Public Health Preparedness at a National Special Security Event: Epidemiology, Food Safety and Food Defense at the 2012 Democratic National Convention: Tuesday, April 8th

This past week we heard from Mr. Larry Michael of the NC Department of Health and Human Services and Ms. Donna Wanucha or the regional office of the FDA. Their unexpectedly fascinating joint lecture was on the preparedness for NSSE—National Special Security Events, particularly food security.  Their thorough description of the planning for the available food and food preparation of the democratic national convention was unexpected in that I would have never considered food to be a vulnerable point for national events. Yet, when they described calling back all 2,000 lunch boxes for the security teams due to potentially “bad” chicken, it was not difficult to see how easily an entire event could be compromised by a little salmonella.

While the talk opened my eyes to all the potential threats that well trained FDA and Public Health officials deal with daily, I found myself thinking of my pet cat, Chui. I have the choice to only frequent establishments with high safety grades and I trust the local and federal government have tracked the food sources sufficiently that I will not get ill from my food. However, my cat does not have this luxury. As recent as 2007, pet food was recalled from over 100 brands contaminated from imported vegetable proteins from China (Roth, Tsay, Pullman, & Gray, 2008). Though we stringently regulate “farm to fork” production of human food, animal nutrition has fallen by the wayside. This does not pose a direct health concern to humans. Any food-born illness is not transferable to human pet owners, unless they are consuming the pet food themselves. However, especially in America, we have great time, money, and emotional investment in our companion animals.  It is estimated that Americans will spend over 22 billion USD on companion animal food in 2014 alone ("Pet Industry Market Size & Ownership Statistics,"). Despite this investment, comparatively poor consideration is given to the supply chain of pet food. Though this does not directly impede on human health, I believe it is a One Health issue as the emotional and financial burden on humans is great. We are becoming accustomed to thinking so carefully about our own food sources; it is time we give as much consideration to the food for our best friends. 

Pet Industry Market Size & Ownership Statistics. from    http://www.americanpetproducts.org/press_industrytrends.asp

           

Roth, A. V., Tsay, A. A., Pullman, M. E., & Gray, J. V. (2008). UNRAVELING THE FOOD SUPPLY CHAIN: STRATEGIC INSIGHTS FROM CHINA AND THE 2007 RECALLS*. Journal of Supply Chain Management, 44(1), 22-39. 

Authored by Chrissy Dideriksen

Black Bear Habitat Fragmentation Leads to more Human Conflicts in Florida

This week, human-black bear interaction in residential areas between Ocala National Forest and Orlando, FL made headlines after a bear bit a woman in her garage.  This problem is not new.  Both bear and human populations in Florida have been growing since the 1970s, and poor housing development plans have fragmented the bears’ habitats as building expands ever closer to Ocala National Forest.  Conflicts have increased because of misunderstandings that could benefit from a One Health approach.  Experts on bear behavior from the Bear Management Program for the Florida Fish and Wildlife Conservation Commission advise maintaining a contiguous habitat for the bears and that bears are easily habituated to humans.  Public education campaigns to advise residents against approaching bears, feeding bears, or failing to secure garbage from bears should be reinforced.

http://news.nationalgeographic.com/news/2014/04/140415-black-bear-florida-attack-habitat-wildlife-conservation/

Paige Meier

Duke University

Impacts of Improved Cookstoves on Environmental Health and Human Health: Tuesday, April 1st

On April 1, the One Health Intellectual Exchange’s session consisted of presentations from Jessica Lewis and Marc Jeuland that concerned the impacts of cookstoves on air pollution, health, and fuel.  Jessica Lewis is a third year PhD student in the Nicholas School of the Environment at Duke University and is an EPA STAR Doctoral Fellow.  She studies household energy and health and focuses on traditional cooking in developing countries.  Marc Jeuland, PhD is an Assistant Professor of Public Policy, Global Health, Environment, and Civil and Environmental Engineering at the Sanford School of Public Policy at Duke University.  In the past, Dr. Jeuland worked with the World Bank and volunteered with the Peace Corps for projects related to water sanitation.  His research includes economic implications of climate change, management of trans-boundary water resources, water sanitation, and environmental health. 

