Food and Agriculture

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Food and Agriculture

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This article has been prepared by Dr F. Käferstein, Chief, Food Safety, World Health Organization. It is entirely based on the report of a WHO Panel on Food and Agriculture which had supported the WHO Commission on Health and Environment to prepare a report for the United Nations Conference on Environment and Development (UNCED), Rio de Janeiro, 1992. Both reports are available from the WHO.

Production Needs in the Face of Population Pressure and Other Forces

Rapid population growth continues in some regions of the world. As compared with the situation in 1990, by the year 2010 there will be an extra 1,900 million people to be fed, a rise of 36% from 5,300 to 7,200 million people.

Ninety per cent of the entire projected growth over the next 20 years is expected to take place in the countries which are currently classified as developing nations. Progressive urbanization of society is taking place. The urban population of the world will reach 3,600 million, a rise of 62% from the 2,200 million city dwellers in 1990. Moreover the urban population of developing countries will increase by 92% (from 1,400 million to 2,600 million) in the twenty years from 1990, a fourfold increase since 1970. Even if family planning receives the urgent attention that it desperately requires from all rapidly growing populations, population growth and urbanization will continue to dominate the scene for the next two decades.

A 36% increase in food, other agricultural products and potable water will be required over the next twenty years simply to match the rise in population; the need for half a billion people to be properly fed instead of remaining undernourished, and the greater demand from populations with a rising income, will all lead to a vast increase in total food production. An excessive demand for food of animal origin will continue to characterize people in the higher income groups, leading to increases in animal feed production.

The pressure on agriculture and food production, as both population and per capita demand increase, will lead to a greater burden on the environment. This burden will be unevenly generated and have uneven environmental effects. Globally, these will be adverse and will require concerted action.

This increased demand will fall on resources of land and water which are finite, where the most productive areas have already been used, and where the cost of bringing marginal land into production, and of using less readily available water, will be high. Much of this marginal land may have only temporary fertility unless specific measures are taken to maintain it, while the productivity of natural fisheries is also sharply limited. The area of arable land will decrease due to soil erosion from over-grazing; laterization of clearfelled areas; soil salinization and other types of land degradation; and the expansion of urban, industrial and other developments.

Water availability and quality, already totally inadequate in much of the world, will remain major problems for rural areas of developing countries and also for many urban populations, who may face the additional problem of high utilization charges. Needs for water will increase greatly, and for several large cities the meeting of water demands will become increasingly costly as supplies will have to be brought from far away. Re-use of water implies more stringent standards for treatment. The increasing production of wastewater and sewage will require more extensive treatment facilities, as well as large outlays of capital.

The continuing long-term need for industrial development to produce goods, services and employment will lead to more intensive food production, which will itself become more industrialized. Consequently, and especially because of urbanization, the demand for, and the resources employed in, packaging, processing, storage and distribution of food will increase in volume and importance.

The public is becoming much more aware of the need to produce, protect and market food in ways which minimize adverse change in our environment, and is more demanding in this respect. The emergence of revolutionary scientific tools (e.g., biotechnological advances) offers the possibility of significantly increasing food production, reducing waste and enhancing safety.

The principal challenge is to meet the increasing demands for food, other agricultural products and water in ways that foster long-term improvements in health, and which are also sustainable, economical and competitive.

Despite the fact that globally there is at present sufficient food for all, great difficulties have to be overcome to ensure the availability and equitable distribution of safe, nutritious and affordable food supplies to meet health needs in many parts of the world, and notably in areas of rapid population growth.

There is often a failure to take the possible health consequences fully into account in the design and implementation of agricultural and fisheries policies and programmes. An example is the production of tobacco, which has very serious and negative impacts on human health and on scarce land and fuelwood resources. Moreover, the lack of an integrated approach to development of the agriculture and forestry sectors results in failure to recognize the important relationship of both sectors to the protection of wildlife habitats, biological diversity and genetic resources.

If timely and appropriate action is not taken to mitigate the environmental impacts of agriculture, fisheries, food production and water use, then the following situations will prevail:

As the urban population increases, the difficulty of maintaining and extending an efficient food distribution system will become greater. This may increase the prevalence of household food insecurity, associated malnutrition and health risks among the growing masses of urban poor.

Microbial, viral and parasitic diseases from contaminated food and water will continue to be serious health problems. New agents of public health importance will continue to emerge. The diarrhoeal diseases related to food and water, causing high infant mortality and universal morbidity, will increase.

Vector-borne diseases from irrigation, other water resource developments, and uncontrolled wastewater will increase substantially. Malaria, schistosomiasis, filariasis and arbovirus fevers will continue to be major problems.

