Selected Topics - Food Safety and Nutrition

• School of Food Science and Technology, UNSW

Events

• School of Public Health and Community Medicine, UNSW - Upcoming Events

Global policies and related documents

• Codex Alimentarius Commission
  The Codex Alimentarius Commission was created in 1963 by FAO and WHO to develop food standards, guidelines and related texts such as codes of practice under the Joint FAO/WHO Food Standards Programme. The main purposes of this Programme are protecting health of the consumers and ensuring fair trade practices in the food trade, and promoting coordination of all food standards work undertaken by international governmental and non-governmental organisations.

Reports, guidelines and projects

• Addressing the Intersection: Preventing Violence and Promoting Healthy Eating and Active Living
  Across the country, healthy food and activity leaders have identified violence and the fear of violence as major roadblocks to the success of chronic disease prevention strategies. The impact of violence in communities is far-reaching: when people don't feel safe in their communities, they are less likely to use local parks and community centers and access services such as public transportation. When parents don't feel safe in their communities, they are hesitant to let their children play outside or walk to school. Also, communities perceived as being unsafe are less likely to benefit from investments such as grocery stores. Until now, very little research on the impact of community violence on healthy eating and activity — and potential solutions — has been done… Addressing the Intersection provides an explanation of the inter-relationship between violence and healthy eating and activity. The findings and recommendations offered in this paper can support practitioners and advocates in their work to prevent chronic disease in communities heavily impacted by violence. We also hope that this paper will be a resource for a broader audience, including funders, policymakers, researchers, and anyone working to build safe, healthy communities. [publisher overview] Executive summary. [Prevention Institute, May-September 2010]
• Associations between maternal experiences of intimate partner violence and child nutrition and mortality: findings from Demographic and Health Surveys in Egypt, Honduras, Kenya, Malawi and Rwanda
  Background: If effective interventions are to be used to address child mortality and malnutrition, then it is important that we understand the different pathways operating within the framework of child health. More attention needs to be given to understanding the contribution of social influences such as intimate partner violence (IPV). Aim: To investigate the relationship between maternal exposure to IPV and child mortality and malnutrition using data from five developing countries. Methods: Population data from Egypt, Honduras, Kenya, Malawi and Rwanda were analysed. Logistic regression analysis was used to generate odds ratios of the associations between several categories of maternal exposure to IPV since the age of 15 and three child outcomes: under-2-year-old (U2) mortality and moderate and severe stunting (<-2 Z-score height-for-age and <-3 Z-score height-for-age) in 6e59-month-old children. Analyses were adjusted for potential confounders, and the role of mediating factors was explored. Results: The prevalence of physical and/or sexual IPV since the age of 15 years ranged from 15.5% (Honduras) to 46.2% (Kenya). For child stunting, prevalence ranged from 25.4% (Egypt) to 58.0% (Malawi) and for U2 mortality from 3.6% (Honduras) to 15.2% (Rwanda). In Kenya, maternal exposure to IPV was associated with higher U2 mortality (adjusted odds ratio (OR)=1.42, 95% CI 1.18 to 1.71) and child stunting (adjusted OR=1.36, 95% CI 1.16 to 1.61). In Malawi and Honduras, marginal associations were observed between IPV and severe stunting and U2 mortality, respectively, with strength of associations varying by type of violence. Conclusion: The relationship between IPV and U2 mortality and stunting in Kenya, Honduras and Malawi suggests that, in these countries, IPV plays a role in child malnutrition and mortality. This contributes to a growing body of evidence that broader public health benefits may be incurred if efforts to address IPV are incorporated into a wider range of maternal and child health programmes; however, the authors highlight the need for more research that can establish temporality, use data collected on the basis of the study’s objectives, and further explore the causal framework of this relationship using more advanced statistical analysis. [author abstract] [J Epidemiol Community Health (2010), jech.2008.081810 - Published Online: 14 September 2010]
• Banning Junk Food and Soda Sales in the State's Public Schools
  On September 15, 2005, California Governor Arnold Schwarzenegger signed into law two bills establishing nutritional standards for the food and beverages sold in the state’s public schools. The first, banned the sale of junk food—candy, cookies, chips and the like. The second, banned the sale of soft drinks—Coke, Pepsi, fruit drinks, sugared waters and similar products. The governor also signed a third bill that provided funding for fruits and vegetables in school breakfast programs. This report reflects on the processes involved in effecting this public policy change and its ongoing implications.
• Ciguatera: A public health perspective
