To the Candidates for the Position of Director-General of the World Health Organization
Unprecedented and rising levels of industrial animal farming are undermining the highest attainable standard of health that is WHO’s mandate. During the 2016 World Health Assembly, Director-General Margaret Chan highlighted climate change, antibiotic resistance, and chronic diseases as “slow-motion disasters.” However, their fundamental link to industrial animal farming has continued to be disregarded.
Industrial Animal Farming: A Global Health Challenge
The consumption of meat and other animal products is part of most cultures, yet large-scale industrial animal farming has gone beyond satisfying dietary needs and cultural practices. The extent to which we now produce and consume animal products is harming our health.
Industrial approaches to animal agriculture have spread across many nations and are rapidly increasing in low- and middle-income countries. Factory farms (also known as concentrated animal feeding operations, or CAFOs) use intensive methods to rear poultry, pigs, and cattle on a large scale for food products. Practices such as the indiscriminate use of antibiotics, close confinement of animals, and unsustainably large scale of production have become the industry standard, and each has grave consequences for human health. The problem, however, is getting worse as a rising proportion of global meat consumption comes from factory farms. Factory farms produce 67% of poultry meat, 50% of eggs, and 42% of pork globally. 1 A return to more traditional husbandry methods is unlikely to occur, as the prevalence of factory farming has been rapidly increasing in both the high- and low- and middle-income countries.
Although many previous attempts to tackle factory farming have been largely framed around animal welfare or environmental concerns, we believe that limiting the size and adverse practices of factory farming is also central to improving global health.
Antibiotic resistance is a major threat to global health. Seven hundred thousand people die from antimicrobial-resistant diseases each year. 2 If current trends continue, diseases caused by drug-resistant microbes could kill up to 9.5 million per year by 2050, more than current cancer-deaths. 3,4 While quantification of specific morbidity and mortality burdens attributable to industrial agriculture is currently not possible, an increasing body of evidence suggests that antibiotic use in factory farming is a major contributor to resistance. Many industrial farms use low doses of antibiotics to marginally speed growth or prevent diseases in healthy chickens, pigs, and cattle, but do not bear the societal cost of antibiotic overuse. Although factory farms use antibiotics with the aim of keeping animals healthy and to increase productivity, accumulating evidence suggests that growth-promotion uses do not achieve this purpose5 and alternatives to antibiotic use for disease prevention such as better husbandry practices and vaccines are available and have been used with success.6
Total consumption of antibiotics in animal food production is projected to grow by almost 70% between 2010 and 2030.5 According to the WHO, two of the three most commonly used classes of antibiotics in U.S. animal farming—penicillins and tetracyclines—are of critical importance to humans. Practices such as the constant low dosing of antibiotics and environmental pollution through animal waste make industrial animal farms the perfect breeding ground for antibiotic resistance by allowing transmission into the environment and nearby community.7 Several studies have found that the presence of antibiotic-resistant bacteria in livestock is closely associated with their presence in humans, and that decreases in antibiotic resistance have followed reductions in the usage of antibiotics in animals raised for food and humans.8, 9, 10 The farming of fish in aquaculture poses similar health risks.11 Currently, in the EU and the US, over 75% of all antibiotics are used in agriculture, 12 while BRICS countries are projected to experience a 99% growth in antimicrobial consumption by 2030, largely due to the continued growth of factory farming. Low- and middle-income countries (LMICs) are estimated to experience rapid growth of both factory farming and antibiotic consumption through agriculture, in part because they may lack the regulatory oversight and veterinary medical workforce that high-income countries have.13 The consequences of antibiotic resistance will likely be more severe in LMICs because of higher bacterial disease burden and the challenges patients face in accessing expensive second and third line antibiotics.14 Moreover, antibiotic resistance places a great burden on health systems, leaving weak health systems ill-prepared to deal with increases in resistance.