Ms. Lewis began with an overview of traditional and improved cookstoves and then highlighted her study in Odisha, India.  Importance of research on cooking methods and their impacts includes the following reasons:  forty percent of the world relies on solid fuel for cooking and heating, and air pollution is responsible for one out of seven deaths, in which household air pollution (HAP) contributes.  HAP includes substances such as particulate matter, black carbon, carbon monoxide, and carcinogenic materials.  Disadvantages of traditional cookstoves and solid fuels are high pollution risk, increased fuel wood use, deforestation, and impacts on health and climate.  Therefore, improved cookstoves are being introduced to improve its efficiency and reduce emissions in order to ultimately achieve health and environmental gains. 

The study in Odisha, India included an extensive baseline survey from five hundred households to assess firewood use, personal air pollution, household air pollution, and health implications.  Monitors were worn by some individuals to measure personal air pollution.  Factors such as household education and fuel prices significantly affect the choice of using improved cookstoves.  The improved cookstove significantly reduced firewood use, household air pollution, and personal air pollution.  Stove “stacking” was common in the village, as multiple stove types were used by households, and only twenty-five percent of households own only one stove.  Further research could determine the length of cookstove use by households, the age of cookstove users, and the health history of cookstove users.  These further questions could indicate additional health implications from cookstove use.  Ms. Lewis also directed the group to visit dukeenergyhealth.org.

Dr. Jeuland followed with a presentation about why people choose to cook with an improved cookstove.  Beginning with background information, Dr. Jeuland explained that people may choose not to cook with an improved cookstove because of cost, lack of knowledge, no preference, being risk averse, and conformism.  In theory, people adopt environmental health technologies because of rationality, costs, time, and interventions.  However, people often do not adopt environmental health technologies, and “free stove” studies may not be successful despite their cheapness and efficiency.

Dr. Jeuland’s presentation then focused on his study in India.  The study aimed to find improved cookstove adoption determinants, collect evaluations of their impacts, and conduct marketing studies.  First, the study evaluated baseline cooking and fuel behaviors, knowledge and perception of cookstoves, and cookstove design preferences through a baseline survey.  The surveys showed that people preferred cheaper cookstoves that emit less smoke, decrease the needed amount of fuel, and increased the number of cooking surfaces.  After the baseline survey, pilots were conducted in which a cookstove was offered to people along with a payment plan and advertised by social marketing.  Some people bought natural draft or electric stoves, and selling in poor, rural areas were difficult.  Following pilot studies, intervention occurred.  Information about cookstoves was distributed via fact sheets, and demonstrations for using cookstoves were performed in communities.  The people paid three installments, and a random rebate was offered.  According to the study, rebates encouraged cookstove purchases and use.  Electrical stoves were most used, but the users also had to pay for electricity.  Fuel savings were largest for households in the NGOs stratum, and fuel expenses increased with rebates, most likely due to electricity costs.  Dr. Jeuland summarized that supply of cookstoves is needed, as the study shows a demand for cookstoves.

Discussion and questions followed the presentation.  Questions included the following topics:

• Practicality and effects of fixing a traditional cookstove instead of introducing a new cookstove
• Children’s health impacted by cookstove use
• Efficiency of a biogas stove
• The need of proof for improved cookstove health impacts
• The household member that decides to buy a cookstove
• The use of a community stove
• How taste is changed from using improved cookstoves versus traditional cookstoves

Post Authored by Erin Beasley, NC State University

“Demon Dogs” or Panicked Public?: A History of Breed Scares Through the Ages: Tuesday, March 25th

On March 25^th the One Health Intellectual Exchange welcomed Browen Dickey, a contributing editor of The Oxford American to discuss “’Demon dogs’ or panicked public? A history of breed scares through the ages.”

Ms. Dickey states that through her research she found breed scares are often cyclic, relative to current society, and often not necessarily about the breeds themselves but potential tension between different social groups. Breed scares/bans began as early as 1066 with the Mastiff. This was when royalty did not want those of lower social cast owning these dogs due to the potential of hunting on land owned by the king. Through her research she found that often breed scares could be pin pointed to certain events, such as the St. Bernard and the release of the movie Cujo or guard dog breeds with the increase of crime rates.

The current breed scare? The Pit Bull.  This “bully” breeds is beginning to be banned by apartment complexes and making it into certain state legislations. Starting in 1974 when dog fighting in certain rings became a popular topic. A media blitz came to bring the breed into the forefront, with reporters and journalists relying on the general public and dog fighters for information on this breed. Ms. Dickey has carried out an effort to interview owners nationwide to gain a better understanding of the Pit Bull breed. She found that that these dogs are often like any other breed, have a bad rap. They are often sweet, kind, and loyal to the owner.

Ms. Dickey made two points about breed panic that stuck out the most: it can lead to exacerbating the problem and letting human’s off the hook. So what will be the next breed to cause panic? Only time will tell.

