet coffee shops 7 3 Eat ethnic meals at home or out 24 6 SOURCE: FMI (2005).

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary TABLE 1-11 Trends in Proportion of Shoppers Who Purchased Organic Food Within the Past Six Months Number of Organic Foods Purchased 2000 (%) 2003 (%) 2004 (%) None 47 50 48 One or two categories 24 24 26 Three or four categories 16 15 14 Five or more categories 13 11 12 Total 100 100 100 SOURCE: FMI et al. (2004). Demand for Organic Foods In recent years, there has been conflicting conclusions regarding the trends in organic food consumption. The Organic Trade Association (OTA) states that the organic industry grew by 20 percent and attained $10.8 billion in sales in 2003 (OTA, 2003). However, according to FMI et al. (2004) organic food sales have remained steady (Table 1-11). The organic market survey of 2005 indicates 37 percent of U.S. shoppers expressed an interest in buying organic fruits and vegetables, 24 percent are interested in or have bought organic cereals and breads, and 23 percent either purchased or would purchase organic packaged foods. Interestingly, 18 percent of consumers surveyed indicated they would be interested in purchasing organic meats, but this product line has grown by only 5 percent since 2000. Apparently, the organic demand for meats is driven by availability. Shoppers indicate that, if there was a greater availability of organic meats, they would take advantage of it. Going forward, we are likely to see steadily increasing demand for organic food and other foods with attributes related to health or a healthy lifestyle. Global Demographics Research by the American Enterprise Institute (AEI) indicates that, to sustain the current global population, every woman must bear 2.1 children (Eberstadt, 2004). Nearly half of the developed world has birth rates below that figure. In the United States, population growth is being fueled by immigration and by a higher birth rate for minorities. Another factor to take into consideration regarding global demographics is the male-to-female ratio. Today more boys than girls are being born. The populations of most nations have an average of 105 boys for every 100 girls born. This imbalance is particularly pronounced in nations such as China (with 121 boys born for every 100 girls) and India (with 126 boys born for every 100 girls). AEI research also indicates that HIV and AIDS are definitely affecting mortality rates in a number of countries, which has the potential to affect global food demand in the future.

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary What about the U.S. workforce and the ratio of workers to retirees? In 1950, the United States had 16 workers for every retiree. In 2005, that number is down to three workers for every retiree, which poses enormous challenges for continued funding of the Social Security system and its benefits to retired workers. This issue is even more pronounced in other countries. For example, in Italy it is projected that there will be 0.7 active workers for each retiree by 2030. This indicates there is a very serious economic problem on the horizon. According to the USDA Economic Research Service, in the last three decades we have seen a tremendous growth in food sales worldwide. In the processed food area, sales are now $3.2 trillion, or about three-fourths of the total world food sales. However, we have not seen significant overall growth in global trade during the same time period. For most countries, the vast majority of processed food consumed is produced within that country. This is not true for the United States. Between 2000 and 2004, U.S. food imports significantly increased by 29 percent, according to the USDA Foreign Agriculture Service, with meat, fresh vegetables, and fruits leading this growth. Without question, U.S. consumers have become accustomed to having year-round access to fresh produce. We must pay very close attention to the production and the quality of such products as they come through our system. Food Safety Food is handled at multiple points throughout the food chain, from farm to fork. This is a factor on an international basis that must be addressed to meet customer and regulatory requirements. Look at most seafood products as an example. It is typical to have oceangoing vessels with full processing and even packaging capability. The product is handled in one particular area on the vessel and then shipped for further processing, potentially in two or more countries, before the finished product actually reaches the retail market. This creates a challenge that needs to be considered as far as food safety and quality are concerned. Imported food products meet consumer demand for varied foods—including fresh fruits and vegetables year-round. Ensuring the safety of imported foods is an absolute priority for the U.S. food industry. When it comes to imported foods, vigilance, verification, and validation of sound food safety systems and practices is a necessary part of doing business. Verifying that food safety systems in countries around the world are equivalent to those in the United States is an important aspect of ensuring that the foods sold in the United States are safe, be they imported or domestically produced. This can be a challenge. For example, in 2004 U.S. meat inspectors reported that meat facilities in France do not meet USDA food safety sanitation standards, and therefore banned the sale of processed meats from France in the United States. In 2005, Brazil voluntarily suspended meat exports to the United States for similar reasons.