Climate change is projected to decrease global prosperity and increase wealth inequalities. It is also expected to cause an additional 250,000 deaths each year between 2030 and 2050.15 As the global health community acknowledges the intertwined nature of planetary and human health, it must also confront the role that factory farming plays in climate change. 16 Experts predict that without rapid and drastic shifts in meat production, agriculture will consume half the world’s carbon budget necessary for keeping global temperature rises under 2° Celsius by 2050.17 Importantly, this contribution to climate change is not due solely to the emissions from raising livestock – animal farming is also a large contributor because of the deforestation that must occur to supply grazing land for cattle and to grow crop feed. The World Bank estimates that between 1970 and 2004, 91% of cleared land in the Amazon has been converted to cattle ranching.18 Furthermore, factory farming is not only linked to macro-level environmental crises such as climate change, but one of the largest contributors to localized environmental problems like air and water pollution, as well as land and soil degradation.19 Although it is difficult to predict the multitude of harms that may spill over from livestock production, evidence suggests this deforestation may also be linked to emerging pathogens, an unexpected channel by which animal farming may contribute to the risk of disease pandemics beyond antibiotic resistance.20 A large proportion of emerging diseases stem from human-animal interaction in the wild, a process that deforestation accelerates. Zoonotic diseases can also emerge from animals in contact with workers in factory farms themselves.21
Lastly, the rise of obesity and noncommunicable diseases (NCDs) can be partly attributed to the dramatic dietary changes made possible by factory farming. WHO has classified processed meat as carcinogenic and red meat as probably carcinogenic.22 High meat consumption has been shown to increase risks for several types of cancer, stroke, obesity, cardiovascular mortality, lung disease and diabetes.23 The Institute for Health Metrics and Evaluation estimates that diets high in processed meat and red meat contributed to over half a million human deaths (or over 16 million disability-adjusted life years, or DALYs) in 2015 – more deaths worldwide than interpersonal violence, and a similar DALY burden to breast cancer or alcohol use disorders.24 The declining cost of meat and its increasing prevalence in LMICs, facilitated by factory farms, contributes significantly to the rapidly rising burden of NCDs.
The Path Forward
The harms caused by large-scale, industrial animal farming are global in nature and felt beyond those who consume meat, dairy, and eggs. Climate change does not recognize borders and neither do drug-resistant infectious diseases. Although they contribute least to the global burden of animal farming, the world’s poorest countries are also the most vulnerable to rising water levels, natural disasters caused by climate change, food insecurity, and infectious diseases. Finding solutions to problems posed by industrial animal farms and shifting us toward more healthful agriculture will therefore require the global leadership of WHO.
Just as the WHO has bravely confronted companies that harm human health by peddling tobacco and sugar-sweetened beverages, it must not waver in advocating for the regulation of industrial animal farming.
We applaud the WHO’s important actions on consumer product industries that jeopardize the right of all people to the highest standard of health. In particular, we recognize the significance of the Framework Convention for Tobacco Control, the inclusion of tobacco reduction in the United Nations Sustainable Development Goals, and WHO’s recommendation on sugar consumption.
We call on academics and researchers to apply their energy to document and publicize the harms of industrial animal farming to human, animal, and planetary health.
We call on all candidates for the WHO-Director General position to publicly acknowledge the harm that industrial animal farming inflicts on global health. The next Director General should take necessary steps to limit the expansion of industrial animal farming and encourage dietary recommendations that reduce meat consumption.
Finally, we call on the next WHO-Director General to provide global leadership to support all member states in finding sustainable alternatives to the rapid growth of industrial animal farming and help shift us toward farming methods that protect public health and the environment.
Concluding Policy Recommendations for the next Director General:
In order to lead us down the path of agricultural production that is better for people’s health than our current industrial animal production system, the WHO should:
- Strengthen WHO’s Global Action Plan on Antimicrobial Resistance to encourage member states of the WHO to ban the use of growth-promoting antibiotics in animal farming, as well as low-dose “disease prevention” antibiotics. This reform may cut unnecessary antibiotic use without additional cost to consumers.
- Negotiate country-level standards for antibiotic use in animal husbandry, in coordination with the Food and Agricultural Organization. Member states should be encouraged to articulate specific, verifiable standards for what constitutes legal antibiotic use in animal farms.
- Incentivize meat producers to dispose of antibiotics and waste residue properly to prevent environmental contamination and excess greenhouse gas emissions.
- Work with all relevant ministries, including those outside of health, to reduce the size and number of factory farms to better balance dietary need and ecological capacity.
- Discourage member states from subsidizing factory farming and its inputs, which can cause significant harm to the public.
- Consider the application of relevant fiscal policies in member states that would help to reduce meat demand and consumption, especially where consumption exceeds health recommendations. The WHO’s internal research expertise is well-suited to investigate the efficacy and tradeoffs of such a policy.