  Ciguatera fish poisoning is a seafood-borne illness caused by consumption of fish that have accumulated lipid-soluble ciguatoxins. In the United States, ciguatera is responsible for the highest reported incidence of food-borne illness outbreaks attributed to finfish, and it is reported to hold this distinction globally. Ciguatoxins traverse the marine food web from primary producers, Gambierdiscus spp., to commonly consumed fish in tropical and subtropical regions of the world. Ciguatoxins comprise 12 known congeners among Caribbean and tropical Atlantic fish and 29 reported congeners among Pacific fish. Expanding trade in fisheries from ciguatera-endemic regions contributes to wider distribution and increasing frequency of disease among seafood consumers in non-endemic regions. Ciguatoxins produce a complex array of gastrointestinal, neurological and cardiological symptoms. Treatment options are very limited and supportive in nature. Information derived from the study of ciguatera outbreaks has improved clinical recognition, confirmation, and timely treatment. Such studies are equally important for the differentiation of ciguatoxin profiles in fish from one region to the next, the determination of toxicity thresholds in humans, and the formulation of safety limits. Analytical information from case and outbreak investigations was used to derive Pacific and Caribbean ciguatoxin threshold contamination rates for adverse effects in seafood consumers. To these threshold estimates 10-fold safety factors were applied to address individual human risk factors; uncertainty in the amount of fish consumed; and analytical accuracy. The studies may serve as the basis for industry and consumer advisory levels of 0.10 ppb C-CTX-1 equivalent toxicity in fish from the tropical Atlantic, Gulf of Mexico, Caribbean, and 0.01 ppb P-CTX-1 equivalent toxicity in fish from Pacific regions. [author abstract] [Toxicon 2009 Sep 23]
• Consumption of Industrially-Produced Chickens in Senegal and Risks to Public Health
  Senegal has been taking part in the worldwide industrial poultry boom, in response to growing demand for animal protein by the urban population in and around the capital city, Dakar. A rise in productivity over the past decade has made this chicken the cheapest meat available. However, the expansion has occurred without any systematic control of hygienic practices along the supply chain, and research by the authors shows that up to 9 % of the chickens sold have unacceptably high levels of contaminants, particularly Salmonella. The health risks to consumers are compounded by preparation methods in the expanding restaurant and fast-food sector, where hygiene practices are wanting and where the cooking temperatures are too low to kill the harmful germs. Resolving these health problems is an important issue for public health in Senegal. It is also a challenge that the industry must meet in order to remain competitive in the context of the new free trade area being established in West Africa. For this, health authorities need to focus not only on improving controls, but also on education and outreach programs for the professionals in the chain, to encourage adoption of improved practices. There is also a role for educating consumers on safe cooking and hygiene practices in the urban environment. [author abstract] [E. Hanak, E. Boutrif, P. Fabre, M. Pineiro, (Scientific Editors), 2002. Food Safety Management in Developing Countries. Proceedings of the International Workshop, CIRAD-FAO, 11-13 December 2000, Montpellier, France, CIRAD-FAO. CIRAD CD-ROM, Montpellier, France]
• Developing an evidence-based approach to Public Health Nutrition: translating evidence into policy
  The aim of this paper is to highlight the importance of an evidence-based approach to the development, implementation and evaluation of policies aimed at improving nutrition-related health in the population. Public Health Nutrition was established to realise a population-level approach to the prevention of the major nutrition-related health problems world-wide. The scope is broad and integrates activity from local, national, regional and international levels. The aim is to inform and develop coherent and effective policies that address the key rate-limiting steps critical to improving nutrition-related public health. This paper sets out the rationale for an evidence-based approach to Public Health Nutrition developed under the umbrella of the European Network for Public Health Nutrition. [author abstract] [Public Health Nutrition, 4(6A): 1393-1397 (2001)]
• Food Marketing to Children and Youth: Threat or Opportunity?
  This study examines the impact of food marketing on health of children and youth in the United States. It asserts that the food marketing industry intentionally and successfully targets children who are too young to distinguish advertising from truth and induces them to eat high-calorie, low-nutrient (but highly profitable) "junk" foods. The report also suggests a number of strategies to combat this influence.
• Hunger in America 2006: National Report Prepared for America's Second Harvest Final Report March 2006
  “...Despite America's great wealth, millions of Americans do not have enough food to eat each day. More than 25 million people use food banks and food-rescue organizations in America's Second Harvest -The Nation’s Food Bank Network (A2H), the nation’s largest network of emergency food providers - each year. This report presents the result of a study conducted in 2005 for Second Harvest. It provides a comprehensive profile of the incidence and nature of hunger and food insecurity in the U.S. The study provides extensive demographic profiles of emergency food clients at charitable feeding agencies and comprehensive information on the nature and efficacy of local agencies in meeting the food security needs."
• Impact of Climate Change and Bioenergy on Nutrition
