Food safety and proper nutrition are essential preconditions for the health and well-being of the population of one country and should be integrated into all policies, not only in health policy, but also in the national economy, agriculture, tourism and trade.

On December 20, 2018, the Secretary-General of the United Nations Assembly adopted resolution 73/250 on the proclamation of the World Food Safety Day. Beginning in 2019, June 7 will be a day to mark activities that indicate the benefits of safe food, as well as any shortcomings in the safe food chain.

Safe food is crucial for health promotion and the elimination of hunger – these are two of the main goals of the Agenda for 2030. There is not enough safe food without food security. In this world where the food chain becomes more complex, any negative food safety incident can have global negative effects on public health, trade, and the economy.

Diseases associated with unsafe foods are most commonly caused by bacteria, viruses, parasites or chemicals that are fed through contaminated foods or water. 600 million people or 1 in 10 people worldwide get sick for consumption of contaminated food and 420 000 die each year. With this, children up to 5 years of age participate with 40% in the burden of diseases associated with unsafe food or 125 000 deaths every year. In 2010, the leading cause of death in unsafe foodborne diseases in the European Region is Salmonella enterica with 1854 deaths, Campylobacter spp so 459, Noroviruses 435, Listeria monocytogenes 399, Echinocoocus multilocularis 239, Hepatitis A 195, Brucella spp 191 (The burden of foodborne diseases in the WHO European Region. Copenhagen 2017).


Biological hazards

Biological hazards pose the greatest threat to food safety and directly to the consumer. Bacteria that cause infection or intoxication can cause major epidemics of acute illness in a short period of time and are a threat that most food businesses may face with. Some bacterial strains can be classified as hazardous for food safety such as Sallmonela, Listeria monocytogenes, Campylobacter, and E. coli 0157. There are pathogenic bacteria that are able to grow in certain foods under favorable conditions and create toxins. Toxin is primarily formed in food before ingestion, and in some cases toxins can still be present even after all the bacterial cells are destroyed by cooking. Bacillus cereus and Staphylococcus aureus are examples of bacteria that can cause intoxication, but the most important and potentially most serious cause is Clostridium botulinum.

Viral gastroenteritis is very common in the world. The most commonly reported are novroviruses and hepatitis A, which are responsible for a large number of epidemics, due to poor personal hygiene from infected food workers or insufficient hygiene of the products.


Year / disease 2018 2017 2016 2015 2014 2013
Enterocolitis 412,5 558,4 545,2 589,0 512,3 582,2
Bacterial alimentary infections and intoxications 20,2 35,9 26,1 27,8 44,0 45,5
Viral hepatitis A 3,5 1,7 1,0 7,6 28,2 4,9
Salmonellosis 18,0 15,3 12,3 16,8 9,9 12,7
Infections caused by E. Colli 9,1 8,4 8,0 10,9 7,8 3,9
Shigellosis 1,2 0,9 0,8 0,3 1,1 0,4
Listeriosis 0,0 0,2 0,0 0,1 0,5 0,0
Campylobacteriosis 0,9 0,1 0,4 0,1 0,1 0,1
Jardiasa 0,6 0,2 0,2 0,3 0,0 0,2

Source: Acute Communicable Diseases in the Republic of Macedonia in 2018, Institute for Public Health of the Republic of North Macedonia, 2019.



The status of acute intestinal infectious diseases is shown in Table 1, which shows that bacterial alimentary infections and intoxications have a variable, but also a high incidence rate, together with laboratory confirmed salmonellosis and E. coli-infected infections.

Table 1 Incidence of 100,000 of diseases in the group of intestinal infectious diseases, Macedonia, period 2013-2018


Chemical hazards

Acute toxicity caused by chemical contaminants in food is rare in developed countries. Public health causes the potentially harmful effect of exposure to low levels of toxic chemicals over food for an extended period of time. Some chemical agents can cause damage to the liver, kidneys, or carcinogenicity of certain organs. There are many potential chemical contaminants that can enter the food chain at any stage of production. Agricultural chemicals, such as herbicides and insecticides, can contaminate fresh products during primary production, or chemicals, such as detergents and lubricants, which can be fed into food during pre-processing. It is also possible to transfer chemical contaminants from the packaging of food during storage. Some of the main classes of chemical contaminants important for food safety are the following: pesticides, veterinary drugs, mycotoxins, dioxins, metals (lead, cadmium, arsenic, mercury) contaminants produced during processing (eg acrylamide), contaminants from contact materials (for example, melamine, formaldehyde) and others. Additives are substances that man deliberately adds to food products in order to improve the properties of the food and their use is regulated by a bylaw that complies with international standards and European legislation.



Public health measures

The national authority in each country plays a key role in ensuring that we all consume safe and nutritionally appropriate food. Policy makers should promote sustainable agriculture and food systems, encourage multisector cooperation between human health, animal health, agriculture and other sectors. Food safety authorities can and should manage the risks to food safety throughout the food chain, including during emergencies. Each country should align the national with the international standards established by the Codex Alimentarius Commission.

Preventive activities should address all food safety issues. All involved in food management – from processing to retail – must ensure compliance with programs such as HACCP, a system that identifies, assesses and controls dangers that are important for food safety from primary production to final consumption.

Implementing the “One Health” approach improves food safety, because people’s health is linked to animal health and the environment. Pathogenic microorganisms that have developed antimicrobial resistance may be transmitted from animals to humans by direct contact or through food, water or the environment.

The health sector with regular and consistent reporting of communicable diseases can contribute to the creation of a realistic picture of the condition of diseases associated with unsafe food. In the end, each individual, each of us, by upgrading personal practices in food handling and food choices can contribute to reducing foodborne illness.

Different groups share responsibility for food security – governments, regional economic bodies, UN organizations, development agencies, trade organizations, consumers and producer groups, academic and research institutions and private sector entities – must work together on issues that affect to all of us, globally, regionally and locally