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Healthy Populations > Food Safety > Flashcards

Food Safety Flashcards

1
Q

Define food defense

A

Preventing intentional adulteration

vs food safety, which is preventing unintentional adulteration

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2
Q

Who might be looking to commit agroterrorism?

A
  1. Anyone with an axe to grind
  2. Disgruntled employees
  3. Lone wold
  4. Domestic Terrorist Organizations (i.e. ALF)
  5. Foreign Terrorist Organizations
  6. DTOs and FTOS: sleeper and active cells, emulators, sympathizers, cyber-recruitment
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3
Q

What constitues agroterrorism?

A
  1. Direct attacks on livestock –> inflict direct ecnomic harm/oss or adulterate food supply
  2. Direct attacks on animal feed ingredients or water supply
  3. Direct attacks on the food/water supply (domestic and imported)
  4. Cyber attacks to adulterate food supply
  5. Cyber attacks on import inspection programs (ACE- CBP, PREDICT - FDA, PHIS - USDA)
  6. Cyber attacks to imply disease or food supply adulteration –> damage consumer confidence, export embargoes
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4
Q

Describe how someone can achieve biological pre-harvest adulteration.

A
  • Agent –> animal –> other animals = decreased productivity or loss of consumer confidence, loss due to death, and loss due to eradication effortf
  • Agent –> animal –> other animals –> human food supply –> human illness
  • Agent –> irrigation water –> plants –> human food supply –> human illness
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5
Q

Describe how someone can achieve chemical pre-harvest adulteration.

A
  • Agent (i.e. pesticide) –> animal feed –> animals –> decreased productivity, loss due to death, and loss due to product contamination
  • Agent (i.e. dioxin) –> animal feed –> animals –> human food supply –> human illness
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6
Q

Describe how someone can achieve post-harvest adulteration.

A
  • Agent –> batch mixing vessel –> processed product –> human food supply –> human illness
  • Agent –> human food supply –> human illness
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7
Q

Agroterrorism all begins with….

A

Data mining = using the internet

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8
Q

What are the 7 attributes of the CARVER + Shock Food/Ag Vunerability Assessment tool?

A
  • C-riticality = measure of public health and economic impacts of an attack
  • A-ccessability = ability to physically access and egress from target
  • R-ecuperability = ability of system to recover from an attack
  • V-unerability = ease of accomplishing an attack
  • E-ffect = amount of direct loss from an attack as measures by loss in production
  • R-ecognizability = ease of identifying the target
  • Shock = combined health, economic, and psychological impacts of an attack
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9
Q

List the 5 steps in a CARVER + Shock assessment.

A
  1. Establish assessment parameters (context/scenario) - who, why, what, how?
  2. Assemble a team of experts to conduct the assessment (example) - operational/farm manager, industrial engineer, vet, coop extension/food safety specialist, law enforcement, financial officer, etc.
  3. Develop process flow charts - parent prcoess, sub processes, what comes in? what goes out?
  4. Score and rank (1-10)
  5. Develop mitigation strategies - Food Defense Mitigation Strategies Database on FDA website
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10
Q

How do food allergies play into food safety?

A
  • 6% of adults and 8% of children have food allergies
  • Most common foods: milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, soybeans, and sesame.
  • USDA FSIS requires an ingredient list with common names. For example it will cay “Contains : (any major allergens)……..”
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11
Q

How does antibiotic resistance play into food safety?

A
  • Antibiotic resistence is one of the biggest threats to global health, food security, and development today.
  • Animals get antibiotics and develop resistant bacteria in their systems
  • Drug-resistant bacteria can remain on meat and spread to humans if the meat is not handled or cooked properly
  • Fertilizer or water containing animals feces and drug-resistant bacteria is used on food crops and then those can remain on crops and be eaten by humans
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12
Q

Describe the causes of antibiotic resistance as it relates to humans and animals.

A
  • Overprescribing antibiotics (human doctors, SA practitioners)
  • Patients not taking antibiotics as prescribed (human patients, small animal owners)
  • Uneccessary antibiotics used in agriculture (food animal practitioners)
  • Poor infection control in hospitals and clinics (human hospitals, vet clinics)
  • Poor hygeine and sanitation practices (humans)
  • Lack of rapid laboratory tests (both)
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13
Q

How can we stop antibiotic resistance?