The problems outlined above will be reflected in static or rising levels of infant and young child malnutrition and mortality, as well as morbidity at all ages, but predominantly among the poor, the very young, the aged and the sick.

diseases linked to inappropriate life-styles, smoking and diet (for example, obesity, diabetes or coronary heart disease), which are characteristic of the more affluent countries, are now emerging and becoming significant problems also in developing countries. The increasing urbanization will accelerate this trend.

As the intensity of food production increases, the risk of occupational diseases and accidents among those working in this and related sectors will increase substantially unless sufficient efforts for safety and prevention are made.

Health Consequences of Biological Contamination and Chemicals in Food

Despite progress in science and technology, contaminated food and water remain to this day major public health problems. Foodborne diseases are perhaps the most widespread health problems in the contemporary world and important causes of reduced economic productivity (WHO/FAO 1984). They are caused by a wide range of agents, and cover all degrees of severity, from mild indispositions to life-threatening illnesses. However, only a small proportion of cases comes to the notice of health services and even fewer are investigated. As a result, it is believed that in industrialized countries only approximately 10% of the cases are reported, whilst in developing countries reported cases probably account for not more than 1% of the total.

Despite these limitations, the data that are available indicate that foodborne diseases are increasing all over the world, both in developing and industrialized countries. Experience in Venezuela illustrates this trend (PAHO/WHO 1989) (figure 1).

Figure 1. Foodborne diseases in Venezuela

Biological contamination

Developing countries

Available information clearly indicates that biological contaminants (bacteria, viruses and parasites) are the major causes of foodborne diseases (table 1).

Table 1. Some agents of important foodborne diseases and salient epidemiological features

Agents	Important reservoir/carrier	Transmission^a by			Multiplication in food	Examples of some incriminated foods
		Water	Food	Person to person
Bacteria
Baccillus cereus	Soil	-	+	-	+	Cooked rice, cooked meats, vegetables, starchy puddings
Brucella species	Cattle, goats, sheep	-	+	-	+	Raw milk, dairy products
Campylobacter jejuni	Chickens, dogs, cats, cattle, pigs, wild birds	+	+	+	-^b	Raw milk, poultry
Clostridium botulinum	Soil, mammals, birds, fish	-	+	-	+	Fish, meat, vegetables (home preserved), honey
Clostridium perfringens	Soil, animals, humans	-	+	-	+	Cooked meat and poultry, gravy, beans
Escherichia coli
Enterotoxigenic	Humans	+	+	+	+	Salad, raw vegetables
Enteropathogenic	Humans	+	+	+	+	Milk
Enteroinvasive	Humans	+	+	0	+	Cheese
Enterohaemorrhagic	Cattle, poultry, sheep	+	+	+	+	Undercooked meat, raw milk, cheese
Listeria monocytogenes	Environment	+	+	-^c	+	Cheese, raw milk, coleslaw
Mycobacterium bovis	Cattle	-	+	-	-	Raw milk
Salmonella typhi and paratyphi	Humans	+	+	±	+	Dairy products, meat products, shellfish, vegetable salads
Salmonella (non-typhi)	Humans and animals	±	+	±	+	Meat, poultry, eggs, dairy products, chocolate
Shigella spp.	Humans	+	+	+	+	Potato/egg salads
Staphylococcus aureus (enterotoxins)		-	+	-	+	Ham, poultry and egg salads, cream-filled bakery products, ice cream, cheese
Vibrio cholerae, 01	Humans, marine life	+	+	±	+	Salad, shellfish
Vibrio cholerae, non-01	Humans, marine life	+	+	±	+	Shellfish
Vibrio parahaemolyticus	Sea water, marine life	-	+	-	+	Raw fish, crabs, and other shellfish
Vibrio vulnificus	Sea water, marine life	+	+	-	+	Shellfish
Yersinia enterocolitica	Water, wild animals, pigs, dogs, poultry	+	+	-	+	Milk, pork, and poultry
Viruses
Hepatitis A virus	Humans	+	+	+	-	Shellfish, raw fruit and vegetables
Norwalk agents	Humans	+	+	-	-	Shellfish, salad
Rotavirus	Humans	+	+	+	-	0
Protozoa		+	+	+	+
Cryptosporidium parvum	Humans, animals	+	+	+	-	Raw milk, raw sausage (non-fermented)
Entamoeba histolytica	Humans	+	+	+	-	Vegetables and fruits
Giardia lamblia	Humans, animals	+	±	+	-	Vegetables and fruits
Toxoplasma gondii	Cats, pigs	0	+	-	-	Undercooked meat, raw vegetables
Helminths
Ascaris lumbricoides	Humans	+	+	-	-	Soil-contaminated food
Clonorchis sinensis	Freshwater fish	-	+	-	-	Undercooked/raw fish
Fasciola hepatica	Cattle, goats	+	+	-	-	Watercress
Opisthorclis viverrini/felinus	Freshwater fish	-	+	-	-	Undercooked/raw fish
Paragonimus sp.	Freshwater crabs	-	+	-	-	Undercooked/raw crabs
Taenia saginata and T. solium	Cattle, swine	-	+	-	-	Undercooked meat
Trichinella spiralis	Swine, carnivora	-	+	-	-	Undercooked meat
Trichuris trichiura	Humans	0	+	-	-	Soil-contaminated food

^a Almost all acute enteric infections show increased transmission during the summer and/or wet months, except infections due to Rotavirus and Yersinia enterocolitica, which show increased transmission in cooler months.

