Food crime is big business. It is everywhere. It is international. The same organised crime networks that profit from drugs, cigarettes, booze, people, or any other kind of international traffic also profit from food crime. You can call it food fraud if you wish. But we should not be tempted to think that the “horsegate” scandal was a novelty, a one off, a “fraud” with no health risks. It was a lucky accident if horsegate did not damage public health; in practice our surveillance systems and knowledge of the provenance of the meat are inadequate to tell us whether it did or not. These were the conclusions of Professor Chris Elliott of Queens University Belfast, presented last month at a meeting of the newly formed Birmingham Food Council, on which we sit.

Elliott challenged us to find a food that could not be adulterated, modified, misrepresented, or sold fraudulently. This year’s olive oil, almond, and champagne shortages create opportunities for food crime; the glut of wheat will present a different kind of crime—storage over a number of years until the price has risen again.

In different cultures and countries other food crimes have been reported. The infamous melamine poisonings of Chinese baby milk in 2004, 2008, and 2010. The adulteration of donkey meat with squirrel in China. An Australian kangaroo cull resulted in kangaroo meat making its way into the food chain. The demand for the super food pomegranate juice cannot be met by existing supply given that the plants need five years to come to fruit. Pangasius fish sold as cod, at twice its price.

“Food fraud” is an understatement. Food crime is what it is. And if you could imagine adulterating a legitimate food source, such as beef with horse, at a scale of tens of thousands of tonnes, you would get an understanding of the potential scale of the crime involved and the criminal infrastructure required—and now set up—to deliver criminal profit.

At the very large scale of adulteration, it would be almost impossible to detect, say, 25% substitution with cheaper foodstuff or perhaps even with a non-food substance. The large sized, frozen blocks of horse meat that went straight into meat shaving machines would produce mixed horse and beef mince and be indistinguishable from regular mince, unless tested by a forensic chemist. It was widely assumed that this was not a public health problem, but how would we know? Should we really expect large scale criminal operations, capable of adulterating tonnes of meat, to be operating with exemplary food hygiene standards? Would we assume that they knew where all the meat came from? Or that they would be fussy about throwing in tainted or diseased meat? The answers are all too obvious!

Why should doctors be concerned about food crime? Because we do not know the scale or breadth of the problem. It might be difficult to sell whole almonds fraudulently, but crushed almonds can readily be mixed with other cheaper nuts or peanuts. The presentation of a food allergy might be the result of an adulterated food. The doctor would need to have a high degree of suspicion, take a detailed food history, and consider food adulteration.

And how much more difficult for food agencies to detect misrepresented foods: line caught versus net caught fish? Organic versus non-organic? Fair trade versus “unfair” trade? Existing fair trade laws don’t help much, permitting as they do products with only 30% fair trade contents to be labelled “fair trade.”

Elliott did not believe the UK big retailers were anything but victims in the horsegate affair. Sainsbury’s had not been affected because it already undertook DNA testing of meat, a fact that the criminal networks knew. Marks & Spencer was not affected because it does not buy processed meat from anyone because of the potential for pork product contamination. Tesco and others have taken major hits, and incurred massive costs in their mitigating actions. In other countries, the proximity of organised crime to food production was much more evident; in Italy, for instance, the mafia is said to have a major interest and involvement in food crime.

The trade response has been to establish networks to share intelligence on food crime “on a protected basis.” The Food and Drink Federation has set up a “testing club” into which the multiples are putting money for widespread and systematic testing. Tesco has undertaken to do more testing and become more transparent, putting all its testing data on its website. More processing companies have been failing recently, only in part owing to recession.

The message is clear for public health agencies that food crime has to be acknowledged and recognised, and taken very seriously. Doctors need to have a high index of suspicion regarding food allergy and be vigilant in investigating suspected food poisoning.

Recognising that food crime is big business, the government has responded to one of the major recommendations in Elliott’s report and set up a national food crime unit. But we should be watchful and wary that the unit is properly resourced to be able to combat major criminal interests in food crime. The Netherlands has had a food crime unit for over 20 years so there is also the likely need for a considerable lead time building expertise and intelligence. As with drugs and people trafficking, as the stakes get higher, the value of the traffic gets higher and therefore stimulates greater traffic.

Ironically, this drive to tackle food crime comes at a time when the public analyst role has become endangered in the UK, and local authority food testing capacity has reduced considerably. There are now only 10 UK local government managed facilities approved by the Food Standards Agency to undertake complex chemical analysis of food; other sampling is undertaken through the private sector or has to be sent abroad, impeding the effectiveness of food crime investigation.

There is concern about the loss of public sector capacity and control over research, inspection, investigation, and intelligence. Public analyst services are victims of the same trends seen in laboratory services in the NHS, for example, where local responsiveness is being sacrificed for short term efficiency and cost saving through large scale processing of tests.

Current austerity policies in most western countries are creating new and bigger markets for criminally processed food. There is growing recognition of the problem of food poverty and acute hunger in the UK, and people who are poor are most vulnerable to being exploited by food criminals. This is in addition to being victims of the legitimate food trade, which disproportionately markets and supplies a diet of processed high fat, high trans fat, high sugar, high salt, low nutrient foods. Affordability of food is crucial, because this will militate against vulnerability to food crime. Living wage policies are an essential element to tackling food poverty.

The public health community has for so long battled against the food industry’s efforts to block food labelling and regulation for healthy food; and it now needs to factor in food crime. It is in everyone’s interests that access to healthy food, safely processed and properly labelled, is available as part of national food policies.

Dr John Middleton is vice president of the UK Faculty of Public Health and has written extensively on the problems of food poverty and food access. He is a member of the Fabian Society’s current Commission on Food and Poverty. He declares no pecuniary or competing interests.

Professor Jim Parle is professor of primary care at the University of Birmingham and a practising GP. He declares no pecuniary or competing interests.

The authors are members of the Birmingham Food Council, a registered charity, which receives a grant from Birmingham City Council Public Health department.

This first appeared on the BMJ blog

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