Since the Food Safety Standards Authority of India has

Since 2006, the Food Safety Standards Authority of India has led efforts to promote food safety, tighten food laws, and harmonise these laws with international standards and quality-management systems. These efforts need to be complemented with interventions focused on practices at the household level, because a substantial proportion of foodborne illnesses come from home kitchens. In a 2006 nationwide study, 13% of households reported foodborne illnesses in the previous fortnight. These illnesses might relate to practices at the individual or household level, which are affected by cultural factors (eg, cooking practices) and structural factors (eg, availability of safe fuel, water, etc; ). In India, semiprocessed primary agricultural produce and raw materials are procured from the market before they are further processed and made suitable for cooking at home. In many rural homes, ingredients are bought loose in small amounts; adulteration is thus a major safety concern. About 11% of all foods sold in India are estimated to be adulterated, such that it SYN-117 is not generally thought of as a problem and most people remain indifferent even to deliberate adulteration. Improved awareness and individual empowerment to hold regulators accountable for enforcement of rules against adulteration is needed. Foods in Indian homes are usually stored in covered containers and consumed within a day of preparation. Many households (about 80%) cook food twice a day, and more than half serve food hot; many reheat leftover foods. Fewer than 10% of Indian homes have refrigerators, and hence campaigns about cross-contamination, reheating, or thawing might be of little relevance. Even without powered refrigeration, many Indians practise traditional ways of storing leftover foods, including storage in a cool place, in water, or in a porous dish with water on its lid. Food is often cooked in small quantities to avoid storage problems. The safety implications of common practices for food storage and consumption need to be better understood so that associated risks can be effectively communicated and feasible alternatives encouraged. Hand washing is relatively routine in India, and is often customarily done before handling or consuming of food. Normative hand washing does not, however, guarantee safety of the foods handled, because a great deal of hand washing is symbolic and done without soap. These customary practices can be strengthened by encouragement of universal access to and use of soap, which can reduce the risk of diarrhoeal diseases by 40–42%. In many Indian homes, the domestic hearth is an area of sanctity and tends to be located next to the area of worship. However, with an estimated 37% of Indians living in poverty, most homes do not have a separate designated kitchen, such that living, cooking, and eating happen in a common place within the house (31%) or veranda (courtyard; 28%). Many households (76%) cook with solid fuels such as firewood, coal, or cow-dung cakes, which release smoke that leads to lacrimation and nasal discharge, posing a food safety hazard. Migration towards cleaner fuels is hindered by factors of affordability, availability, and accessibility. Similarly, availability of safe drinking water is beyond the control of the common consumer.
We read with great interest the Comment by Soumyadeep Bhaumik and colleagues (Sept, p e129) advocating universal access to health-care information. The communication is important and timely; however, we believe that Bhaumik and colleagues have extrapolated their arguments and made disproportionate and dubious claims to support their viewpoint. For instance, on the basis of the study by Jafar and colleagues, the authors say that a quarter of Pakistani physicians are unaware of the hypertension guidelines “because they do not have adequate information about medicines” and thereby prescribe sedatives. Bhaumik and colleagues then reiterate that governments are legally obliged to ensure adequate access to health-care information. However, the gaps in the practices of Pakistani physicians appear to be because of lack of continued medical education sessions and a subdued tutorial system in medical schools (as elaborated by Jafar and colleagues) rather than inadequate access to health-care information.