^b Under certain circumstances, some multiplication has been observed. The epidemiological significance of this observation is not clear.

^c Vertical transmission from pregnant woman to foetus occurs frequently.

+ = Yes; ± = Rare; - = No; 0 = No information.

Adapted from WHO/FAO 1984.

In the developing countries, they are responsible for a wide range of foodborne diseases (e.g., cholera, salmonellosis, shigellosis, typhoid and paratyphoid fevers, brucellosis, poliomyelitis and amoebiasis). Diarrhoeal diseases, especially infant diarrhoea, are the dominant problem and indeed one of massive proportions. Annually, some 1,500 million children under the age of five suffer from diarrhoea and of these over three million die as a result. Formerly it was thought that contaminated water supplies were the main direct source of pathogens causing diarrhoea, but now it has been shown that up to 70% of diarrhoeal episodes may be due to foodborne pathogens (WHO 1990c). However, the contamination of the food may in many cases originate from contaminated water that is used for irrigation and similar purposes.

Industrialized countries

Although the situation regarding foodborne diseases is very serious in developing countries, the problem is not limited to these countries, and in recent years, industrialized countries have experienced a succession of major epidemics. In the United States it is estimated there are 6.5 million cases per year, with 9,000 fatalities, but according to the US Food and Drug Administration this figure is an underestimate and may be as high as 80 million cases (Cohen 1987; Archer and Kvenberg 1985; Young 1987). The estimate for former West Germany was one million cases in 1989 (Grossklaus 1990). A study in the Netherlands found that as many as 10% of the population may be affected by foodborne or waterborne diseases (Hoogenboom-Vergedaal et al. 1990).

With today’s improvements in standards of personal hygiene, development of basic sanitation, safe water supplies, effective infrastructure and the increasing application of technologies such as pasteurization, many foodborne diseases have been either eliminated or considerably reduced in certain industrialized countries (e.g., milkborne salmonellosis). Nevertheless, most countries are now experiencing an important increase in several other foodborne diseases. The situation in former West Germany (1946-1991) illustrates this phenomenon (figure 2) (Statistisches Bundesamt 1994).

Figure 2. Infectious enteritis, typhoid fever and para-typhoid fever (A, B and C), Germany

Salmonellosis, specifically, has increased tremendously on both sides of the Atlantic over the past few years (Rodrigue 1990). In many cases it is due to Salmonella enteritidis. Figure 3 shows the increase of this micro-organism in relation to other Salmonella strains in Switzerland. In many countries, poultry meat, eggs and foods containing eggs have been identified as the predominant sources of this pathogen. In certain countries, 60 to 100% of poultry meat is contaminated with Salmonella spp., and meat, frogs’ legs, chocolate and milk have also been implicated (Notermans 1984; Roberts 1990). In 1985, some 170,000 to 200,000 persons were involved in an outbreak of salmonellosis in Chicago which was caused by contaminated pasteurized milk (Ryzan 1987).

Figure 3. Serotypes of Salmonella in Switzerland

Chemicals and toxicants in food

Considerable efforts have been undertaken at the national and international levels to ensure the chemical safety of food supplies. Two joint FAO/WHO committees have, over a period of three decades, evaluated a large number of food chemicals. The Joint FAO/WHO Expert Committee on Food Additives (JECFA) evaluates food additives, contaminants and veterinary drug residues, and the Joint FAO/WHO Meeting on Pesticide Residues (JMPR) evaluates pesticide residues. Recommendations are made on the acceptable daily intake (ADI), on maximum residue levels (MRLs) and maximum levels (MLs). Based on these recommendations, the Codex Alimentarius Commission and governments establish food standards and safe levels for these substances in foodstuffs. Moreover, the Joint UNEP/FAO/WHO Food Contamination Monitoring Programme (GEMS/Food) provides information on the levels of contaminants in food and on time trends of contamination, enabling preventive and control measures.