Authored by Jessica Vasquez

Food Safety from Farm to Fork to Physician: Moving Towards a One Health Approach: Tuesday, March 4th

In this week's session, Barbara Kowalcyk, Ph.D. and CEO of the Center for Foodborne Illness Research and Prevention (CFI), a national non-profit organization that prevent foodborne disease by advancing a stronger, science-based food safety system, was our honored guest at the North Carolina One Health Intellectual Exchange Group. She received her master's degree in Applied Statistics from the University of Pittsburgh and a Doctorates in Environmental Health with a focus in Epidemiology and Bio-statistics from the University of Cincinnati. Although she began her career as a Statistician at a pharmaceutical company, her passion shifted to foodborne illnesses and food safety, due to a tragic personal event. Since then, her research has focused on the microbial aspect of foodborne pathogens and a system to improve epidemiology surveillance and awareness to prevent a pandemic outbreak.

Dr. Kowalcyk began her discussion by describing food safety and food security along with reasons why it should be a main priority and concern in people's lives. Statistics show approximately 48 million people contract illnesses, 128 thousand are hospitalized and 3 thousand deaths occur globally due to foodborne pathogens. The numbers are so high and increasing from the high transmission rate through food, people, water systems and petting zoos. The most vulnerable populations are pregnant women, senior citizens and children. Dr. Kowalcyk emphasizes the concerns of the under-analyzed effects of foodborne diseases globally, which inhibits the improvements of surveillance. Pathogens, including Norovirus, Salmonella, and E. coli 0157:H7, are continually evolving into new strains of antibiotic resistance that will cause a public health crisis in the 21st century.

Food companies, or the 'producers', have recently been the blame for the spread of foodborne illnesses instead on the consumers. Due to concerns of the spread of these pathogens, they have caused the CDC to implement sterilization procedures, like irradiation (a simple disinfecting process from a  UV light to kill the microbes growing in the food) and systematic preventive programs, like FoodNet, PulseNet, and Hazard Analysis Critical Control Point (HCCP), to food processing companies. Also, in 2011, Congress enacted the Food Safety Modernization Act (FSMA), a food safety law to mandate new risk-based approaches to the FDA's oversight of foodborne illness. This law will ensure the quality and amount of detection of bacteria to monitor the spread around the country. Fortunately, over the years, there has been an increasing amount of attention to improve the surveillance of foodborne diseases and to attempt to prevent sporadic outbreaks from occurring.

Dr. Kowalcyk then further argued the issues of people's assumption that foodborne diseases only result in acute illnesses, such as a 'tummy ache,’ as well as “it's something minor that is not necessary to visit or report to a physician.” In her paper, she describes the many long-term effects to numerous organ systems that people are unaware about the effects. Prominent sequelae of these infections include effects to the gastrointestinal, immune, nervous, respiratory, cardiovascular, endocrine and hepatic systems. Profuse diarrhea, another condition caused by foodborne infections, in children can cause deficits in cognition and development while in adults will make it more chronic [1]. The long-term consequences from the foodborne infections are detrimental to human health and must be taken with precaution. Dr. Kowalcyk wants to educate the people through CFI and provide a source of information about these pathogens, so that it is not something to be under-evaluated. 

Looking ahead towards the future, promising technology and procedures are being tested and formulated to eliminate the outbreaks of infections. An increase of epidemiology will drive preventive actions through the ability to constantly identify and detect the cluster of diseases that significantly harm people around the world. Dr. Kowalcyk quotes "surveillance goes beyond the detection of disease, but it is critical for prevention. There needs to be a surveillance shift from reactive to proactive action." The rise of antibiotic resistant pathogens and the continual difficulty of tracking the origin of the pathogens will force companies, farmers, and other countries to integrate to more cost effective surveillance protocols. Ultimately, the mission to prevent the spread of foodborne diseases is to advocate the necessity of funding for more studies and surveillance techniques to wealthy companies or governments as well as to educate the consumers on safe sterilization that will clean the foods from the burden of these pathogens. Lastly, Dr. Kowalcyk ends her discussion with a slide of children that have died or have severe complications of their lifestyle due to foodborne illnesses as a reminder of the true reason to promote proper surveillance and prevention of foodborne diseases.

[1] Batz, M. B., Henke, E., & Kowalcyk, B. (2013). Foodborne illness: Latest threats and emerging issues. Infectious Disease Clinics of North America, 27, 599-616.

Authored by Thanh-thao Thi Le