Food, Sex and Salmonella. David Waltner-Toews

are stowaways on ships and airplanes crisscrossing the globe, feeding the industrialized countries’ frenzy for all the food, all the time. Out of sight, out of mind.

      On top of this, more people are traveling than ever before in history, either as economic, environmental, or political refugees or as free-wheeling tourists. International migrants increased from 75 million in 1960 to more than 190 million in 2005, almost 3 percent of the world’s population. International tourist arrivals—the number of tourists arriving at their destinations— increased from about 25 million to 650 million between 1950 and 1999. If the foods cannot come to us, we are going to them.

      Not only separated from our ancestral homes, we are increasingly displaced from a rural to an urban environment. Since 1950, the proportion of people living in cities has almost doubled; in 2005, almost half of all people lived in urban areas. By 2030, that proportion will be 60 percent. The students in my class on foodborne diseases, taught at a university that prides itself on its agricultural origins, are typical of students just about everywhere in the world. They have never been on farms. They have no real idea where food comes from. They are thus estranged even from those foods that can be grown nearby. This double displacement means that most of us are, in effect, carrying on intimate relationships with environments of which we have no knowledge; it is like engaging in sex with a blindfold on. Just as reducing individuals with personalities and histories to anonymous sexual objects defined only by physical characteristics can lead to abusive relationships with people, so reducing foods from biological entities with specific ecological histories to tradable commodities defined by price, fiber, fat, or protein content has resulted in an abusive relationship with the environment.

      We now have urban economists and developers who can without embarrassment talk about the loss of farmland to urbanization as progress or necessity, or as a matter of esthetic choices, jobs versus environment, or some other nonsensical juxtaposition of options. They can naively speak of food as if it were a simple commodity, like shoes or condoms. I have heard suggestions that agriculture is a tiny part of the national economy and therefore, by implication, unimportant. Under which stones do they find these policymakers and economists? I suggest that they be forced to do without the products of agriculture as they reconsider the importance of agriculture. Maybe a light bulb would go on somewhere. Do you mean food comes from farms?

      We even have public health advocates fighting diseases such as avian influenza by promoting economies of scale and high biosecurity (putting all your eggs in one basket and guarding it well) when all the evidence says that every basket, sooner or later, gets dropped. The result of this ignorance will surely be a continued loss of farmland, the loss of the biological food-producing foundation of our civilization, and the degradation of rural environments. It will mean increased intensity and scale in food production and in processing and distribution systems, increased abuse of farm animals, increased levels (because of increased stress-related shedding and increased cross-contamination) and distribution (because of centralization and economies of scale) of foodborne pathogens, increased use of chemicals or high-energy technology to control those pathogens (in response to urban demands), and the undermining of the ability of both farmers and consumers to make free and intelligent decisions about their food.

      What may save us yet—and it may sound perverse for me to wish this—are the foodborne illnesses that follow us around the world and from the countryside to the city. For microbes and parasites, the invisible travelers through our kitchens, foods we eat are ecosystems unto themselves. Eating, from their viewpoint, is either just another way that humans plunder animals smaller than themselves or, just as often, a form of microbial self-perpetuation and extension into a new environment. In a real sense, we are simply an environment that allows bacteria, parasites, viruses, and chemicals to recycle themselves. The fact that they sometimes make us sick as they pass through is incidental and not to be confused with malicious intent.

      These accidental infections are, alas, common. According to the World Health Organization, every year a billion people around the world get sick and about 2 million, mostly children under five years old, die because of infections transmitted to them in their food or water. The Centers for Disease Control and Prevention in the United States estimates that in the United States 76 million people a year get sick from foodborne diseases and five thousand people die from them. In the early 1980s, Ewen Todd of Health and Welfare Canada suggested that more than 2 million Canadians suffered from foodborne illnesses annually. More recent estimates put the number of foodborne illnesses in Canada at more than 11 million per year.

      Nobody knows the real numbers. These estimates are just that. Estimating the magnitude of the risks of acute illness due to food is a bit of a casino game. Only a small fraction of cases—one in a few hundred for bacteria to one in thousands for viruses—ever gets counted. Not everyone with an intestinal problem visits the doctor. Even if one does suspect that the cause of one’s illness is food, one may feel compelled to keep silent in the service of more lofty causes, such as the sanctity of Grandmother’s cooking or a potential romantic liaison. The doctor may not do a suffciently detailed workup to feel comfortable reporting your diarrhea as a case of foodborne disease. Not reporting it saves the doctor some paperwork. If there is a big outbreak following the supper at the church, mosque, temple, synagogue, or community hall, any individual doctor may treat only a few of the people that were affected and so may not be aware of the outbreak. If the doctor thought you were part of a bigger picture, he or she might report. The argument is cyclic; doctors do not report you because they do not know you are part of an epidemic, and they do not know you are part of an epidemic because all the other doctors are similarly ignorant.

      Even if the doctor does report, the health agency may fail to conduct thorough investigations. First, for financially conservative governments, which consider public service a necessary evil at best, labor shortages and financial restrictions may be paramount. The government does not provide money or people to do these investigations unless there is a lot of public pressure. Second, local medical officers of health and health agencies may not want to look bad or stir up political trouble by reporting foodborne disease outbreaks. This may be not so much a conspiracy to cover up as a natural tendency not to want to throw indigestible items at a fan next to which one is sitting.

      The estimates of millions of sick people from the World Health Organization, the Centers for Disease Control and Prevention, or the Public Health Agency of Canada may be accurate. True or not, these estimates are themselves used to estimate how many millions of dollars these diseases cost us as a society through lost income and productivity, loss of leisure time, suffering, and medical costs, as well as child-care costs while you were in bed, death (a minor item in this balance sheet), costs of recalling items and closing restaurants, and loss of international trade. Looked at in this light, a few trips to the toilet can take on cosmic significance. The assumption is that you would have been doing something productive had you gone to work. It overlooks the fact that the way our economy is set up, personal disaster is good for the gross national product. Consider, for instance, all those jobs created in the medical and insurance businesses, all on account of the custard on the counter you stuck your finger into. Personal catastrophe is good for the economy.

      Several countries, as well as the World Health Organization, have instituted more active surveillance programs to try to get a clearer picture of what is going on, but overall measurement of the burden of disease from food is likely to remain a guessing game for some time to come. To a certain extent, doing the body counts of how many people get sick from food and water misses the point. We need to find ways to take better care of our food partners; they are the most important members of every economy on earth. We cannot live without food, so we are not in a great bargaining position. We need our food more than our food needs us; our relationship is not a one-night stand. Either we are in this for long-term commitment, or we can kiss the planet good-bye.

      Although the exact number of people who get sick may be a good topic for a game of chance, every person who spends the night worshiping at the porcelain throne after the church picnic, every nursing home resident who dies from foodborne vero-toxin-producing Escherichia coli (VTEC), and every woman who aborts from foodborne listeriosis makes a lie of the notion that we are free of the bounds of nature, that we can fornicate with the environment and not bear a cost.

      In the long run, the risks associated with eating