While information from most of the developing countries is scarce, surveys made in the industrialized countries suggest that the food supply is largely safe from the chemical viewpoint owing to the extensive food safety infrastructure (i.e., legislation, enforcement mechanisms, surveillance and monitoring systems) and the general level of responsibility of the food industry. However, accidental contamination or adulteration does occur, in which case the health consequences may be grave. For example, in Spain in 1981-82, adulterated cooking oil killed some 600 people and disabled—temporarily or permanently—another 20,000 (WHO 1984). The agent responsible for this mass poisoning has not yet been identified in spite of intensive investigations.

Environmental chemicals

A number of chemical substances may occur in the food supply as a result of environmental contamination. Their effects on health may be extremely serious and have caused great concern in recent years.

Serious consequences have been reported when foods contaminated with heavy metals such as lead, cadmium or mercury have been ingested over extended periods of time.

The Chernobyl accident provoked great concern over the health risks to people exposed to accidental radionuclide emissions. People living in the vicinity of the accident were exposed, and this exposure included radioactive contaminants in food and water. In other parts of Europe and elsewhere, at some distance from the accident, this concern focused on contaminated foods as a source of exposure. In most countries, the estimated average dose acquired from eating contaminated foods amounted to only a very small fraction of the dose normally received from background radiation (IAEA 1991).

Other environmental chemicals of interest are polychlorinated biphenyls (PCBs). PCBs are used in various industrial applications. Information on the effects of PCBs on human health were originally noted following from two large-scale incidents which occurred in Japan (1968) and in Taiwan, China (1979). Experience from these outbreaks showed that as well as their acute effects, PCBs may also have carcinogenic effects.

DDT was widely used between 1940 and 1960 as an insecticide for agricultural purposes and for the control of vector-borne diseases. It is now banned or restricted in many countries because of its potential risk to the environment. In many tropical countries, DDT is still an important chemical, used for the control of malaria. No confirmed ill effects have been reported due to residues of DDT in food (UNEP 1988).

Mycotoxins

Mycotoxins, the toxic metabolites of certain microscopic fungi (moulds), may cause serious adverse effects in humans, as well as in animals. Animal studies have shown that besides acute intoxication, mycotoxins are capable of causing carcinogenic, mutagenic and teratogenic effects.

Biotoxins

Intoxication by marine biotoxin (also known as “fish poisoning”) is another problem of concern. Examples of such intoxications are ciguatera and various kinds of shellfish poisoning.

Plant toxicants

Toxicants in edible plants and poisonous plants which resemble them (mushrooms, certain wild green plants) are important causes of ill health in many areas of the world and present a troublesome problem for food safety (WHO 1990b).

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Environmental Health Hazards References

Allan, JS. 1992. Viral evolution and AIDS. J Natl Inst Health Res 4:51-54.

Angier, N. 1991. Study finds mysterious rise in childhood cancer rate. New York Times (26 June):D22.

Arceivala, SJ. 1989. Water quality and pollution control: Planning and management. In Criteria for and Approaches for Water Quality Management in Developing Countries. New York: United Nations.

Archer, DL and JE Kvenberg. 1985. Incidence and cost of foodborne diarrhoea disease in the United States. J Food Prod 48(10):887-894.

Balick, MJ. 1990. Ethnobotany and the identification of therapeutic agents from the rainforest. CIBA F Symp 154:22-39.

Bascom, R et al. 1996. Health effects of outdoor air pollution. State of the Art. Am J Resp Crit Care Med 153:3-50.

Blakeslee, S. 1990. Scientists confront an alarming mystery: The vanishing frog. New York Times. 20 February:B7.

Blaustein, AR.1994. UL repair and resistance to solar UV-B in amphibian eggs: A link to population declines. Proc Natl Acad Sci USA 91:1791-1795.

Borja-Arburto, VH, DP Loomis, C Shy, and S Bangdiwala. 1995. Air pollution and daily mortality in Mexico City. Epidemiology S64:231.

Bridigare, RR. 1989. Potential effects of UVB on marine organisms of the Southern Ocean: Distribution of phytoplankton and krill during Austral Spring. Photochem Photobiol 50:469-478.

Brody, JE. 1990. Using the toxin from tiny frogs, researchers seek clues to disease. New York Times. 23 January.

Brody, JE. 1991. Far from fearsome, bats lose ground to ignorance and greed. New York Times. 29 October:Cl,C10.

Carlsen, E and A Gimmercman. 1992. Evidence for decreasing quality of semen during the past 50 years. Br Med J 305:609-613.

Castillejos, M, D Gold, D Dockery, T Tosteson, T Baum, and FE Speizer. 1992. Effects of ambient ozone on respiratory functions and symptoms in school children in Mexico City. Am Rev Respir Dis 145:276-282.