A
  • Improve labs
  • Collect and share data - NARMS
  • Use antibiotics wisely - judicious use in foood animals, VFDs
  • Take measures to prevent infections - beef quality assurance (BQ), farmers assuring responsible management (FARM), pork quality assurance plus (PQA plus)
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14
Q

Describe NARMS and its usefulness when it comes to antibiotic resistance and food safety.

A
  • National antimicrobial monitoring system for enteric bacteria
  • Collaboration among local public health departments, CDC, FDA, and USDA
  • Tracks changes in antimicrobial susceptibility of certain enteric bacteria
  • CDC human populations, FDA retail meats, USDA animal populations (HACCP)
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15
Q

What are the 5 VFD key facts?

A
  1. Definition - written statement provided by a veterinarian that authorizes the client to use a VFD drug or combination of VFD drug in or on animal feed to treat animals in accordance with approved use
  2. Feed mills have responsibility to notify FDA with intent to distribute VFD, fill VFD orders, and retian VFD orders for two years
  3. FDA guidance #209 - removed medically important antibiotics for growth properiton to VFD status which requires veterinary oversight
  4. FDS guidance #213 - Set 3-year road map to move medically important antibiotics from OTC to VFD status
  5. Updated requirments - electronic signature from veterinarian, estimated # of animals that will be treated and the duration of use
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16
Q

True or false: 80% of antibiotics used in the US are used in food animals.

A

False. Pound for pound, humans and their pets you 10x the amount of antibiotics than what is used in food animal production.

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17
Q

True or false: Food animal antibiotic use is the leading contributor to antimicrobial resistnace.

A

False. According to the CDC, most human antibiotic resistant infections are acquired in hospitals and residental health care facilities.

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18
Q

What are the GMO crops in the US (11)?

A
  1. Potato
  2. Papaya
  3. Summer squash
  4. Pink pinapple
  5. Apple
  6. Soybean
  7. Cotton
  8. Alfalfa
  9. Canola
  10. Corn
  11. Sugar beet
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19
Q

What are the 3 kinds of food hazards?

A
  1. Biological (viruses, bacteria, parasites, etc.)
  2. Chemical (mycotoxins, pesticides, industrial chemicals, heavy metals, etc.)
  3. Physical (sharp hazards, choking hazards, filth (dirt, insect parts), animal food (size/hardness)
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20
Q

Intoxication vs Infection

A

Intoxication - toxins produced by bacteria, chemical contamination, or environmental toxins (i.e. mercury, fertilizer). QUICKER

Infection - bacteria, parasites, viruses. SLOWER, person to person

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21
Q

What prodcuts does the FDA regulate (9)?

A

80% of the US food supply
1. Packaged foods that are <3% raw red meat and/or <2% cooked poultry
1. Dairy
1. Seafood except catfish
1. Processed produce (canned, freezer bags)
1. Shell egss of domestic chickens, turkeys, ducks, geese, guinea; processing plants
1. Wild game (turkeys, ducks, geese, bison, deer, elk, moose)
1. Bottled water
1. Infant formula
1. Supplements and food additives

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22
Q

What are the two primary agencies involved in food safety?

A

FDA and USDA

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23
Q

What food safety programs are utilized under the FDA?

A
  • Pure Food and Drug Act 1906 - gave power to inspect food and drugs for adulteration or midbranding; replaced with below now
  • Federal Food, Drug, and Cosmetic Act of 1938
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24
Q

Describe the Federal Food, Drug, and Cosmentic Acts 1938.

A
  • Food Quality Protection Act - mandates health-based standard for pesticides in foods
  • Food Safety Moderinization Act - new regulatory power about how foods are grown, harvested, and processed due to high number of foodborne illnesses from 2000-2010
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25
Q

What is the purpose of the Food Safety Modernization Act?

A
  • Mandates preventative controls for food facilities (HARPAC)
  • Mandates produce safety standards (production and harvesting of fruits and vegetables)
  • Regulates radiological hazards along with chemical safety
  • Regulates the prevention of intentional adulteration of food (Food defense)
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26
Q

What are the missions of the FDA in terms of food safety?

A
  • Ensures nations food supply is safe, sanitary, and wholesome
  • Honest labeling
  • Inspection of regulated products and manufacturers
  • Conduction of sample analysis of regulated products
  • Review of imported products
  • Outbreak investigation, recalls, safety alerts on website
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27
Q

What is the role of the Center of Veterinary Medicine? What organization is it under?