  Food security has four dimensions: food availability, access to food, stability of supply and access and safe and healthy food utilization. Food security is a key factor in good nutrition, along with health, sanitation and care practices. The paper begins by laying out the current state of global food insecurity and malnutrition, including magnitude, trends and future projections. The causes, consequences and costs of food insecurity and malnutrition are explored. Malnutrition is clearly a severe impediment to sustainable development and human security as it slows down economic growth and the achievement of equity. The paper briefly lays out a number of factors besides climate change, bioenergy and rising prices that will likely contribute to malnutrition in the future. The paper then explores the implications of climate change and rising bioenergy demand for nutrition. Agricultural activities contribute to climate change, but can also play an important role in adaptation and mitigation strategies, as well as in boosting food availability. Next, the paper examines the direct nutrition effects of rising bioenergy demand, as well as its contribution to rising food prices. It also discusses potential strategies for cultivation of bioenergy crops that can contribute to poverty reduction, food security and sustainable natural resource management. A chapter on policy implications provides a number of options for improving food security and nutrition, as well as for addressing the links between climate change and bioenergy demand on the one hand and nutrition on the other. The paper concludes with recommendations.
• Methodological Toolbox on the Right to Food
  The purpose of the Methodological Toolbox is to provide a practical aid for the implementation of the Right to Food Guidelines. It contains a series of analytical, educational and normative tools that offer guidance and hands-on advice on the practical aspects of the right to food. It covers a wide range of topics such as assessment, legislation, education, budgeting and monitoring. It emphasises the operational aspects of the right to food and contributes to strengthening in-country capacity to implement this right. [FAO, 2009]
• Monitoring compliance with the International Code of Marketing of Breastmilk Substitutes in west Africa: Multisite cross sectional survey in Togo and Burkina Faso
  Objectives: To monitor compliance with the International Code of Marketing of Breastmilk Substitutes in health systems, sales outlets, distribution points, and the news media in Togo and Burkina Faso, west Africa. Design: Multisite cross sectional survey. Participants: Staff at 43 health facilities and 66 sales outlets and distribution points, 186 health providers, and 105 mothers of infants aged <5 months in 16 cities. Results: Six (14%) health facilities had received donations of breast milk substitutes. All donations were being given to mothers free of charge. Health providers in five (12%) health facilities had received free samples of breast milk substitutes for purposes other than professional research or evaluation. Health professionals in five (12%) health facilities had received promotional gifts from manufacturers. Promotional materials of commercial breast milk substitutes were found in seven (16%) health facilities. Special displays to market commercial breast milk substitutes were found in 29 (44%) sales and distribution points. Forty commercial breast milk substitutes violated the labelling standards of the code: 21 were manufactured by Danone, 11 by Nestlé, and eight by other national and international manufacturers. Most (148, 90%) health providers had never heard of the code, and 66 mothers (63%) had never received any counselling on breast feeding by their health providers. Conclusion: In west Africa manufacturers are violating the code of marketing of breast milk substitutes. Comparable levels of code violations are observed with (Burkina Faso) or without (Togo) regulating legislation. Legislation must be accompanied by effective information, training, and monitoring systems to ensure that healthcare providers and manufacturers comply with evidence based practice and the code. [author abstract] [BMJ, Volume 326, 18 January 2003, pp.127-132]
• Nutrition Education in Primary Schools - A Planning Guide for Curriculum Development
  This 2007 report is a “….wide-ranging new guide on teaching good eating habits to primary school children in an effort to reduce malnutrition and diet-related diseases. The agency notes that one of the most effective strategies for overcoming malnutrition and chronic diet-related diseases, such as excess weight and obesity, diabetes, hypertension and cardiovascular diseases, is educating school children in healthy nutrition…”.
• Nutrition in India: Facts and Interpretations
  "In spite of India’s rapid economic growth, there has been a sustained decline in per capita calorie consumption during the last twenty-five years. While the decline has been largest among better-off households, it has taken place throughout the range of household per capita total expenditure. For both adults and children, anthropometric indicators of nutritional status in India are among the worst in the world. While these indicators have shown improvement over time, the rate of progress is slow relative to what might be expected based on international and historical experience. This paper presents the basic facts about growth, poverty and nutrition in India, it points to a number of puzzles, and it sketches a preliminary story that is consistent with the evidence. The reduction in calorie consumption cannot be attributed to declining real incomes, nor to any increase in the relative price of food. Our leading hypothesis, on which much work remains to be done, is that, as real incomes and wages have increased, leading to some nutritional improvement, there has been an offsetting reduction in calorie requirements due to declining levels of physical activity and possibly also to various improvements in the health environment. If correct, this analysis does not imply that Indians are currently adequately nourished; nothing could be further from the truth. Calorie intake has serious limitations as a nutritional intake; while calories are extremely important, there are too many sources of variation in calorie requirements for standard, invariant, calorie-norms to be usefully applied to large sections of the population. We conclude with a plea for better, and more regular, monitoring of nutritional status in India."
• Nutritional Information in Crisis Situations