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary Proper allocation of resources to enhance food safety is paramount. All stakeholders need to work together in addressing the challenges that lie before the United States and the global community. Mad cow disease and the potential emergence of pandemic avian flu are just two examples of those challenges. Only if we apply the appropriate collaborative effort, and certainly the proper allocation of resources, are we going to make progress in addressing the key food safety challenges facing the United States and the global community. ANNEX 1-1 TABLE 1-4 Food Expenditure Patterns Among Selected Countries, Bread and Cereals   1997 (%) 2003 (%) High-income average 16.5 15.9 Upper-middle income average 21.9 21.1 Lower-middle income average 17.7 18.0 Low-income average 26.1 25.6 SOURCE: USDA (2005b). TABLE 1-5 Food Expenditure Patterns Among Selected Countries, Meat and Seafood   1997 (%) 2003 (%) High-income average 35.2 34.3 Upper-middle income average 27.3 28.9 Lower-middle income average 31.4 29.8 Low-income average 19.4 20.3 SOURCE: USDA (2005b). TABLE 1-6 Food Expenditure Patterns Among Selected Countries, Dairy and Eggs   1997 (%) 2003 (%) High-income average 11.5 11.3 Upper-middle income average 15.5 14.9 Lower-middle income average 12.0 11.3 Low-income average 12.8 11.9 SOURCE: USDA (2005b).

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary TABLE 1-7 Food Expenditure Patterns Among Selected Countries, Oils and Fats   1997 (%) 2003 (%) High-income average 2.8 2.8 Upper-middle income average 5.2 4.8 Lower-middle income average 5.6 5.7 Low-income average 6.4 5.3 SOURCE: USDA (2005b). TABLE 1-8 Food Expenditure Patterns Among Selected Countries, Fruits and Vegetables   1997 (%) 2003 (%) High-income average 18.6 18.8 Upper-middle income average 19.0 19.1 Lower-middle income average 18.0 17.6 Low-income average 24.6 24.1 SOURCE: USDA (2005b). TABLE 1-9 Food Expenditure Patterns Among Selected Countries, Sugar and Confectionary   1997 (%) 2003 (%) High-income average 7.5 7.6 Upper-middle income average 6.6 6.4 Lower-middle income average 5.0 5.1 Low-income average 4.5 5.9 SOURCE: USDA (2005b). REFERENCES ACNielsen. 2004. What’s Hot Around the Globe: Insights on Growth in Food and Beverages 2004. [Online]. Available: http://www2.anielsen.com/reports/documents/2004_whatshot_food-bev.pdf [accessed April 14, 2006]. Branigin W, Allen M, Mintz J. 2004 (December 3). Tommy Thompson resigns from HHS: Bush asks Defense Secretary Rumsfeld to Stay. The Washington Post. [Online]. Available: http://www.washingtonpost.com/wp-dyn/articles/A31377-2004Dec3.html [accessed August 2, 2006]. CDC (Centers for Disease Control and Prevention). 2003. Nicotine poisoning after ingestion of contaminated ground beef—Michigan, 2003. Morbidity and Mortality Weekly Report 52(18): 413–416. Chertoff M. 2005 (March 17). Homeland security chief to shift from “sky is falling” approach. New York Times. P. A21.