A
  • FDA
  • Regulation of animal drugs - classificaiton of prescription vs OTC, VFDs, extralabel use
  • Animal food and feeds - AAFCO, horse and livestock feed
  • Recalls
  • Investigaiton of foodborne illness outbreaks
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28
Q

What foods does the USDA regulate?

A
  • Meat - beef, pork, lamb, AMS offers grading
  • Processed meat >3% (hot dogs, salami, etc.)
  • Poultry - chicken, turkey, duck, goose
  • Farmed catfish
  • Real egg products (if egg is cracked)
  • Raw fruits and vegetables
  • Organic
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29
Q

Describe the programs/organizations used by the USDA to maintain food safety?

A
  • Federal Meat Inspection Act 1906 - illegal to adulterate or misbrand meant and meat products being sold as food and ensures that meat/products are slaughtered and processed under regulated sanitary conditions (includes imports)
  • Poultry Products Inspection ACT - requires FSIS to inspect all domesticated birds when slaughtered and processed into products for human food (imports too)
  • Egg Products Inspection Act
  • Silurfiformes spp. Fish including Catfish - mandatory inspection program for fish and products from these fish
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30
Q

Who certifies breeding stock and hatcheries of poultry?

S. enteritidis

A

APHIS national poultry improvement plan - USDA

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31
Q

Who is responsible for the surveillance program to ensure proper disposition of restricted shell eggs?

A

Agricultural Marketing Service (AMS) - USDA

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32
Q

Who is responsible for inspecting egg breaking plants, liquid, frozen, or dried egg products, wahsing/sanitizing for eggs before breaking, and continous inspection while egg breaking?

A

FSIS - USDA

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33
Q

Who is responsible for the prevention of S. enteritidis in shell eggs during production, transportaiton, and storage?

A

Egg safety rule - FDA

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34
Q

HHS/PHS/FDA responsibilities for milk

A

Pasteurized milk oridnace - tech assitance, training, research, standards development, certificaiton activities.

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35
Q

USDA/Ag marketing service responsibilities for milk

A

US grade standards (voluntary)

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36
Q

NCIMS responsibilities for milk

A

Non-profit - farmers, plant personell, inspectors, policy makers, researchers

37
Q

Mission of the USDA FSIS

A
  • Prevent contamination and food-borne illness
  • Inspection of meat, poultry, and egg products to prevent contamination
  • Education of consumers about the importance of safe food handling and how to reduce the risks associated with foodborne illness
  • Product recalls
38
Q

Mission of the USDA APHIS

A
  • VS - protects and improves health, quality, and marketability animals
  • Livestock and poultry disease - protect against ag animals
  • LS - diagnosis, support control/eradication programs, training
  • VB - vaccines, bacterins, anti-sera, diagnostic tests

One Health Services - Antimicrobial resistance

39
Q

What is the role of CDC in food safety?

A
  • Vital link between FI and FS systems of government agencies and food producers
  • Works w partners to determine major sources of foodborne illness - investigates MULTISTATE FI OUTBREAKS, implements systems to prevent, detect, stop
  • Helps stat/locla authorities improve tracking and investigation through surveillance systems (PulseNet, FoodNet, SEDRIC, FDOSS)
  • Use data to assess prevention measures
  • Works internationally to improve tracking, investigation and prevention of FI
40
Q

PulseNet

A

Whole genome sequencing; molecular

41
Q

FoodNet

A
  • Specific bacteria (campy, cyclospora, listeria, salmonella, shigella, 0157 and non-0157 E. coli, vibrio, yersinia
  • 10 states
  • Enteric only
42
Q

FDOSS

A

National Outbreak Reporting System (NORS dashboard) - foodborne and waterborne disease outbreaks and enteric disease outbreaks spread by contact with environmental sources, infected people or animals, and other means.

43
Q

SEDRIC

A

Cloud-based, fast info

44
Q

What are the top 5 germs causing illness, hospitalizations, and deaths from food eaten in the US?