  This report is issued by the United Nations Standing Committee on Nutrition. The report is designed to provide information on key outcome indicators from emergency affected populations, play an advocacy role in bringing the plight of emergency affected populations to the attention of donors and humanitarian agencies and to identify recurrent problems in international response capacity. The Reports on Nutrition Information in Crisis Situations aim to cover populations affected by crisis, such as refugees, internally displaced populations and resident populations.
• Obesity and the Economics of Prevention: Fit not Fat – Executive summary
  Obesity has risen to the top of the public health policy agenda worldwide. Before 1980, rates were generally well below 10%. They have since doubled or tripled in many countries, and in almost half of the OECD, 50% or more of the population is overweight. A key risk factor for numerous chronic diseases, obesity is a major public health concern. There is a popular perception that explanations for the obesity epidemic are simple and solutions within reach. But the data reveal a more complicated picture, one in which even finding objective evidence on the phenomenon is difficult. Policy makers, health professionals and academics all face challenges in understanding the epidemic and devising effective counter strategies. This book contributes to evidence-based policy making by exploring multiple dimensions of the obesity problem. It examines the scale and characteristics of the epidemic, the respective roles and influence of market forces and governments, and the impact of interventions. It outlines an economic approach to the prevention of chronic diseases that provides novel insights relative to a more traditional public health approach. The analysis was undertaken by the OECD, partly in collaboration with the World Health Organization. [publisher overview] [OECD and World Health Organization. WHO – 2010]
• Obesity Metaphors: How Beliefs about the Causes of Obesity Affect Support for Public Policy
  "Context: Relatively little is known about the factors shaping public attitudes toward obesity as a policy concern. This study examines whether individuals’ beliefs about the causes of obesity affect their support for policies aimed at stemming obesity rates. This article identifies a unique role of metaphor-based beliefs, as distinct from conventional political attitudes, in explaining support for obesity policies. Methods: This article used the Yale Rudd Center Public Opinion on Obesity Survey, a nationally representative web sample surveyed from the Knowledge Networks panel in 2006/07 (N=1,009). The study examines how respondents’ demographic and health characteristics, political attitudes, and agreement with seven obesity metaphors affect support for sixteen policies to reduce obesity rates. Findings: Including obesity metaphors in regression models helps explain public support for policies to curb obesity beyond levels attributable solely to demographic, health, and political characteristics. The metaphors that people use to understand rising obesity rates are strong predictors of support for public policy, and their influence varies across different types of policy interventions. Conclusions: Over the last five years, the United States has begun to grapple with the implications of dramatically escalating rates of obesity. Individuals use metaphors to better understand increasing rates of obesity, and obesity metaphors are independent and powerful predictors of support for public policies to curb obesity. Metaphorical reasoning also offers a potential framework for using strategic issue framing to shift support for obesity policies." [author abstract]
• Prevention of overweight and obesity from a public health perspective
  International organizations have raised awareness of the increasing prevalence of overweight and obesity worldwide and the impact on morbidity, mortality, quality of life, and cost of healthcare. The development and implementation of obesity prevention strategies requires the identification and understanding of determinant factors that can be influenced by effective large-scale action plans over time. Strategies aimed at the primary prevention of obesity in a population should be multifaceted and designed to actively involve stakeholders and other major parties concerned; in addition, multiple settings for implementation should be considered. In this paper, an overview is presented of the strategies currently in place for obesity prevention, particularly in Spain. [author abstract] [Nutrition Reviews, Vol. 67 (Suppl. 1):S83–S88 (2009)]
• Public Policies on Nutrition Labelling: Effects and Implementation Issues: A Knowledge Synthesis
  Following a brief discussion of the targeted problem, namely, obesity in Canada, this document defines the subject of the present knowledge synthesis: nutrition labelling, whose effectiveness we attempt to document, along with its unintended effects, equity, cost, feasibility and acceptability. Next follows a description of the method used to study public policies on nutrition labelling: explication of their logic model; review of the scientific and grey literatures; and organization of deliberative processes that bring together Canadian actors involved in addressing obesity. This document next describes the logic model for nutrition labelling. It then synthesizes the data gathered from the literature on the status of nutrition-labelling policies in industrialized countries, on the effectiveness of nutrition labelling, and on its unintended effects, equity, cost, feasibility and acceptability. Then, the data on these same topics gathered through deliberative processes are presented. The document concludes with a summary of the key points to note regarding the effects and implementation of public policies on nutrition labelling. [publication forward] [Institut national de santé publique du Québec, National Collaborating Centre for Healthy Public Policy - NCCHPP– Canada, 2011]
• Repositioning nutrition as central to development: A strategy for large scale development