- Encourage member states to adopt nutrition standards and implement health education campaigns which inform citizens of the health risks of meat consumption.
- Work closely with ministers of health and agriculture to formulate policies that advocate for a greater proportion of plant-based foods in the diets of member states.
- Consider funding the scientific development of plant-based and other meat alternatives, which have the potential to eliminate or reduce the harms of factory farming.
 Rischkowsky and Pilling 2007
 Cecchini et al 2015
 OECD 2016
 WHO fact sheet “Cancer” 2017
 Sneeringer et al 2015
 O’Neil 2015
 Van Boeckel et al 2015
 Silbergeld et al. 2008, You and Silbergeld 2014, Economou and Gousia 2015
 Vieira et al 2005
 Aarestrup 2005
 Schwarz et al., 2001
 Sapkota et al 2008
 OECD 2016
 Lam et al. 2016
 Whitby et al, 2001, Filice et al. 2010, Ganguly et al 2011
 WHO fact sheet 2016
 Steinfeld et al. 2006; Springmann et al., 2016
 Bajželj et al. 2014, Hedenus, Wirsenius, Johansson 2014
 Margulis 2004
 Burkholder et al. 2007, Ilea 2009, Cambra-López 2010).
 Lindahl, Grace 2015, Aguirre, Tabor 2008, Patz et al. 2000
 Ma et. al 2008
 Bouvard et al 2015
 Rouhani et al. 2014; Bouvard et al. 2015; Varraso and Camargo 2015; Yang et al. 2016; Wang et al. 2016; Pan et al. 2012; Pan et al. 2011; Micha et al., 2010; Wolk 2017
 IHME 2016
Aarestrup, Frank M. 2005. “Veterinary Drug Usage and Antimicrobial Resistance in Bacteria of Animal Origin.” Basic & Clinical Pharmacology & Toxicology 96 (4): 271–81. doi:10.1111/j.1742-7843.2005.pto960401.x.
Aguirre, A. A., & Tabor, G. M. (2008). Global factors driving emerging infectious diseases. Annals of the New York Academy of Sciences, 1149(1), 1-3.
Sapkota, Amir, Amy R. Sapkota, Margaret Kucharski, Janelle Burke, Shawn McKenzie, Polly Walker, and Robert Lawrence. 2008. “Aquaculture Practices and Potential Human Health Risks: Current Knowledge and Future Priorities.” Environment International 34 (8): 1215–26. doi:10.1016/j.envint.2008.04.009.
Bailey, R., Froggatt, A., & Wellesley, L. (2014). Livestock–climate change’s forgotten sector. Chatham House.
Bajželj, B., Richards, K. S., Allwood, J. M., Smith, P., Dennis, J. S., Curmi, E., & Gilligan, C. A. (2014). Importance of food-demand management for climate mitigation. Nature Climate Change, 4(10), 924-929.
Boeckel, Thomas P. Van, Charles Brower, Marius Gilbert, Bryan T. Grenfell, Simon A. Levin, Timothy P. Robinson, Aude Teillant, and Ramanan Laxminarayan. 2015. “Global Trends in Antimicrobial Use in Food Animals.” Proceedings of the National Academy of Sciences 112 (18): 5649–54. doi:10.1073/pnas.1503141112.
Bouvard, Véronique, Dana Loomis, Kathryn Z Guyton, Yann Grosse, Fatiha El Ghissassi, Lamia Benbrahim-Tallaa, Neela Guha, Heidi Mattock, and Kurt Straif. 2015. “Carcinogenicity of Consumption of Red and Processed Meat.” The Lancet Oncology 16 (16): 1599–1600. doi:10.1016/S1470-2045(15)00444-1.
Burkholder, J., Libra, B., Weyer, P., Heathcote, S., Kolpin, D., Thome, P. S., & Wichman, M. (2007). Impacts of waste from concentrated animal feeding operations on water quality. Environmental health perspectives, 308-312.
Cambra-López, M., Aarnink, A. J., Zhao, Y., Calvet, S., & Torres, A. G. (2010). Airborne particulate matter from livestock production systems: A review of an air pollution problem. Environmental pollution, 158(1), 1-17.
Cecchini, Michele, Julia Langer, and Luke Slawomirski. 2015. “Antimicrobial Resistance in G7 Countries and beyond: Economic Issues, Policies and Options for Action.” OECD. https://www.oecd.org/els/health-systems/Antimicrobial-Resistance-in-G7-Countries-and-Beyond.pdf.