CDC

A
  1. Norovirus
  2. Salmonela
  3. C. perffingens
  4. Campylobacter
  5. Staph aureus
45
Q

Norovirus:
Incubation period
Symptoms
Types of food involved/transmission

A
  • Incubation: exposure –> 12-48 hours –> symptoms for 1-3 days –> shed for 2 days after
  • Symptoms: gastroenteritis in humans - non-bloody diarrhea, vomiting, nausea, and stomach pain
  • Food/transmission: person to person, contaminated food/drinks (leafy greens, fresh fruits, shellfish/oysters), contaminated objects
46
Q

Salmonella:
Incubation period
Symptoms
Types of food involved/transmission

Non-typhoidal

A
  • Incubation: exposure –> 6h - 6 days –> symptoms for 4-7 days
  • Symptoms: diarrhea, fever, stomach cramps. severe complications causing infections in kidneys, blood, bones, joints or NS possible
  • Food/transmission: contaminate fruits/vegetables, meat, peanut butter, cashew brie, shell eggs, cereal
47
Q

Describe the trend of salmonella in chicken and consumer illness after Healthy People 2020 & 2030

A
  • Consumer illness from salmonella about the same
  • Consumer illness attributed to almonell on chicken increasing
  • Salmonella occurenc on chicken decreasing
48
Q

C. perfringens type A:
Incubation period
Symptoms
Types of food involved/transmission

A
  • Incubation: exposure –> 6-24 hours –> 24 hours symptoms
  • Symptoms: diarrhea, stomach cramps, NO vomiting
  • Foods/transmission: consumtion of large batch of foods that sit out - poultry, beef, pork, gravy; spores protect from heat and dry, vegitate on food, produce enterotoxin

Nursing homes, schools, weddings, prisons, hospitals, etc.

49
Q

Campylobacterosis:
Incubation period
Symptoms
Types of food involved/transmission

A

Incubation: exposure –> 2-5 days –> 7 days of symptoms
Symptoms: bloody diarrhea, fever, stomach cramps…Guillain-Barre patients!
Transmission/foods: jejuni naturall colonizies asympt in intestines of poultry and cattle; 20-100% retail chickens contaminated, eggs are safe, raw milk, fruits veggies and water w potential fecal contamination

jejuni 85% of cases, then coli
track via PulseNet, FoodNet or NARMS

50
Q

Staph aureus:
Incubation period
Symptoms
Types of food involved/transmission

A

Incubation: exposure –> 0.5 to 6 hours –> 30 mins to 1 day
Symptoms: sudden nausea, vomiting, stomach cramps, sometimes diarrhea, 21-30% humans carriers on skin, nostrils, lower repro
Transmission/food: toxin in food, prepared without hands, heating kills bacteria but NOT toxin

Rare to diagnose due to very short onset and duration

51
Q

How many types of E. coli are associated with diarrhea?

A

6

52
Q

Enterohemorrhagic E. coli (EHEC):
Incubation period
Symptoms
Types of food involved/transmission

A
  • Incubation: exposure –> 3-4 days –> 5-7 days symptoms
  • Symptoms: large intestnial gastroenteritis, enterocolitis, bloody diarrhea, 10 % w bloody diarrhea get Hemolytic-Uremic Syndrome (acute renal failure, hemolytic anemia, thrombocytopenia) 7 days after 1st symptoms
  • Transmission/foods: warmer month, uncooked beef, raw milk/juice

STECt surveilance overview - NEDS (CDC)

53
Q

Cyclosporiasis:
Incubation period
Symptoms
Types of food involved/transmission

A
  • Incubation: oocyst invades SI –> 1 week –> days-months of symptoms
  • Symptoms: frequent watery diarrhea, stomach cramps, bloating, gas
  • Foods: imported herbs, lettuce, fruit

Cyclospora cayetanensis, tx trimethoprim sulfamethoxazole

54
Q

Shigellosis:
Incubation period
Symptoms
Types of food involved/transmission

A
  • Incubation: exposure –> 1-2 days –> 5-7 days (months to be normal)
  • Symptoms: mild abdominal pain to sever dysentry - cramps, bloody diarrhea, tenesmus, fever
  • Food/transmission: eating food prepared by someone w shigella, recreational water, contaminated drinking water

Not destroyed by stomach acid, small infective dose. Travelers!