  This World Bank Report examines malnutrition..."the world’s most serious health problem and the single biggest contributor to child mortality. Nearly one-third of children in the developing world are either underweight or stunted, and more than 30 percent of the developing world’s population suffers from micronutrient deficiencies. Unless policies and priorities are changed, the scale of the problem will prevent many countries from achieving the Millennium Development Goals (MDGs)—especially in Sub-Saharan Africa, where malnutrition is increasing, and in South Asia, where malnutrition is widespread and improving only slowly."
• Shared Principles of Ethics for Infant and Young Child Nutrition in the Developing World
  Background: The defining event in the area of infant feeding is the aggressive marketing of infant formula in the developing world by transnational companies in the 1970s. This practice shattered the trust of the global health community in the private sector, culminated in a global boycott of Nestle products and has extended to distrust of all commercial efforts to improve infant and young child nutrition. The lack of trust is a key barrier along the critical path to optimal infant and young child nutrition in the developing world. Discussion: To begin to bridge this gap in trust, we developed a set of shared principles based on the following ideals: Integrity; Solidarity; Justice; Equality; Partnership, cooperation, coordination, and communication; Responsible Activity; Sustainability; Transparency; Private enterprise and scale-up; and Fair trading and consumer choice. We hope these principles can serve as a platform on which various parties in the in the infant and young child nutrition arena, can begin a process of authentic trust-building that will ultimately result in coordinated efforts amongst parties. Summary: A set of shared principles of ethics for infant and young child nutrition in the developing world could catalyze the scale-up of low cost, high quality, complementary foods for infants and young children, and eventually contribute to the eradication of infant and child malnutrition in the developing world. [author abstract] [BMC Public Health 10: 321, 2010]
• Soaring food prices: Facts, perspectives, impacts and actions required
  "Further sharp price hikes and continued volatility in markets for food supplies appear to be likely for the next few seasons, according to a report released by the United Nations Food and Agriculture Organization (FAO) in the run-up to a summit on the global food crisis which is being held in Rome. FAO lists 22 countries that it says are particularly vulnerable to food price increases because of high levels of chronic hunger and because they are net importers of both food and fuel. The report [by FAO, May 2008] cites Eritrea, Niger, Comoros, Haiti and Liberia as being especially at risk."
• Socioeconomic inequality in malnutrition in developing countries
  This paper, written by Ellen Van de Poel, Ahmad Reza Hosseinpoor, Niko Speybroeck, Tom Van Ourti and Jeanette Vega, and published in the Bulletin of the World Health Organization (BLT) - Volume 86, Number 4, April 2008, 241-320, describes how "disparities in health outcomes between the poor and the rich are increasingly attracting attention from researchers and policy-makers, thereby fostering a substantial growth in the literature on health equity. “Socioeconomic inequality” in malnutrition refers to the degree to which childhood malnutrition rates differ between more and less socially and economically advantaged groups. This is different from “pure inequality”, which takes into account all factors influencing childhood malnutrition… This paper contributes to the literature in several ways. First, it updates and enlarges the evidence base on average malnutrition and socioeconomic inequality in malnutrition using the most recent Demographic and Health Survey (DHS) data from 47 developing countries. The inclusion of such a large number of countries makes it possible to obtain insights into the regional clustering of poor–rich malnutrition disparities in the developing world and into the association between the average level of malnutrition and socioeconomic inequality. Given the focus on average rates of malnutrition in international development targets, it is of interest to establish how countries compare in terms of average rates of malnutrition and inequality in malnutrition. In addition to quantifying the degree of socioeconomic inequality using a single index, this paper also illustrates the different patterns found for the distribution of malnutrition across socioeconomic groups…".
• Socioeconomic Status and Obesity
  This study by Lindsay McLaren, and published in Epidemiologic Reviews (29: 29-48 (2007), reviewed a total of 333 published studies, representing 1,914 primarily cross-sectional associations. "The overall pattern of results, for both men and women, was of an increasing proportion of positive associations and a decreasing proportion of negative associations as one moved from countries with high levels of socioeconomic development to countries with medium and low levels of development. Findings varied by SES indicator; for example, negative associations (lower SES associated with larger body size) for women in highly developed countries were most common with education and occupation, while positive associations for women in medium- and low-development countries were most common with income and material possessions... The overall pattern of results, for both men and women, was of an increasing proportion of positive associations and a decreasing proportion of negative associations as one moved from countries with high levels of socioeconomic development to countries with medium and low levels of development. Findings varied by SES indicator; for example, negative associations (lower SES associated with larger body size) for women in highly developed countries were most common with education and occupation, while positive associations for women in medium- and low-development countries were most common with income and material possessions." [author abstract]
