Foodborne Disease Continues to Pose Major Global Public Health and Economic Risks

• Foodborne disease remains a major preventable global health burden, particularly in low- and middle-income countries where food safety, water, sanitation, and healthcare systems remain underdeveloped.  
• Children under five will continue to bear a disproportionate share of illness and mortality due to increased vulnerability to both biological and chemical foodborne hazards.  
• Chemical hazards, especially inorganic arsenic, lead, and methylmercury, contribute substantially to mortality and long-term disability.  
• Extreme weather events, environmental degradation, and increasingly interconnected food supply chains are likely to increase the frequency and geographic reach of contamination events and outbreaks.  
• Foodborne disease also contributes to significant economic losses through healthcare costs, workforce absenteeism, productivity declines, supply chain disruptions, and impacts on trade and tourism.  

Foodborne illness remains an important global public health issue and a major source of economic loss. According to the WHO, unsafe food causes an estimated 866 million illnesses and 1.5 million deaths each year, making foodborne disease one of the world's most significant and preventable health challenges.  

Young Children at Disproportionate Risk  

Children under five are particularly vulnerable to foodborne disease because of their developing immune systems, nutritional needs, and greater risk of severe outcomes from diarrheal illness. The WHO estimates indicate that this age group accounts for nearly one-third of all foodborne disease cases globally.  

In addition to acute illness and dehydration, exposure to contaminants such as lead, methylmercury, and inorganic arsenic can result in long-term neurological and developmental harm. These risks are more severe in settings where access to clean water, sanitation, safe food storage, healthcare, and nutrition services is limited.  

Biological and Chemical Hazards  

Biological hazards, such as bacteria, viruses, and parasites, continue to account for most foodborne illnesses, with approximately 860 million cases recorded in 2021. Common causes include contaminated water, poor food handling practices, inadequate cooking, improper storage, and cross-contamination during food preparation and distribution.  

However, updated WHO estimates highlight the substantial burden associated with chemical hazards, which accounted for approximately 73 percent of foodborne deaths in 2021. Most of these deaths were linked to inorganic arsenic and lead exposure due to their association with cardiovascular disease and cancer. Chemical contaminants, including heavy metals, can enter the food chain through natural sources, industrial activity, agricultural practices, and environmental contamination. Once present, they are often difficult or impossible to remove, making prevention at source essential.  

Regional Inequalities  

Although the overall burden of foodborne disease has declined since 2000, significant regional inequalities persist. The African and South-East Asian regions account for nearly three-quarters of all foodborne illnesses and 60 percent of related deaths. These disparities are driven by a combination of inadequate water and sanitation infrastructure, weak food safety systems, informal food markets, poverty, conflict, and limited access to healthcare.  

Emerging environmental and health pressures are likely to complicate food safety management. Rising temperatures, flooding, and extreme weather events can increase contamination risks by disrupting water systems and food supply chains while altering the geographic and seasonal patterns of foodborne pathogens. At the same time, antimicrobial resistance is making some bacterial foodborne infections increasingly difficult to treat. 

The economic consequences of unsafe food extend well beyond healthcare costs. Foodborne disease contributes to substantial productivity losses, disrupts workforces and supply chains, undermines consumer confidence, and can negatively affect tourism and international trade. The WHO estimates that foodborne disease caused hundreds of billions of dollars in lost productivity in 2021. As food systems become increasingly interconnected, localized contamination events can rapidly develop into cross-border public health and economic concerns.  

South Africa faces many of the same food safety challenges identified globally, despite having relatively robust food safety regulations and surveillance systems. Recent poisoning incidents linked to food purchased from informal retailers and spaza shops have highlighted persistent vulnerabilities in food safety oversight, product traceability, food handling practices, and the sale of potentially hazardous products in some communities. These incidents, which disproportionately affected children reinforced calls for improved inspection, licensing, and enforcement measures.  

Food safety risks are further compounded by socioeconomic inequalities, inconsistent access to safe water and sanitation, and the continued reliance on informal food markets in many communities. While these markets play an important role in food security and livelihoods, limited infrastructure and regulatory oversight can increase the risk of contamination and foodborne illness.  

Beyond direct public health impacts, food safety incidents can also have broader economic consequences. Recent outbreaks of foot-and-mouth disease among livestock have highlighted the interconnected nature of food systems, animal health, and trade.  

Foodborne disease is likely to remain a persistent global health challenge despite continued improvements in food safety standards in many countries. While advances in surveillance, regulation, and food production practices have reduced some risks, population growth, urbanization, environmental pressures, globalized food supply chains, and antimicrobial resistance are creating new vulnerabilities.  

The greatest burden will likely continue to fall on low- and middle-income countries where food safety systems, laboratory capacity, water and sanitation infrastructure, and healthcare access remain limited. Children under five will remain the most vulnerable population group.  

Chemical contaminants may receive greater attention from policymakers and public health authorities following the publication of the WHO's updated burden estimates. Unlike many biological hazards, chemical contaminants can cause long-term health effects that may not become apparent for years or decades, complicating detection and prevention efforts.  

Large outbreaks, contamination incidents, and disruptions to food production or distribution networks have the potential to affect workforce health, travel, supply chains, and business continuity. Strengthening food safety systems and adopting a One Health approach will remain critical to reducing future disease burden and improving resilience across food systems. This represents the most complete data available as of June 10.  

• From a medical and traveler-health perspective, individuals can reduce their risk of foodborne illness by applying consistent food and water precautions, particularly in higher-risk destinations or when living as expatriates in locations where food safety standards may vary.  
• Travelers should drink bottled, sealed, boiled, or properly treated water, and avoid ice unless they are confident it was made from safe water.  
• Food should ideally be eaten hot, freshly cooked, and served steaming, with preference given to busy restaurants or high-volume food stalls where ingredients are likely to turn over quickly.  Travelers should be cautious with buffet food, lukewarm dishes, and desserts such as ice cream, especially where refrigeration may be unreliable.
• Avoid raw or undercooked meat, seafood, eggs, and unpasteurized dairy products. Particular caution is warranted with salads, raw vegetables, cut fruit, sauces, chutneys, garnishes, and uncooked herbs. Fruit that can be peeled personally is generally safer.  
• Good hand hygiene remains one of the most effective protective measures: wash hands before eating, use alcohol-based hand sanitizer when soap and water are unavailable, and avoid touching the face or mouth with unclean hands.    
• Expatriates should take additional precautions at home by identifying reliable food suppliers, checking expiry dates, ensuring refrigerators and freezers are functioning properly, separating raw and cooked foods during preparation, cooking food thoroughly, and storing leftovers promptly.  
• Medical care should be sought promptly for severe diarrhea, bloody stool, persistent fever, signs of dehydration, inability to keep fluids down, or illness in young children, older adults, pregnant travelers or immunocompromised individuals.  

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