Castillejos, M, D Gold, A Damokosh, P Serrano, G Allen, WF McDonnell, D Dockery, S Ruiz-Velasco, M Hernandez, and C Hayes. 1995. Acute effects of ozone on the pulmonary function of exercising schoolchildren from Mexico City. Am J Resp Crit Care Med 152:1501-1507.

Centers for Disease Control (CDC). 1991. Preventing Lead Poisoning in Young Children. Washington, DC: US Department of Health and Human Services.

Cohen, ML. 1987. Prepared statement in “Hearing before the Committee of Agriculture, Nutrition and Forestry”. US Senate, 100th Congress, First Session. (US Government Printing Office, Washington, DC).

Coleman, MP, J Esteve, P Damiecki, A Arslan, and H Renard. 1993. Trends in Cancer Incidence and Mortality. IARC Scientific Publications, No.121. Lyon: IARC.

Davis, DL, GE Dinse, and DG Hoel. 1994. Decreasing cardiovascular disease and increasing cancer among whites in the United States from 1973-1987. JAMA 271(6):431-437.

Davis, DL and D Hoel. 1990a. International trends in cancer mortality in France, West Germany, Italy, Japan, England and Wales and the USA. Lancet 336 (25 August):474-481.

—. 1990b. Trends in Cancer Mortality in Industrial Countries. Annals of the New York Academy of Sciences, No. 609.

Dockery, DW and CA Pope. 1994. Acute respiratory effects of particulate air pollution. Ann Rev Publ Health 15:107-132.

Dold, C. 1992. Toxic agents found to be killing off whales. New York Times. 16 June:C4.

Domingo, M and L Ferrer. 1990. Morbillivirus in dolphins. Nature 348:21.

Ehrlich, PR and EO Wilson. 1991. Biodiversity studies: Science and policy. Science 253(5021):758-762.

Epstein, PR. 1995. Emerging diseases and ecosystem instability. Am J Public Health 85:168-172.

Farman, JC, H Gardiner, and JD Shanklin. 1985. Large losses of total ozone in Antarctica reveal seasonal ClOx/NOx interaction. Nature 315:207-211.

Farnsworth, NR. 1990. The role of ethnopharmacology in drug development. CIBA F Symp 154:2-21.

Farnsworth, NR, O Akerele, et al. 1985. Medicinal plants in therapy. Bull WHO 63(6):965-981.

Federal Health Office (Switzerland). 1990. Bulletin of Federal Health Office. 29 October.

Floyd, T, RA Nelson, and GF Wynne. 1990. Calcium and bone metabolic homeostasis in active and denning black bears. Clin Orthop Relat R 255 (June):301-309.

Focks, DA, E Daniels, DG Haile, and JE Keesling. 1995. A simulation model of the epidemiology of urban dengue fever: literature analysis, model development, preliminary validation, and samples of simulation results. Am J Trop Med Hyg 53:489-506.

Galal-Gorchev, H. 1986. Drinking-Water Quality and Health. Geneva:WHO, unpublished.

—. 1994. WHO Guidelines for Drinking Water Quality. Geneva:WHO, unpublished.

Gao, F and L Yue. 1992. Human infection by genetically diverse SIVsm-related HIV-2 in West Africa. Nature 358:495.

Gilles, HM and DA Warrell. 1993. Bruce-Chwatt’s Essential Malaniology. London: Edward Arnold Press.

Gleason, JF, PK Bhartia, JR Herman, R McPeters, et al. 1993. Record low global ozone in 1992. Science 260:523-526.

Gottlieb, OR and WB Mors. 1980. Potential utilization of Brazilian wood extractives. J Agricul Food Chem 28(2): 196-215.

Grossklaus, D. 1990. Gesundheitliche Fragen im EG-Binnemarkt. Arch Lebensmittelhyg 41(5):99-102.

Hamza, A. 1991. Impacts of Industrial and Small-Scale Manufacturing Wastes On Urban Environment in Developing Countries. Nairobi: United Nations Centre for Human Settlements.

Hardoy, JE, S Cairncross, and D Satterthwaite. 1990. The Poor Die Young: Housing and Health in Third World Cities. London: Earthscan Publications.

Hardoy, JE and F Satterthwaite. 1989. Squatter Citizen: Life in the Urban Third World. London: Earthscan Publications.

Harpham, T, T Lusty, and P Vaugham. 1988. In the Shadow of the City—Community Health and the Urban Poor. Oxford: OUP.

Hirsch, VM and M Olmsted. 1989. An African primate lentivirus (SIVsm) closely related to HIV-s. Nature 339:389.

Hoel, DG. 1992. Trends in cancer mortality in 15 industrialized countries, 1969-1986. J Natl Cancer Inst 84(5):313-320.