• Solving the Problem of Childhood Obesity Within a Generation
  "The childhood obesity epidemic in America is a national health crisis. One in every three children (31.7%) ages 2-19 is overweight or obese. The life-threatening consequences of this epidemic create a compelling and critical call for action that cannot be ignored. Obesity is estimated to cause 112,000 deaths per year in the United States, and one third of all children born in the year 2000 are expected to develop diabetes during their lifetime. The current generation may even be on track to have a shorter lifespan than their parents. Along with the effects on our children’s health, childhood obesity imposes substantial economic costs. Each year, obese adults incur an estimated $1,429 more in medical expenses than their normal-weight peers. Overall, medical spending on adults that was attributed to obesity topped approximately $40 billion in 1998, and by 2008, increased to an estimated $147 billion. Excess weight is also costly during childhood, estimated at $3 billion per year in direct medical costs." [US White House Task Force on Childhood Obesity, Report 11 May 2010]
• State of Food Insecurity in the World 2005
  The State of Food Insecurity in the World 2005 was prepared as a collaborative effort within FAO led by the Economic and Social Department (ES). WFS), The State of Food Insecurity in the World 2005 focuses on the critical importance of reducing hunger, both as the explicit target of the WFS and MDG 1 and as an essential condition for achieving the other MDGs.
• State of the Evidence Review on Urban Health and Healthy Weights
  “…The relationship between urban environments and obesity has received little systematic attention. Our purpose was to review and synthesize the evidence on: a) structural and community level characteristics of urban environments that promote or inhibit the achievement of healthy weights; and b) the effectiveness of interventions to assist urban populations in achieving healthy weights. Research findings were categorized and tabulated within a framework that examines social determinants of health and multiple levels of the environment (i.e. community-level vs. structural). Four outcome areas were considered: obesity/healthy weights, food/diet/nutrition, physical activity and sedentary behaviour. The resulting analyses provide a high-level overview of the strengths of and gaps in the research on associations between urban environments and healthy weights. The report also identifies priorities for future policy-relevant research and presents the author suggestions for promising interventions that may help to reduce population obesity levels in urban places…”.
• The challenge of obesity in the WHO European Region and the strategies for response
  Edited by Francesco Branca, Haik Nikogosian and Tim Lobstein, "this book collects the papers that were written by a large group of experts in public health, nutrition and medicine to provide background for the Conference; a smaller book already published by the Regional Office summarizes many of their conclusions. Both this book and the summary illustrate the dynamics of the epidemic and its impact on public health throughout the European Region. In particular, the obesity epidemic’s rapid expansion to the countries in the eastern half of the Region causes great concern, as they now suffer from a double burden of disease linked to both under- and overnutrition…".
• The Future Control of Food: A Guide to International Negotiations and Rules on Intellectual Property, Biodiversity and Food Security
  “…Guide to the key issues of intellectual property and ownership, genetics, biodiversity, and food security. Proceeding from an introduction and overview of the issues, comprehensive chapters cover negotiations and instruments in the World Trade Organization, Convention on Biological Diversity, UN Food and Agriculture Organization, World Intellectual Property Organization, the International Union for the Protection of New Varieties of Plants, and various other international bodies. The final part discusses civil society responses to relevant changes and developments in these issues, how they affect the direction of research and development, the nature of global negotiation processes and various alternative futures.”
• The Global Epidemic of Obesity: An Overview
  "For centuries, the human race struggled to overcome food scarcity, disease, and a hostile environment. With the onset of the industrial revolution, the great powers understood that increasing the average body size of the population was an important social and political factor. The military and economic might of countries was critically dependent on the body size and strength of their young generations, from which soldiers and workers were drawn. Moving the body mass index (BMI) distribution of the population from the underweight range toward normality had an important impact on survival and productivity, playing a central role in the economic development of industrialized societies… This overview provides an introduction to this issue of Epidemiologic Reviews, highlighting, in historical perspective, key scientific aspects of obesity that are addressed by the 11 articles that follow. This compilation of reviews underscores the multidisciplinary nature of obesity research and the need to expand even further our scope to fully understand and confront the obesity epidemic."
• The Obesity Epidemic: Analysis of Past and Projected Future Trends in Selected OECD Countries