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary Crawford LM. 2002 (September 6). A Conversation on Food Safety and Global Security. Secretary’s Open Forum, Department of State, Washington, D.C. [Online]. Available: http://www.fda.gov/oc/speeches/2002/state0906.html [accessed June 28, 2006]. Death sentence for China poisoning. 2002a (September 30). BBC News. [Online]. Available: http://news.bbc.co.uk/2/hi/asia-pacific/2287801.stm [accessed April 26, 2006]. Death sentence over Chinese poisonings. 2002b (September 30). CNN News. [Online]. Available: http://edition.cnn.com/2002/WORLD/asiapcf/east/09/30/china.poison/ [accessed May 4, 2006]. Eberstadt N. 2004 (August 20). Four Surprises in Global Demography. Washington, D.C.: AEI. [Online]. Available: http://www.aei.org/publications/pubID.21076,filter.all/pub_detail.asp [accessed June 28, 2006]. Ex-lab worker tainted food. 1998 (September 12). Houston Chronicle. P. A48. FDA (Food and Drug Administration). 2006. Hazard Analysis and Critical Control Point. Available: http://www.cfsan.fda.gov/~lrd/haccp.html [accessed May 5, 2006]. FMI (Food Marketing Institute). 2005. Grocery Shopper Trends for 2005. [Online]. Available: http://www. fmi.org/ [accessed April 14, 2006]. FMI, Prevention Magazine, and Rodale, Inc. 2004. The organic market. Ch. 4 In: Shopping for Health: Making Sense of Nutrition News and Health Claims. Washington, D.C.: The Food Marketing Institute. Pp. 55–62. Hennessy TW, Hedberg CW, Slutsker L, White KE, Besser-Wiek JM, Moen ME, Feldman J, Coleman WW, Edmonson LM, MacDonald KL, Osterholm MT. 1996. A national outbreak of Salmonella enteritidis infections from ice cream. The Investigation Team. New England Journal of Medicine 334(20):1281–1286. Khan AS, Swerdlow DL, Juranek DD. 2001. Precautions against biological and chemical terrorism directed at food and water supplies. Public Health Reports 116(1):3–14. Kolavic SA, Kimura A, Simons SL, Slutsker L, Barth S, Haley CE. 1997. An outbreak of Shigella dysenteriae type 2 among laboratory workers due to intentional food contamination. Journal of the American Medical Association 278(5):396–398. Murphy FA, Nathanson N. 1994. The emergence of new virus diseases: An overview. Seminars in Virology 5(2):87–102. NPD Group. 2006. NPD Group Homepage. [Online]. Available: http://www.npdfoodworld.com/foodServlet? nextpage=pr_body.html&content_id=2228 [accessed April 14, 2006]. Osterholm MT. 2005. (October 25). Session I: The Current U.S. Food Supply. Presentation at the Forum on Microbial Threats Workshop Meeting, Foodborne Threats to Health: The Policies and Practices of Surveillance, Prevention, Outbreak Investigations, and International Coordination, Washington, D.C., Institute of Medicine, Forum on Microbial Threats. OTA (Organic Trade Association). 2003. Organic Trade Association Homepage. [Online]. Available: http://www.ota.com/index.html [accessed April 14, 2006]. Phills JA, Harrold AJ, Whiteman GV, Perelmutter L. 1972. Pulmonary infiltrates, asthma and eosinophilia due to Ascaris suum infestation in man. New England Journal of Medicine 286(18): 965–970. Sholl J. 2005 (June 28). Session III: Vulnerabilities of the Ready to Eat Food Supply. Pictures taken by Jeff Sholl and presented at the Forum on Microbial Threats Working Group Meeting, Food Supply Terrorism as Biosecurity Issue—Assessing the Problem and the Ethical Considerations of Infectious Disease Research and Surveillance (slide 31), Washington, D.C., Institute of Medicine, Forum on Microbial Threats. Torok TJ, Tauxe RV, Wise RP, Livengood JR, Sokolow R, Mauvais S, Birkness KA, Skeels MR, Horan JM, Foster LR. 1997. A large community outbreak of salmonellosis caused by intentional contamination of restaurant salad bars. Journal of the American Medical Association 278(5): 389–395.

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Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination - Workshop Summary USDA (U.S. Department of Agriculture). 2004. Food CPI, Prices and Expenditures: Food Expenditures by Families and Individuals as a Share of Disposable Personal Income. Economic Research Service. [Online]. Available: http://www.ers.usda.gov/Briefing/CPIFoodAndExpenditures/data/table7.htm [accessed July 25, 2006]. USDA. 2005a. National Agriculture Statistics Service: Workforce Plan for FY 2005–2009. [Online]. Available: http://www.nass.usda.gov/About_Nass/Strategic_Plan/nassworkforceplanfy2005.pdf [accessed April 26, 2006]. USDA. 2005b. Global Food Markets: International Consumer and Retail Trends. [Online]. Available: http://www.ers.usda.gov/Briefing/ globalfoodmarkets/consumer.htm [accessed April 14, 2006]. WHO (World Health Organization). 2002. Terrorist Threats to Food: Guidelines for Establishing and Strengthening Prevention and Response Systems. [Online]. Available: http://www.who.int/foodsafety/publications/fs_management/terrorism/en/ [accessed April 28, 2006]. Wilkinson P. 1992 (September 1). British Scholar, author on terrorism. The Daily Telegraph. [Online]. Available: http://www.bartleby.com/66/25/64725.html [accessed May 5, 2006].