Economou, Vangelis, and Panagiota Gousia. 2015. “Agriculture and Food Animals as a Source of Antimicrobial-Resistant Bacteria.” Infection and Drug Resistance 8 (April): 49–61. doi:10.2147/IDR.S55778.
Filice, G. A., Nyman, J. A., Lexau, C., Lees, C. H., Bockstedt, L. A., Como-Sabetti, K., … & Lynfield, R. (2010). Excess costs and utilization associated with methicillin resistance for patients with Staphylococcus aureus infection. Infection Control & Hospital Epidemiology, 31(04), 365-373.
GBD 2015 Risk Factors Collaborators. 2016. “Global, Regional, and National Comparative Risk Assessment of 79 Behavioural, Environmental and Occupational, and Metabolic Risks or Clusters of Risks in 188 Countries, 1990–2015: A Systematic Analysis for the Global Burden of Disease Study 2015.” The Lancet 388: 1659–1724.
Hedenus, F., Wirsenius, S., & Johansson, D. J. (2014). The importance of reduced meat and dairy consumption for meeting stringent climate change targets. Climatic change, 124(1-2), 79-91.
Ilea, R. C. (2009). Intensive livestock farming: Global trends, increased environmental concerns, and ethical solutions. Journal of Agricultural and Environmental Ethics, 22(2), 153-167.
Lam, Y., Fry, J., Hu, E., Kim, B., & Nachman, K. (2016). Industrial Food Animal Production in Low- and Middle-Income Countries: A Landscape Assessment. Retrieved May 6, 2017, from http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-a-livable-future/_pdf/projects/IFAP/IFAPLowmid_income_countriesWeb1.pdf
Laxminarayan, Ramanan, Thomas Van Boeckel, and Aude Teillant. 2015. “The Economic Costs of Withdrawing Antimicrobial Growth Promoters from the Livestock Sector.” http://www.oecd-ilibrary.org/agriculture-and-food/the-economic-costs-of-withdrawing-anti-microbial-use-in-the-livestock-sector_5js64kst5wvl-en.
Lindahl, J. F., & Grace, D. (2015). The consequences of human actions on risks for infectious diseases: a review. Infection ecology & epidemiology, 5.
Ma, W., Kahn, R. E., & Richt, J. A. (2008). The pig as a mixing vessel for influenza viruses: human and veterinary implications. J Mol Genet Med, 3(1), 158-166.
Margulis, S. (2004). Causes of deforestation of the Brazilian Amazon (Vol. 22). World Bank Publications.
Micha, Renata, Sarah K. Wallace, and Dariush Mozaffarian. 2010. “Red and Processed Meat Consumption and Risk of Incident Coronary Heart Disease, Stroke, and Diabetes Mellitus: A Systematic Review and Meta-Analysis.” Circulation 121 (21): 2271–83. doi:10.1161/CIRCULATIONAHA.109.924977.
Nierenberg, Danielle, and Lisa Mastny. 2005. Happier Meals: Rethinking the Global Meat Industry. State of the World Library 171. Washington, D.C: Worldwatch Institute.
OECD. 2016. “Antimicrobial Resistance: Policy Insights.” https://www.oecd.org/health/health-systems/AMR-Policy-Insights-November2016.pdf.
O’Neill, J. (2015). Antimicrobials in agriculture and the environment: reducing unnecessary use and waste. The review on antimicrobial resistance.
Pan, An, Qi Sun, Adam M. Bernstein, Matthias B. Schulze, JoAnn E. Manson, Meir J. Stampfer, Walter C. Willett, and Frank B. Hu. 2012. “Red Meat Consumption and Mortality: Results from Two Prospective Cohort Studies.” Archives of Internal Medicine 172 (7): 555–63. doi:10.1001/archinternmed.2011.2287.
Pan, An, Qi Sun, Adam M. Bernstein, Matthias B. Schulze, JoAnn E. Manson, Walter C. Willett, and Frank B. Hu. 2011. “Red Meat Consumption and Risk of Type 2 Diabetes: 3 Cohorts of US Adults and an Updated Meta-Analysis.” The American Journal of Clinical Nutrition 94 (4): 1088–96. doi:10.3945/ajcn.111.018978.
Patz, J. A., Graczyk, T. K., Geller, N., & Vittor, A. Y. (2000). Effects of environmental change on emerging parasitic diseases. International journal for parasitology, 30(12), 1395-1405.