Hoogenboom-Vergedaal, AMM et al. 1990. Epdemiologisch En Microbiologisch Onderzoek Met Betrekking Tot Gastro-Enteritis Bij De Mens in De Regio’s Amsterdam En Helmond in 1987 En 1988. Netherlands: National Institute of Public
Health and Environmental Protection.

Huet, T and A Cheynier. 1990. Genetic organization of a chimpanzee lentivirus related to HIV-1. Nature 345:356.

Huq, A, RR Colwell, R Rahman, A Ali, MA Chowdhury, S Parveen, DA Sack, and E Russek-Cohen. 1990. Detection of Vibrio cholerae 01 in the aquatic environment by fluorescent-monoclonal antibody and culture methods. Appl Environ Microbiol 56:2370-2373.

Institute of Medicine. 1991. Malaria: Obstacles and Opportunities. Washington, DC: National Academy Press.

—. 1992. Emerging Infections: Microbial Threats to Health in the United States. Washington, DC: National Academy Press.

Intergovernmental Panel on Climate Change (IPCC). 1990. Climate Change: The IPCC Impacts Assessment. Canberra: Australian Government Publishing Service.

—. 1992. Climate Change 1992: The Supplementary Report to the IPCC Impacts Assessment. Canberra: Australian Government Publishing Service.

International Agency for Research on Cancer (IARC). 1992. Solar and Ultraviolet Radiation. IARC Monographs On the Evaluation of Carcinogenic Risks to Humans. Lyon: IARC.

International Atomic Energy Agency (IAEA). 1991. International Chernobyl Project Assessment of Radiological Consequences and Evaluation of Protective Measures. Vienna: IAEA.

Kalkstein, LS and KE Smoyer. 1993. The impact of climate change on human health: Some international implications. Experiencia 49:469-479.

Kennedy, S and JA Smyth. 1988. Confirmation of cause of recent seal deaths. Nature 335:404.

Kerr, JB and CT McElroy. 1993. Evidence for large upward trends of ultraviolet-B radiation linked to ozone depletion. Science 262 (November):1032-1034.

Kilbourne EM. 1989. Heat waves. In The public health consequences of disasters. 1989, edited by MB Gregg. Atlanta: Centers for Disease Control.

Kingman, S. 1989. Malaria runs riot on Brazil’s wild frontier. New Scientist 123:24-25.

Kjellström, T. 1986. Itai-itai disease. In Cadmium and Health, edited by L Friberg et al. Boca Raton: CRC Press.

Koopman, JS, DR Prevots, MA Vaca-Marin, H Gomez-Dantes, ML Zarate-Aquino, IM Longini Jr, and J Sepulveda-Amor. 1991. Determinants and predictors of dengue infection in Mexico. Am J Epidemiol 133:1168-1178.

Kripke, ML and WL Morison. 1986. Studies on the mechanism of systemic suppression of contact hypersensitivity by UVB radiation. II: Differences in the suppression of delayed and contact hypersensitivity in mice. J Invest Dermatol 86:543-549.
Kurihara, M, K Aoki, and S Tominaga. 1984. Cancer Mortality Statistics in the World. Nagoya, Japan: The University of Nagoya Press.

Lee, A and R Langer. 1983. Shark cartilage contains inhibitors of tumor angiogenesis. Science 221:1185-1187.

Loevinsohn, M. 1994. Climatic warming and increased malaria incidence in Rwanda. Lancet 343:714-718.

Longstreth, J and J Wiseman. 1989. The potential impact of climate change on patterns of infectious disease in the United States. In The Potential Effects of Global Climate Change in the United States, edited by JB Smith and DA
Tirpak. Washington, DC: US Environmental Protection Agency.

Martens, WM, LW Niessen, J Rotmans, TH Jetten, and AJ McMichael. 1995. Potential impact of global climate change on malaria risk. Environ Health Persp 103:458-464.

Matlai, P and V Beral. 1985. Trends in congenital malformations of external genitalia. Lancet 1 (12 January):108.

McMichael, AJ. 1993. Planetary Overload: Global Environmental Change and the Health of the Human Species. London: Cambridge University Press.

Meybeck, M, D Chapman, and R Helmer. 1989. Global Freshwater Quality: A First Assessment. Geneva: Global Environmental Monitoring System (GEMS/-WATER).

Meybeck, M and R Helmer. 1989. The quality of rivers: From pristine stage to global pollution. Paleogeogr Paleoclimatol Paleoecol 75:283-309.

Michaels, D, C Barrera, and MG Gacharna. 1985. Economic development and occupational health in Latin America: New directions for public health in less developed countries. Am J Public Health 75(5):536-542.

Molina, MJ and FS Rowland. 1974. Stratospheric sink for chloro-fluoro-methanes: Chlorine atom-catalyzed destruction of ozone. Nature 249:810-814.

