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1、 Food safety and public health Food safety is unique among the various public health programmes. Its pluri- disciplinary(学科) and multi-sectoralnature（自然联盟）), which can be interpreted as both an advantage and a disadvantage, results in a blend of voluntary and mandatory （强制性）approaches which have no
2、counterparts（同行） in other programmes. The health sector is usually expected to assume a coordination role for all the stakeholders（利益相关者） including government,industry and consumer.The Agreement on the Application of Sanitary and Phytosanitary Measures of the World Trade Organization （卫生与植物卫生措施的世界贸易
3、组织） calls for growing integration（整合） of health science into food safety requirements to increase their consistency and transparency（透明度）. As part of the Health for All strategy of the World Health Organization, the food safety programme should be given higher priority in the design and implementati
4、on of the national plans of action for nutrition.Keywords: public health; “Health for All” strategy; primary health care; International Conference for Nutrition; risk analysis; food trade.INTRODUCTION The accumulated advances in food safety can be seen in the context of our success in the control an
5、d prevention of communicable（传染性）diseases. Over the past hundred years, better scientific under- tanding of food safety hazards（危害）and their control, including the application of food technology - e.g. asturisation has contributed to an ever safer food supply, at least in industrialized countries. S
6、everal food-borne diseases such as cholera（霍乱）, typhoid （伤寒） and para- yphoid fevers, have been virtually eliminated（消除） in the eveloped world. However, the number of reported cases of food-borne diseases started to increase beginning about three decades ago.In some developed countries,sharp increas
7、es in salmonellosis and campy- obacterosis have been reported.THE MEANING OF PUBLIC HEALTH AND “HEALTH FOR ALL” STRATEGY Before answering the above questions, it may be useful to go back to the original meaning of public health and try to position food safety as a sub-domain（子） of public health. In
8、order to define public health, we need to begin by examining what we mean by public. The public is usually thought of as a population or sub- group of people who share a certain profile（侧面）, often identified by a geographic and temporal location. A given public may have, more or less, a common lifes
9、tyle, a certain set of daily demands, living condi- tions, and/or exposures（暴露） to health/social hazards. Even a common degree of access to health and social services may define a given public. Throughout history, there have been such epochsand such places, where a clearly identified public existed.
10、 It was the case for coal miners and, to some extent, their families, who lived in Great Britain during the nineteenth century, for instance. They can be considered as a public, in the sense that they all confronted common socio-economic and health prob- lems.The fact that the formation of slums（贫民窟
11、） for the working classes in industrial cities during the Industrial Revolution overlapped（重叠）the genesis（创世纪） of public health is not a mere coincidence. It is obvious that the evolution of epidemiology as a modern science has led to the policies and interventions which we now callpublic health. To
12、day, not only in industrialized countries but also in developing countries, it is becoming more and more difficult to characterize a traditional social class as a public. Often when such a public is identified, it is more heterogeneous and transient, as seen in refugee populations. Accordingly, one
13、can hardly foresee itsformation, nor can interventions be developed and implemented（实施） in due course. Paradoxically（矛盾的是）, at the same time as traditional publics are fragmented（支离破碎）, globalization is contributing to the homogenization（均）of other aspects of the worlds popula- tion. The travel and
14、migration（迁移） of human beings and the transport of merchandise（货物） as well as the transmission of information have introduced common elements into widely divergent（发散） cultures and societies. We are not surprised to note, for instance, certain brands of fast food are scattered（分散） all over the world
15、. As seen so far, the concept of the public in a conventional sense is giving way to newly emerging straightforward manner and who share fewer common features than did the old. As with the word public, the term health has also changed its meaning. As is well known, health science has, by and large（总
16、的来说）, two major branches. The one focuses on promotion of health and prevention of diseases; the other is centred on treatment of diseases and rehabilitation（康复） of disorders（紊乱）. Though health science put its early emphasis on the curative（治疗） side, it rapidly enlarged its field to the preventive s
17、ide, and particularly, to the promotion of health. The epidemics（流行病） of emerging dis- eases, such as HIV/AIDS, for which we possess no effective means of treatment so far, requir epreventive approaches. The increasing burden of health care cost in many countries has lead us to turn towards more cos
18、t-effective preventive approaches. The target of preventive health care is usually the public, since its methodology（目标） is based on the validity（有效的） across individuals. It is the curative measures that deal with sick individuals. In other words, any public health oriented（导向） approach should have
19、in its scope the public as object either suffering from the same pathology or subject to the same health risk inherent（固有） in their lifestyles, living conditions, or other common factors.When we look at the current world situation, the most striking（显著的）fact is that the disparity（差距） in health statu
20、s between least developed countries and developed countries has actually widened over the past decade. For instance, infant mortality now ranges from 5-160. It is in this context that the Director-General（总干事） of WHO stated in May 1995 that access to health for all, including the poorest and most vu
21、lnerable countries and population groups, remains the guiding purpose of WHOs programmes and its cooperation with countries. If these gaps are to be bridged through our concerted efforts, equity and solidarity are key concepts in realizing the goal of Health for All acrossmany populations facing dif
22、ferent kinds of social and economic problems.Food safety, which is one of the preventive approaches to health, cannot be free from the trends above regarding the changing nature of the public and the ever growing health gaps（人群） between population groups. In order to prevent not only a range of food