Rischkowsky, B., & Pilling, D. (2007). The state of the world’s animal genetic resources for food and agriculture. Food & Agriculture Org.
Rouhani, M. H., A. Salehi-Abargouei, P. J. Surkan, and L. Azadbakht. 2014. “Is There a Relationship between Red or Processed Meat Intake and Obesity? A Systematic Review and Meta-Analysis of Observational Studies.” Obesity Reviews: An Official Journal of the International Association for the Study of Obesity 15 (9): 740–48. doi:10.1111/obr.12172.
Schwarz, S., C. Kehrenberg, and T. R. Walsh. 2001. “Use of Antimicrobial Agents in Veterinary Medicine and Food Animal Production.” International Journal of Antimicrobial Agents 17 (6): 431–37. doi:10.1016/S0924-8579(01)00297-7.
Silbergeld, E. K., Graham, J., & Price, L. B. (2008). Industrial food animal production, antimicrobial resistance, and human health. Annu. Rev. Public Health, 29, 151-169.
Sneeringer, S., MacDonald, J., Key, N., McBride, W., & Mathews, K. (2015). Economics of antibiotic use in US livestock production. USDA Economic Research Service, Economic Research Report, 200.
Springmann, M., H. C. J. Godfray, M. Rayner, and P. Scarborough (2016), Analysis and valuation of the health and climate change cobenefits of dietary change, Proc. Natl. Acad. Sci., 113(15), 4146–4151, doi:10.1073/pnas.1523119113.
Steinfeld, H., Gerber, P., Wassenaar, T. D., Castel, V., & de Haan, C. (2006). Livestock’s long shadow: environmental issues and options. Food & Agriculture Org..
Varraso, Raphaëlle, and Carlos A. Camargo. 2015. “The Influence of Processed Meat Consumption on Chronic Obstructive Pulmonary Disease.” Expert Review of Respiratory Medicine 9 (6): 703–10. doi:10.1586/17476348.2015.1105743.
Vieira, Antonio R., Peter Collignon, Frank M. Aarestrup, Scott A. McEwen, Rene S. Hendriksen, Tine Hald, and Henrik C. Wegener. 2011. “Association between Antimicrobial Resistance in Escherichia Coli Isolates from Food Animals and Blood Stream Isolates from Humans in Europe: An Ecological Study.” Foodborne Pathogens and Disease 8 (12): 1295–1301. doi:10.1089/fpd.2011.0950.
Wang, Xia, Xinying Lin, Ying Y. Ouyang, Jun Liu, Gang Zhao, An Pan, and Frank B. Hu. 2016. “Red and Processed Meat Consumption and Mortality: Dose-Response Meta-Analysis of Prospective Cohort Studies.” Public Health Nutrition 19 (5): 893–905. doi:10.1017/S1368980015002062.
Whitby, M., McLaws, M. L., & Berry, G. (2001). Risk of death from methicillin-resistant Staphylococcus aureus bacteraemia: a meta-analysis. Medical Journal of Australia, 175(5), 264-267.
Wolk, A. 2017. “Potential Health Hazards of Eating Red Meat.” Journal of Internal Medicine 281 (2): 106–22. doi:10.1111/joim.12543.
World Health Organization. 2013. “Critically Important Antimicrobials for Human Medicine.” 4th revision. http://apps.who.int/iris/bitstream/10665/251715/1/9789241511469-eng.pdf?ua=1.
———. 2016. “Climate Change and Health: Fact Sheet.” http://www.who.int/mediacentre/factsheets/fs266/en/.
———. 2017. “Cancer: Fact Sheet.”
Yang, Cuili, Lei Pan, Chengcao Sun, Yongyong Xi, Liang Wang, and Dejia Li. 2016. “Red Meat Consumption and the Risk of Stroke: A Dose-Response Meta-Analysis of Prospective Cohort Studies.” Journal of Stroke and Cerebrovascular Diseases: The Official Journal of National Stroke Association 25 (5): 1177–86. doi:10.1016/j.jstrokecerebrovasdis.2016.01.040.
You, Yaqi, and Ellen K. Silbergeld. 2014. “Learning from Agriculture: Understanding Low-Dose Antimicrobials as Drivers of Resistome Expansion.” Frontiers in Microbiology 5. doi:10.3389/fmicb.2014.00284.