Every $1 USD invested in food safety infrastructure could result in a $46 return on investment (ROI) in the form of public health value, according to a new report from the World Health Organization (WHO).

The Global Burden of Foodborne Disease

Globally in 2010, foodborne illnesses caused 600 million cases of illness and 420,000 premature deaths, resulting in a loss of 33 million years of healthy life due to premature mortality or disability, per WHO. These losses are equivalent to $95 billion lost annually in low- and middle-income countries due to reduced productivity. The global health burden of foodborne disease is comparable to that of tuberculosis and malaria.

Analysis Methodology and Scoring System

To derive its estimates for the new report, WHO analyzed national foodborne disease interventions for 17 countries in line with the standards set for the Joint External Evaluation (JEE) of the 2005 International Health Regulations (IHR). The average ROI for these interventions was calculated for the 17 countries analyzed.

Based on the countries' diarrheal foodborne illness surveillance capacities, they were assigned “JEE scores,” comprising:

• The existence of an indicator- or event-based surveillance system and supporting laboratory analysis to detect and assign the etiology of foodborne diseases or the origin of contamination and to investigate foodborne hazards linked to cases, outbreaks, or events
• The existence of a national food safety emergency plan
• The existence of a designated International Food Safety Authorities Network (INFOSAN) Emergency Contact Point and a World Organization for Animal Health (WOAH) focal point on the safety of animals for food production, and a central coordination mechanism.

Improved Surveillance Associated with 6.4 Percent Less Foodborne Illness

WHO estimated that by raising its JEE score from 3 to 4, a country could achieve an estimated 6.4 percent reduction in the incidence of foodborne diarrheal disease.

The 17 countries included in the analysis were all given a JEE score of 3, meaning that surveillance activities may be nascent but unconsolidated, testing capacities may be weak at provincial and district levels, and surveillance data may not be used for tracking epidemiological trends or detecting future threats. The countries included Bangladesh, Indonesia, Jordan, Kenya, Kuwait, Libya, Mongolia, Mozambique, Namibia, North Macedonia, Qatar, Rwanda, South Africa, Sri Lanka, Tunisia, Ukraine, and Vietnam.

A JEE score of 4 indicates a country’s ability to undertake rapid risk assessments of acute foodborne illness events at national and intermediate levels, in addition to having an indicator- or events-based surveillance and laboratory analysis system.

Raising the JEE score from 3 to 4 would involve investments in a country’s technical capacities and coordination across sectors, including:

• Competent food safety authorities and food business operators updating processes and coordinating risk analysis
• Hospitals and healthcare providers updating processes, software, and equipment
• Laboratory staff, public health officials, and healthcare workers training in new procedures, data collection, reporting, and risk assessment
• Public and private laboratories augmenting their testing capacities.

The Cost and ROI of Improving Foodborne Disease Surveillance

The total cost of the investment for the 17 countries raising their JEE scores from 3 to 4 would be $492 million over ten years, according to WHO. This investment could avert an expected 19 million cases of foodborne illness and 13,092 associated deaths, generating a value of $23 billion in the 17 countries over ten years.

Conversely, in the absence of investment in national food safety infrastructure, there may be 303 million cases of illness and 203,600 premature deaths from foodborne disease.

Combined, the 17 countries included in the analysis have a population of approximately 800 million.

The financial returns of the health benefits achieved by an investment in foodborne disease surveillance were measured as the total number of disability-adjusted life years (DALYs) according to WHO estimates of the number of DALYs per case of foodborne diarrhea by world subregion.

Benefits Vary by Country

WHO notes that the ROI will vary country-by-country, depending on disease incidence, treatment capacity, population, and income. For example:

• Prevention of foodborne diseases is more valuable in countries with limited treatment capacity
• Larger populations benefit from economies of scale
• Labor costs and the value of health benefits increase with a country’s income.

While relatively small investments in foodborne disease surveillance capacity may enable governments to reduce the healthcare costs of foodborne illness, investments in surveillance tend to bring the most significant value to countries with a high burden of foodborne diarrhea and where treatment costs are high, such as in the WHO regions of Africa and Southeast Asia.

WHO emphasizes that, although investing in food safety infrastructure may yield high returns, in resource-constrained settings, it is essential to consider comparative value for money. Countries with limited resources often need to consider which of many high-return and impactful health investments (e.g., universal healthcare) to prioritize within their budgets, requiring additional analysis of context-relevant cost-effectiveness before investment.

Although WHO’s analysis focused on 17 countries, the findings are globally relevant.