23、-borne（食源） diseases but also the malnutrition（营养不良） caused by infectious diarrhoea（腹泻）, a wide range of biomedical analyses and socio-economic evaluations of the target population will be necessary when developing a food safety programme. In addressing（解决） this major issue of public health, WHO iden
24、tified promoting and protecting health as one of four interrelated（相关） policy orientations in its Ninth General Programme of Work covering the period 19962001. The Programme aims at mobilizing all resources related to health promotion and protection, including employment, education, housing, town pl
25、anning, price control, agricultural policy, financing and economic policies and laws and regulations, so that nutritional status（地位） for all population groups be improved continuously, that they have universal access to safe and healthy environments and living conditions and that all people adopt an
26、d maintain（维持） healthy lifestyles and behaviour.MODULARITY OF PUBLIC HEALTH AND ITS POSITION IN GOVERNMENT SYSTEMSPublic health, as a comprehensive（综合的） set of sciences and measures aiming at the protection and promotion of the health of the public, is implemented（实施） in real society through two maj
27、or structures. The first one is the so-called functional infrastructure（基础建设）, ie basic mechanisms（机制） which assess the needs of the population and put the necessary measures in place. They include norm setting and management bodies, national and local health offices, dispensaries, hospitals and oth
28、er facilities, manpower development courses, information systems, mass media and research institutes（机构） and laboratories, to name but a few.The second component can be seen as a kind of software which is designed to run on the hardware mentioned above. Each piece of software corresponds o a specifi
29、c programme of public health, such as maternal(公共项目) and child health, non-communicable（非传染性）disease control, and food safety. It should be borne in mind that the development of he former component constitutes one of the necessary conditions for the implementation（实施） of the latter, and, hat conside
30、rable interactions（互动） take he hardware and the software different software programmes at service delivery system. A simple example suffices. If an important part of the infrastructure, eg an information system, is lacking, this then handicaps（障碍） the whole system of primary health care. Conversely,
31、 once a specific part of the infrastructure is put in place, it can contribute to every public health programme. This may even stimulate competition between different programmes for the privileged（特权）use of such resources. However. the interactions are not necessarily negative ones. Positive interac
32、tions are also expected and should been couraged by public health managers. For example, family education for the safe preparation of weaning food is all the more efficient and effective when implemented（实施）by the same public health nurse who visits the families and checks the infants growth and dev
33、elopment. The essential point is that each programme should maximally benefit from the interaction with otheractions of public health. Furthermore, different infrastructure areas and programme elements must be coordinated at the family, community, district and higher levels. The cooperation and coor
34、dination between adjacent modules/levels are indispensable for the primary health care system to be comprehensive, efficient and sutainable. INTERNATIONAL PERSPECTIVEThe International Conference on Nutrition (ICN), which was held in December 1992 in Rome, adopted the World Declaration(宣言) and Plan o
35、f Action for Nutrition, recognizing that access to nutritonally adequate and safe food is a right of each indivdiual. The World Health Organization, which has made nutrition a priorty（优先）area, has been assisting governments in implementing（实施） the recommendations of ICN, through the publication of g
36、uideline documents and the evaluation of the national plans of action. The United Nations Conference on Environment and Development (UNCED), which took place in June 1992 in Riode Janeiro, also referred to the need for promotion and protection of health through prevention of communicable diseases an
37、d the management of toxic（有毒） chemicals. Together with the United Nations Environmental Programme and the Food and Agriculture Organization, WHO has been monitoring（监测） the environmental contamination level in food of heavy metals, pesticides and other contaminants.WHO is also responsible for the sc
38、ientific assessment（评估） of the risks such chemical pose to human health, not only in food but also in other routes of exposure.CONCLUSION Food safety can be defined as all conditions and measures that are necessary during the production, processing, storage, distribution（配送） and preparation of food
39、to ensure that, when ingested（消化、吸收）, it does not represent an appreciable risk to health. In this sense, food safety is certainly a branch of public health which deserves higher priority in any public health programme. The fact that food safety is a common concern of government, industry and consum
40、ers calls for a coordination（协调） of the quality assurance processes along the food chain. In this context, the health sector should assume the lead role for norm setting. This implies that the health sector is expected to be involved at all stages of the food chain（链条）, nationally and internationall
41、y. WHOs role in promoting and protecting the health of people is based on public health principles. Technical cooperation with individual governments and the elaboration of international norms are among the pillars of WHOs Health for All strategy. It is exactly the case for food safety. All the sect
42、ors, national or international, need to collaborate with each other. They should share the overall responsibility for food safety as a part of public health programmes.REFERENCES Abdussalam, M. and Kiiferstein, F.K. (1994) Food safety in primary health care, World Health Forum 15, 393-399 Allen, R.J
43、.L. and Klferstein, F.K. (1983) Foodborne disease, food hygiene and consumer education. Archiv fur Lehensmittelhygiene 34, 81-108 Anonymous: Protecting consumers through improved food quality and safety, Theme Paper No. 2, Major Issues for Nutrition Sfrategies, International Conference on Nutrition
44、- Final Document Joint FAO/WHO Food Standards Programme - Codex Alimentarius Commission (1992) Code of Efhics for international Trade in Food Rev I GATT (1994) Understanding the World Trade Organization Agreement on Sanitary and Phytosanitary Measures Moy, G., KPferstein, F.K. and Motarjemi, Y. (1994) Application of HACCP to food manufacturing, Food Control 5(3), 131-139 WHO (1995) Application of risk analysis io food standards issues, Report of the Joint FAO/WHO Expert Consultation, WHO/ FNU/FOS 95.3