  "This [OECD] paper provides an overview of past and projected future trends in adult overweight and obesity in OECD countries. Using individual-level data from repeated cross-sectional national surveys, some of the main determinants and pathways underlying the current obesity epidemic are explored, and possible policy levers for tackling the negative health effect of these trends are identified. First, projected future trends show a tendency towards a progressive stabilisation or slight shrinkage of pre-obesity rates, with a projected continued increase in obesity rates. Second, results suggest that diverging forces are at play, which have been pushing overweight and obesity rates into opposite directions. On one hand, the powerful influences of obesogenic environments (aspects of physical, social and economic environments that favour obesity) have been consolidating over the course of the past 20-30 years. On the other hand, the long term influences of changing education and socio-economic conditions have made successive generations increasingly aware of the health risks associated with lifestyle choices, and sometimes more able to handle environmental pressures. Third, the distribution of overweight and obesity in OECD countries consistently shows pronounced disparities by education and socio-economic condition in women (with more educated and higher socio-economic status women displaying substantially lower rates), while mixed patterns are observed in men. Fourth, the findings highlight the spread of overweight and obesity within households, suggesting that health-related behaviours, particularly those concerning diet and physical activity, are likely to play a larger role than genetic factors in determining the convergence of BMI levels within households."
• Vitamin A deficiency and child mortality in Mozambique
  Background: In areas where vitamin A deficiency (VAD) is prevalent, vitamin A repletion reduces child mortality by 23% on average. Objectives: To estimate the potential child survival benefits of policies and programmes aimed at controlling VAD in Mozambique, and to make policy and programme recommendations. Methods: The potential contribution of VAD to child mortality in Mozambique was estimated by combining the observed VAD prevalence in the under-5s (71.2%), the measured child mortality effects of VAD (risk of death in children with VAD = 1.75 times higher than in children without VAD) and the observed under-5 mortality rate in the country (210 per 1000 live births). Results: In Mozambique, an estimated 2.3 million children below the age of 5 years are vitamin-A-deficient. In the absence of appropriate policy and programme action, VAD will be the attributable cause of over 30 000 deaths annually in the under-5s. This represents 34.8% of all-cause mortality in this age group. Discussion: Vitamin A supplementation (VAS) has been adopted as a short- to medium-term strategy to control VAD in children, and is integrated into routine child health services. However, the last VAS coverage survey showed that only 46% of children received a vitamin A supplement in the 6 months preceding the survey. If VAS coverage is to increase significantly in the foreseeable future, four areas appear to be of paramount importance: (1) reduce missed opportunities for VAS such as visits of sick children to child health services and community outreach activities; (2) take advantage of all potential opportunities for accelerating VAS coverage, such as additional vaccination campaigns and emergency response activities; (3) strengthen health workers’ training, supervision and monitoring skills; and (4) increase community demand for VAS of children. Biannual VAS, as the primary component of an integrated strategy for VAD control in children, has the promise to be among the most cost-effective/high-impact child survival interventions in Mozambique. [author abstract] [Public Health Nutrition, 2005: 8(1), 29–31]
• Weight of nations: a socioeconomic analysis of women in low- to middle-income countries
  Background: The increasing trend in body mass index (BMI) and overweight in rapidly developing economies is well recognized. Objective: We assessed the association between socioeconomic status and BMI and overweight in low- to middle-income countries. Design: We conducted a cross-sectional analysis of nationally representative samples of 538,140 women aged 15–49 y drawn from 54 Demographic and Health Surveys conducted between 1994 and 2008. BMI, calculated as weight in kilograms divided by height squared in meters, was specified as the outcome, and a BMI (in kg/m²) of ≥ 25 was additionally specified to model the likelihood of being overweight. Household wealth and education were included as markers of individual socioeconomic status, and per capita Gross Domestic Product (pcGDP) was included as a marker of country-level economic development. Results: Globally, a one-quartile increase in wealth was associated with a 0.54 increase in BMI (95% CI: 0.50, 0.64) and a 33% increase in overweight (95% CI: 26%, 41%) in adjusted models. Although the strength of this association varied across countries, the association between wealth and BMI and overweight was positive in 96% (52 of 54) of the countries. Similar patterns were observed in urban and rural areas, although SES gradients tended to be greater in urban areas. There was a positive association between pcGDP and BMI or overweight, with only weak evidence of an interaction between pcGDP and wealth. Conclusion: Higher BMI and overweight remain concentrated in higher socioeconomic groups, even though increasing BMI and overweight prevalence are important global public concerns. [author abstract] [Am J Clin Nutr 2011; 93: 413–421]
• What is known about the effectiveness of economic instruments to reduce consumption of foods high in saturated fat and other energy dense foods for preventing and treating obesity
  This is a Health Evidence Network (HEN) synthesis report summarizing the available evidence concerning the effectiveness of economic instruments (including taxes, price policies and incentives) in containing or reducing food consumption, particularly of foods high in saturated fats and other energy-dense foods. Available evidence suggests – but does not demonstrate – that introduction of policy-related economic instruments, particularly in the form of taxes and price policies, could reduce food consumption, including of high saturated fat and other energy-dense foods, and increase the purchasing of healthful foods.

