At a first meeting in September 2006, "WHO Foodborne Disease Burden Epidemiology Reference Group (FERG) defined a strategy to evaluate the global borden of foodborne diseases. The estimate of this cost is indeed an essential data for the political makers in charge of defining and of treating on a hierarchical basis in terms of priorities the most relevant actions. It invited the CIIA to its second meeting on November 20, 2008.

For all, it is necessary to point out frequent confusions between " life safety " and " food safety ": the food safety, which primarily refers to the quantitative availability out of food, was the principal concern of the policy makers NGO leaders at the time of the blaze of the food world prices in 2007-2008. An insufficient availability reduced as much natural immunizing defenses and weakens even more the populations confronted with other endemic disease. However, foodborne disease risks are permanent.

The analysis of the impact of the foodborne diseases is generally centered on the microbial infection impact (cf "Foodborne Pathogenic Microphone-organisms and Natural Toxins Handbook" published by USDA Food Safety Inspection Service). With good reason, WHO includes the parasites as well as the allergens and the nutritional deficiencies. For the most concerned consumers of their health, the risks can be also related to chemical residues (pesticides, antibiotics, etc). It would be necessary to add the life risks related to the fraudulent behaviors. It is necessary to recall that, in 1981, the death of 500 people and 20.000 hospitalized after consuming adulterated colza oil caused a big traumatism in Spain and threw suspicion on all the processed foodstuffs. In 2008, fraudulent incorporation of melamine in dried milk poisoned more than 50.000 chinese children.

In addition, this last dramatic episode of intoxication showed, for the first time, the international impact which the marketing of counterfeited or mismade products can have. There always have been counterfeitings. In the traditional society, the mismakings perpetuated by craftsmen without scruples had local consequences. The industrial revolution extended the risks at the regional level, even national. It is why the French legislator voted a law in 1905 to fight against the frauds. The French law stipulates that the products put on sale must have three qualities: faithful and commercial to ensure an equal competition ; but the first required quality is to be "healthy", respectful of the consumer health. Today , except exceptional case, the spread of the market worldwide abolished the borders. Thus, in 2008, the authorities in charge of the food safety of 10 countries have found high quantities of the harmful ingredient incorporated by a Chinese manufacturer in various products. This report led several countries, of which Europe and the USA, to prohibit the importation of products containing dairy products coming from China. This prohibition involves obviously an economic cost for the country of origin (direct loss of sales turnover), but also for the whole of the companies of the food sector whose probity is then systematically questioned.

In 2006, one of the FREG’s recommendations was to measure the global burden of foodborne diseases related to "the DALYs" supply (Disability-Adjusted Life Years). Certainly, the life of the people does not have any price. Nevertheless, in addition to the census of in-patients and deaths, the American CDC (Centers for Disease Control) made an economic evaluation of these diseases. The data which was published is heterogeneous. Thus, the total number of hospitalizations related to the food was estimated in 2000 in the USA at 325.000 with 5.000 deaths including 31.000 hospitalized and 1.229 deaths because of 5 pathogenic germs. The cost of the diseases due to these 5 germs was then evaluated at 6,9 billion USD.

The people weakened by an endemic disease are the first with being victims of the foodborne diseases. It is then difficult to carry out the diagnosis and to evaluate the cost directly related to these diseases without double account.

Some scientific studies, unfortunately too compartmental, identify particularly sensitive levels of the food chain in the developed countries : they are freight vehicles, restaurants and the equipment of refrigeration management by stores and consumers. A cecent study carried out in the United Kingdom estimates as well as half of the food poisonings are generated in the restaurants.

In the the least developed countries, it would undoubtedly be advisable to add the distribution on the street markets and along the roads of fresh products or cut out imported frozen livestock products. In a more general way, the rules of good practices are not always complied with (Re-congelation of defrosted products, D-packing of products beyond the initial CLD that is indicated by the producer…). The procedures of analyzes and control which would make it possible to identify these products at risk are complex and expensive, especially when these products are marketed without the label and the guarantee of a credible and solvent operator.

After the drama of the adulterated colza oil, professionals and the ministries for Health and the Interior created a medical network of alarm. This was extended to all the European Community. Then, the EC took off structures and a regulation which effectively protect the European consumer health. Remain to identify and evaluate the cross effects of the endemic diseases nonrelated to the food with the various sources of intoxication and infection so that the preventions and decisions are most relevant possible, without excessive precautions.

The importance of the reality of the epidemics related to the food, except those related to dirty water, is difficult to encircle. On the basis of the American CDC’ data, the number of really sick people with a reduced capacity of work is 150 times more than that of the deaths…

• The episodes of intoxications by ingredients incorporated fraudulently in food are rare but can have important medical impacts. The CIIA proposes to take into account toxic ingredients, in particular those fraudulently built-in in animal feed, among the causes of diseases ;
  
• The types of diets are multiple in the world. They have very different characteristics and present specific potential risks. In the same area of the world, the food practices can vary between the populations of the rural zones which kept traditional diets and those of the large urban areas. The CIIA proposes that WHO causes a research program aiming at a typology of the principal diets, then to identify the medical risks which are specific for them ;
  

• In addition to an indicator in term of % of the GDP would undoubtedly be adapted better to allow the international comparisons and in spite of the difficulties of analysis (medical environment, life expectancy, investment on the future of the children which strongly differ from country to country…), it is proposed to ask the OECD, in connection with institutes of research, to work out an economic methodology of evaluation which could be used as reference.
  
• The CIIA proposes that is drawn up a matrix of the cross risks and synergies between factors of risks.
  
• The CIIA proposes to take stock of the respect of the methods of analyzes enacted by the Alimentarius Codex around the world

Paris, December 12^th 2008