Montgomery, S. 1992. Grisly trade imperils world’s bears. The Boston Globe. March 2:23-24.

Nelson, RA. 1973. Winter sleep in the black bear. Mayo Clin Proc 48:733-737.

Nimmannitya, S. 1996. Dengue and dengue haemorrhagic fever. In Manson’s Tropical Diseases, edited by GC Cook. London: WB Saunders.

Nogueira, DP. 1987. Prevention of accidents and injuries in Brazil. Ergonomics 30(2):387-393.

Notermans, S. 1984. Beurteilung des bakteriologischen Status frischen Geflügels in Läden und auf Märkten. Fleischwirtschaft 61(1):131-134.

Noweir, MH. 1986. Occupational health in developing countries, with special reference to Egypt. Am J Ind Med 9:125-141.

Pan American Health Organization (PAHO) and World Health Organization (WHO). 1989. Final Report of the Working Group on Epidemiological Surveillance and Foodborne Diseases. Unpublished document HPV/FOS/89-005.

Patz, JA, PR Epstein, TA Burke, and JM Balbus. 1996. Global climate change and emerging infections diseases. JAMA 275:217-223.

Pope, CA, DV Bates, and ME Razienne. 1995. Health effects of particulate air pollution: Time for reassessment? Environ Health Persp 103:472-480.

Reeves, WC, JL Hardy, WK Reisen, and MM Milky. 1994. The potential effect of global warming on mosquitoborne arboviruses. J Med Entomol 31(3):323-332.

Roberts, D. 1990. Sources of infection: Food. Lancet 336:859-861.

Roberts, L. 1989. Does the ozone hole threaten antarctic life. Science 244:288-289.

Rodrigue, DG. 1990. International increase in Salmonella enteritidis. A new pandemic? Epidemiol Inf 105:21-21.

Romieu, I, H Weizenfeld, and J Finkelman. 1990. Urban air pollution in Latin America and the Caribbean: Health perspectives. World Health Stat Q 43:153-167.

—. 1991. Urban air pollution in Latin America and the Caribbean. J Air Waste Manage Assoc 41:1166-1170.

Romieu, I, M Cortés, S Ruíz, S Sánchez, F Meneses, and M Hernándes-Avila. 1992. Air pollution and school absenteeism among children in Mexico City. Am J Epidemiol 136:1524-1531.

Romieu, I, F Meneses, J Sienra, J Huerta, S Ruiz, M White, R Etzel, and M Hernandez-Avila. 1994. Effects of ambient air pollution on respiratory health of Mexican children with mild asthma. Am J Resp Crit Care Med 129:A659.

Romieu, I, F Meneses, S Ruíz, JJ Sierra, J Huerta, M White, R Etzel, and M Hernández. 1995. Effects of urban air pollution on emergency visits for childhood asthma in Mexico City. Am J Epidemiol 141(6):546-553.

Romieu, I, F Meneses, S Ruiz, J Sienra, J Huerta, M White, and R Etzel. 1996. Effects of air pollution on respiratory health of children with mild asthma living in Mexico City. Am J Resp Crit Care Med 154:300-307.

Rosenthal, E. 1993. Hibernating bears emerge with hints about human ills. New York Times 21 April:C1,C9.

Ryzan, CA. 1987. Massive outbreak of antimicrobial-resistant salmonellosis traced to pasteurized milk. JAMA 258(22):3269-3274.

Sanford, JP. 1991. Arenavirus infections. In Chap. 149 in Harrison’s Principles of Internal Medicine, edited by JD Wilson, E Braunwald, KJ Isselbacher, RG Petersdorf, JB Martin, AS Fauci, and RK Root.

Schneider, K. 1991. Ozone depletion harming sea life. New York Times 16 November:6.

Schultes, RE 1991. Dwindling forest medicinal plants of the Amazon. Harvard Med Alum Bull (Summer):32-36.

—.1992: Personal communication. 24 January 1992.

Sharp, D. (ed.). 1994. Health and Climate Change. London: The Lancet Ltd.

Shope, RE. 1990. Infectious diseases and atmospheric change. In Global Atmospheric Change and Public Health: Proceedings of the Center for Environmental Information, edited by JC White. New York: Elsevier.

Shulka, J, C Nobre, and P Sellers. 1990. Amazon deforestation and climate change. Science 247:1325.

Statistisches Bundesamt. 1994. Gesundheitswersen: Meldepflichtige Krankheiten. Wiesbaden: Statistisches Bundesamt.

Stevens, WK. 1992. Terror of the deep faces harsher predator. New York Times. 8 December:Cl,C12.

Stolarski, R, R Bojkov, L Bishop, C Zerefos, et al. 1992. Measured trends in stratospheric ozone. Science 256:342-349.