Educational resources

• Arbor Nutrition Guide
  A comprehensive resource on issues of food nutrition
• FAO GeoNetwork
  "FAO GeoNetwork is a tool to fight hunger and rural poverty by using satellite imagery, spatial databases and interactive maps to help developing countries isolate the causes of food shortages was launched by the United Nations Food and Agriculture Organization. ... Users overlay maps from multiple servers housed at development institutions worldwide to create customized thematic maps on their own computers covering such variables as land cover, soil quality, vegetation, population density and marketing access. ...When an emergency occurs, the maps created by the different agencies in their respective fields of expertise can be combined to see the relationship between different factors affecting the populations and the environment..."
• FAO Knowledge Forum
  "The FAO Knowledge Forum provides a direct gateway to the Organization’s vast expertise and wealth of knowledge through a series of interactive services. It is also an opportunity to learn from and give a voice to the agricultural community regarding a wide range of issues affecting Food Security and Agricultural Production today. Through the Knowledge Forum, FAO uses knowledge exchange and dialogue to help build a world without hunger."
• HungerWeb
  "The aim of HungerWeb is to help prevent and eradicate hunger by facilitating the free exchange of ideas and information regarding the causes of, and solutions to, hunger. It contains primary information, made available by the World Hunger Program."
• Martindales: The 'Virtual' Nutrition Center
  A large collection of information on all aspects of nutrition, almost daily updates
• Public Health Nutrition Victoria (Australia)
  This web site provides information for health professionals, educators and practitioners in Public Health Nutrition and health promotion focusing on issues that affect the whole population rather than the specific dietary needs of individuals. The emphasis is on promoting health and disease prevention.
• University of Pennsylvania Food Safety Home Page
  A resource for anyone interested in the cause and prevention of foodborne illness. It provides basic information about the bacteria, parasites and viruses that can cause foodborne illness, gives factual information on current food safety issues and contains links to many government, university and industry web pages.
• Vegetarian Resource Group
  "A non-profit organization dedicated to educating the public on vegetarianism and the interrelated issues of health, nutrition, ecology, ethics, and world hunger."

Organisations and Networks

UN and multinational

• Food and Environmental Protection FAO/IAEA
  The Food and Environmental Protection Section of the Joint Division and its associated Agrochemicals Unit of the FAO/IAEA Agricultural and Biotechnology Laboratory provides assistance and support to countries in their efforts to ensure the safety and quality of food and agricultural commodities while at the same time facilitating international trade.
• WHO Food Safety
  The Food Safety Department (FOS) strives to reduce the serious negative impact of foodborne diseases worldwide
• WHO Nutrition
  WHO-EURO Nutrition Homepage

Government

• FDA Center for Food Safety and Applied Nutrition (USA)
  "This Center regulates domestic food, imported food, and cosmetics sold in the US. It promotes and protects United States public health and economic interest by ensuring that: food is safe, nutritious and wholesome, and cosmetics are safe; and that food and cosmetics are honestly, accurately and informatively labeled."
• National Food Safety Initiative (USA)
  An intersectoral collaboration between Food and Drug Administration, U. S. Department of Agriculture, U. S. Environmental Protection Agency, and Centers for Disease Control and Prevention.

Non Government

• Center for Food Safety (USA)
  "This centre focuses on the impacts of our food production system on human health, animal welfare and the environment"
• Center for Science in the Public Interest (CSPI) [USA]
  "A non-profit education and advocacy organization that focuses on improving the safety and nutritional quality of our food supply and on reducing the adverse impact of alcoholic beverages. CSPI seeks to promote health through educating the public about nutrition and alcohol; it represents citizens' interests before legislative, regulatory, and judicial bodies; and it works to ensure that advances in science are used for the public good"
• Eating Disorder Referral and Information Center (USA)
  "This centre provides information and treatment resources for all forms of eating disorders. Its goal is to provide assistance, in the form of information and resources, to those suffering with eating disorders to get them started on the road to recovery and healthy living"
• Food and Nutrition Information Center (USA)
  The Food and Nutrition Information Center at the National Agricultural Library (USA) provides resource lists, databases and food and nutrition related links.
• Insulin Free World Foundation
  Devoted to helping people to find ways --- not to manage, not to live with --- but to overcome diabetes. This site was created by diabetics, for diabetics
• International Federation of Organic Agriculture Movements (IFOAM)
  "IFOAM is the worldwide umbrella organization for the organic movement, uniting more than 750 member organizations in 116 countries. Organic trade is a rapidly growing reality all over the world. The growth rates of the organic sector demonstrate that organic products are moving from the ‘niche’ and entering mainstream markets. The total land under certified organic production worldwide has reached over 26 Million hectares. IFOAM is at the center of this development."
• Linus Pauling Institute
  Based at Oregon State University (USA) the mission of the Institute is to determine the function and role of micronutrients, phytochemicals and microconstituents of food in maintaining human health and preventing and treating disease, and to advance the knowledge in areas which were of interest to Linus Pauling particularly in orthomolecular medicine through research and education.
• Soil Association (UK)
  "The UK's leading campaigning and certification body for organic food and farming. We develop and provide practical and sustainable solutions which combine food production and environmental protection and human health."

Academic Institutions with particular focus in this area

• School of Public Health and Community Medicine, UNSW - Health Promotion Activities
• School of Public Health and Community Medicine, UNSW - Research

Key Conferences, conference and workshop reports

Journals, Newsletters, Forums

Bibliographies, Libraries

Public health bookshops

• Public Health bookshop