55
Q

Yersinia enterocolitica:
Incubation period
Symptoms
Types of food involved/transmission

A
  • Incubation: exposure –> 4-7 days –> 1-3 weeks+
  • Symptoms: fever, abdominal pain, bloody diarrhea, vomiting…CHILDREN = pseudoapendicitis
  • Transmission/food: undercooked meat - pork! (chitlins), raw milk, water contaminated by feces
56
Q

Vibrio:
Incubation period
Symptoms
Types of food involved/transmission

A
  • Incubation: exposure –> 24 hours –> 3 days
  • Symptoms: watery diarrhea, crmaping, fever, chills (Warmer months)
  • Transmission: cholera = international travel, the rest = raw or undercooked shellfish (oysters!)
57
Q

Toxoplasma:

Symptoms
Types of food involved/transmission

A
  • Symptoms: flu like swollen ln, muscle ache/pain to severe brain damage, eye damage, or other organs
  • Food: raw/undercoooked pork, bivavle shellfish, raw goat milk
58
Q

Listeria m:
Incubation period
Symptoms
Types of food involved/transmission

A
  • Incubation: exosure –> 24 hours –> 1-3 days
  • Symptoms: diarrhea nd vomiitng, invasive after 2 weeks = fever, muscle aches, fatigue, headache, stiff neck, confusion, ataxia, seizures
  • Foods: soft cheeses, meats/cheese/salads from deli, cold cuts/hot dogs, dry sausage, pate, cold smoked fish, sprouts, melons, raw milk
59
Q

Botulism:
Incubation period
Symptoms
Types of food involved/transmission

A
  • Incubation: exposure –> 12–36hrs
  • Symptoms: CN, flaccid paralysis, resp failure, NO FEVER
  • Food: honey, improperly preserved fish, home-canned food
60
Q

Hepatitis A:
Incubation period
Symptoms
Types of food involved/transmission

A
  • Incubation: exposure –> 2-6 weeks –> 8 weeks
  • Symptoms: nausea, vomiting, diarrhea, jaundice, fever, abdominal pain, may recur
  • Food: undercooked/raw shellfish
61
Q

Federal Meat Inspection Act of 1906

A
  1. Mandates antemortem inspection (cattle, swine, sheep, goats, horses)
  2. Mandates postmortem inspection of every carcass
  3. Sets sanitary standards for slaughterhouses and meat processing plants
  4. Authorizes continued monitoring (USDA) and inspection within slaughterhouses and plants
  5. Prohibits the sale of adulterated or misbranded livetock meat

Applies to imported meat, destruciton of condemed carcasses

62
Q

Wholesome Meat Act of 1967

A

Requires that states have inspection programs ‘equal to’ that of the FSIS USDA

63
Q

Why are antemortem inspections performed?

A
  • They are the first line of defense
  • Remove obviously diseases animals prior to slaughter to help prevent unnecessary contamination of the slaughtering facility
  • Identify suspects better for more extensive postmortem testing
  • Withhold animals with conditions undetectable on routine postmortem or abnormal conditions (neurologic) that make them unfit for humans
  • Cooperate with animal disease control agencies for eradicaiton programs (USDA APHIS)
64
Q

Describe what is included in antemortem inspections.

A
  • FSIS vet or food inspecter under vet superviison
  • Checking human handling
  • Pen conditions
  • Observation of animals at rest and in motion
65
Q

What are the 3 outcomes of antemortem inspection?

A
  • Passed for slaughter - free of diseases and conditions, fit for human food
  • US Suspect - any evidence of diseases for condemnation to inspect further
  • US Condemned - swine = hog cholera, eryspeals, severe infection, sexual odor, tapeworm cysts, cattle = generalized edema, malignant neoplasm, metastatic SCC, severe infection, icterus, severe emaciation
66
Q

Describe the 5 human methods for slaughter.

A

First must be rended insensible to pain quickly (STUN):
1. Captive bolt - penetrating
2. Captive bolt - non-penetrating
3. Gunshot
4. Electronarcosis
5. Carbon dioxide (sheep, calves, swine)

Then shackled or hoisted by a hind limb and then exsanguinaiton into thoracic cavity and severe carotids and jugulars

67
Q

Describe the slaughter process in hogs.

A
  1. Stunned by electrical or CO2 gas
  2. After bleeding - cleaned: scalding water, dehairing machines, suspended and remaining hair shaved/singed off
  3. Heads removed and viscera, pluck, kidneys, and fat removed (biproducts)
  4. Split down the backbone
  5. Into the cooler for 24 hours
68
Q

Describe the slaughter process for cattle/sheep.