Taylor, HR. 1990. Cataracts and ultraviolet light. In Global Atmospheric Change and Public Health: Proceedings of the Center for Environmental Information, edited by JC White. New York: Elsevier.

Taylor, HR, SK West, FS Rosenthal, B Munoz, HS Newland, H Abbey, EA Emmett. 1988. Effects of ultraviolet radiation on cataract formation. N Engl J Med 319:1429-33.

Terborgh, J. 1980. Where Have All the Birds Gone? Princeton, NJ: Princeton University Press.

Tucker, JB. 1985. Drugs from the sea spark renewed interest. Bioscience 35(9):541-545.

United Nations (UN). 1993. Agenda 21. New York: UN.

United Nations Conference on Environment and Development (UNCED). 1992. Protection for the quality and supply of freshwater resources. In Chap. 18 in Application of Integrated Approaches to the Development, Management and Use of Water Resources. Rio de Janeiro: UNCED.

United Nations Environment Programme (UNEP). 1988. Assessment of Chemical Contaminants in Food. Nairobi: UNEP/FAO/WHO.

—. 1991a. Environmental Effects of Ozone Depletion: 1991 Update. Nairobi: UNEP.

—. 1991b. Urban Air Pollution. Environment Library, No. 4. Nairobi: UNEP.
Urban Edge. 1990a. Reducing accidents: Lessons learned. Urban Edge 14(5):4-6.

—. 1990b. Road safety a lethal problem in third world. Urban Edge 14(5):1-3.

Watts, DM, DS Burke, BA Harrison, RE Whitmire, A Nisalak. 1987. Effect of temperature on the vector efficiency of Aedes aegypti for dengue 2 virus. Am J Trop Med Hyg 36:143-152.

Wenzel, RP. 1994. A new hantavirus infection in North America. New Engl J Med 330(14):1004-1005.

Wilson, EO. 1988. The current state of biological diversity. In Biodiversity, edited by EO Wilson. Washington, DC: National Academy Press.

—. 1989. Threats to biodiversity. Sci Am 261:108-116.

—. 1992. The Diversity of Life. Cambridge, Mass.: Harvard University Press.

World Bank. 1992. Development and the Environment. Oxford: OUP.

World Health Organization (WHO). 1984. Toxic Oil Syndrome: Mass Food Poisoning in Spain. Copenhagen: WHO Regional Office for Europe.

—. 1987. Air Quality Guidelines for Europe. European Series, No. 23. Copenhagen: WHO Regional Office for Europe.

—. 1990a. Acute Effects On Health of Smog Episodes. WHO Regional Publications European Series, No. 3. Copenhagen: WHO Regional Office for Europe.

—. 1990b. Diet, Nutrition and Prevention of Chronic Diseases. WHO Technical Report Series, No. 797. Copenhagen: WHO Regional Office for Europe.

—. 1990c. Global Estimates for Health Situation, Assessment and Projections. WHO Technical Report Series, No. 797. Geneva: WHO.

—. 1990d. Potential Health Effects of Climatic Change. Geneva: WHO.

—. 1990e. Public health impact of pesticides used in agriculture. World Health Statistics Quarterly 43:118-187.

—. 1992a. Indoor Air Pollution from Biomass Fuel. Geneva: WHO.

—. 1992b. Our Planet, Our Health. Geneva: WHO.

—. 1993. Weekly Epidemiol Rec 3(69):13-20.

—. 1994. Ultraviolet Radiation. Environmental Health Criteria, No. 160. Geneva: WHO.

—. 1995. Update and Revision of the Air Quality Guidelines for Europe. Copenhagen: WHO Regional Office for Europe.

—. in press. Potential Health Effects of Global Climate Change: Update. Geneva: WHO.
World Health Organization (WHO) and ECOTOX. 1992. Motor Vehicle Air Pollution. Public Health Impact and Control Measures. Geneva: WHO.

World Health Organization (WHO) and FAO. 1984. The Role of Food Safety in Health and Development. WHO Technical Report Series, No. 705. Geneva: WHO.

World Health Organization (WHO) and UNEP. 1991. Progress in the Implementation of the Mar Del Plata Action Plan and a Strategy for the 1990s. Geneva: WHO.

—. 1992. Urban Air Pollution in Megacities of the World. Blackwells, UK: WHO.

World Health Organization (WHO) Commission on Health and Environment. 1992a. Report of the Panel On Urbanization. Geneva: WHO.

—. 1992b. Report of the Panel On Energy. Geneva: WHO.

World Meteorological Organization (WMO). 1992. GCOS: Responding to the Need for Climate Observations. Geneva: WMO.
Young, FE. 1987. Food safety and FDA’s action plan phase II. Food Technol 41:116-123.

Food and Agriculture

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Environmental Health Hazards References