A
  1. Stunned mechanically for the most part (maybe electrical in sheep)
  2. Feet removed and suspended
  3. Skinned by the hide puller
  4. Heads removed at the atlas joint
  5. Evisceration but kidney and fat are left for grading
  6. Split down the backbone
  7. Cooler for 24 hours sheep/calves, 48 hours cattle
69
Q

Describe the slaughter process of poultry.

A
  1. Trained workers suspend living birds by feet on moving line - low light and rub bars on chest to keep them calm
  2. Stunned via electrical stunning or controlled atmosphere stunnia (CO2, reduced atmospheric pressure)
  3. Exsanguination by mechanical cut to throat
70
Q
A
71
Q

Describe the postmortem inspection of livestock.

A
  • Inspection Program Personell perform with PHV oversight
  • Looking at sanitation as well
  • Generally use sight, touch, smell, and sound (carcass hitting floor) as assessment
72
Q

What are the 3 possible outcomes of postmortem inspection

A
  • Passed
  • Retained for the PHV to specifically look at
  • Condemned
73
Q

Outline the carcass postmortem steps.

A
  1. Visual inspection
  2. Carcass presentation (head and viscera)
  3. Carcas split lengthwise
  4. Pathway for resitricted products
74
Q

What structure is. abig deal for postmortem inspection of carcasses?

A

Lymph nodes!

75
Q

What are the important lymph nodes collected for postmortem inspection?

A

Mandibular, parotid, lateral and medical retropharyngeal

76
Q

What parts of the head are collected/assessed postmortem

A

Eyes (SCC)
LN
Cheek muscles
Tongue

77
Q

What viscera are collected/assesed postmortem?

A

Lymphnodes, esophagus, spleen, palpate rumen/reticular junction, costal surfaces of lungs, liver
Incise lungs and lymph nodes, heart, bild duct (lfukes)

78
Q

What are the 4 pathways for restricted products?

A
  1. Refrigeration (frozen for cysticercosis)
  2. Heating - minimum internal temp of 140F for sheep and beef cysticercosis
  3. Cooking - 170F internally for 30 mins (Tb, CL, swine cysticercosis, non zoonotic parasites
  4. Comminuted cooked meat –> finely ground w uniform appeaance (eosinophilic myositis or boar carcasses with some odor but not too bad
79
Q

All pork muscle products are considered potentially contaminated with… and must be thoroughly cooked before being eaten.

A

Thrichinosis

80
Q

Specified Risk Materials

A
  • BSE
  • Tonsils and distal ileum
  • > 30 months old - skull, eyes, brain, trigeminal ganglia, vertebral column and spinal cord
81
Q

Condemned products: specific FSIS controls …

A

Can look edible
Identificaiton, separation, descruction (rendering, incineration, denatured), documentation

82
Q

During postmortem inspections, what disease processes make partial condemnation complicated?

A
  • Tuberculosis
  • Actinomycosis and actinobacillosis
  • Cysticercus bovis
83
Q

HACCP vs HARPC

A

HARPC = + supply chain programs must provide HARPC w/ verification, evaulation of the probability and severity of consumer impact, provide recall plans
HARPC = mandatory…HACCP = voluntary

84
Q

Which groups of people are more vunerable to food insecurity?

A
  • Children
  • Women
  • Ethnic minorities (driven by increased socioeconomic obstacles and poverty)
85
Q

Global Food and Nutrition Security (GAFS)

A
  • Collaboration of the World Bank and G7 group
  • Focus areas = advice, alert, action, advancement
  • Recognizes that for food security objectives to be realized, all four dimensions must be fulfilled simultaneously
86
Q

What is the US doing globally about food insecurity?

A
  • US Department of state - office of global food security leads and coordinates US engagmenet on food systems, security, and nutrition
  • US department of homeland security - inspector general, US agency for international development (USAID) advances national security, economic prosperity, promotes path to self0reliance and resilience, feed the future initiate to strengthen ag growth, emergency food assitance to vunverable populations
  • USDA - builds local capacities, increases productivity with reserch, improves markets and trade with analyses
87
Q

What are the US agencies involved in national food security?

A

USDA, Economic research service, CDC, healthy people

88
Q

Food security is affected by…

A
  • Poverty and unemplyoment
  • Lack of affordable housing
  • Chronic health conditions
  • Racism and discrimination

Healthy Populations (10 decks)

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