Health Facts


In April, a parliamentary working group was ready to publish a damning report on the health effects of unsafe food.

The most serious accusation was not the food industry’s role in causing 26,500 hospitalisations nor its purported role in 164 deaths in the five-year period the working group studied ending in 2016. It was the General Assembly’s striking accusation that unsafe food was responsible for the stratospheric rise in new cancer cases in Vietnam.

Then, the group was suddenly disbanded. The report was labelled “inaccurate”, a danger to consumers and food producers, according to a response by the Health Minister Nguyen Thi Kim Tien reported by VNExpress International. Chronic infection, not food, causes cancer, the minister said.

The remarks have done little to abate a widespread public belief in the opposite, an idea corroborated by medical professionals in remarks we’ve reported in the past

The Billion Dong Question

So, is food safe in Vietnam, or not?

A positive answer to that question could lead to enormous fortunes for this county’s pig farmers who since 2012 have been in limbo with the Chinese market due to a ban on Vietnamese pork.

Vietnam could export elsewhere, and indeed has been approached by Ukraine in a bid to secure pork for the east European nation. But missing out on China means missing out on a big, pork-hungry group of consumers right next door.

Although China contains a fifth of the world’s population, the country consumes about half of the world’s pork.

The country’s pork farmers are struggling to keep up. China has been remaking a pork production model that’s recently had to scale quickly from a collection of small farms to a larger, more robust industrial-scale operation in the service of meeting its 50 million-plus tonne annual pork demand. Nguyen Tuan Viet, director of VIETGO Co Ltd import-export consultancy, observed that Chinese farmers are currently falling five million tonnes short of the country’s need.

Vietnam could fill that cheaply. Chinese pork prices have fluctuated wildly between about US$2.70 and US$2.20 per kilogram this year. Vietnam’s US$2-per-kilogram pork—a three-month high—looks comparatively attractive.

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Mr Viet made the statement in May 2017. At that time, Chinese officials were in formal negotiations with the Vietnamese government to settle terms of an agreement to lift the ban on pork from their southern neighbour. At the time, Vietnamese pork farmers were hungry for some kind of relief as their pig raising operations were generally not profitable due to the low prices.

The problem? Pig health and the quality of production have remained an unresolved concern for Chinese officials responsible for greenlighting Vietnam’s entry into their country’s pork market. Except for a few temporary suspensions of the bans, Vietnam’s pork has remained officially forbidden from the market since 2012 over concerns of foot-and-mouth disease.

Vietnam’s Pigs Sneak Over On “Feet”

So, health concerns over Vietnam’s pork have led to a stiff ban from the Chinese market.

Officially, that is.

Unofficially, a sophisticated network of suppliers and complicit Chinese authorities are ensuring a steady supply of cheap Vietnamese pork makes it into China. About 15,000 pigs were making it into the country each day when Chinese state broadcaster CCTV broke its investigatory report in 2016.

The illegal supply network has been known since at least 2015 when Reuters reported that Hong Kong smugglers were earning up to $50 a trip offering themselves as “feet”, individuals who carry supplies of illicit meat on foot.

“You have people stuck with meat on the Vietnam side of the border they can’t sell. They start taking it up and down the river and breaking it into smaller units to bring it in,” a Shanghai-based meat industry advisor told Reuters. “It’s more underground and therefore more dangerous.”

No additional reporting indicates the network has been meaningfully hindered or disrupted.

Infected Meat

The Chinese ban on Vietnam’s pork is not without cause.

An extensive 2016 World Bank report on food safety cited an alarming rate of salmonella infection in pork sold at local markets: about half of the meat tested.

China’s pork hungry populace is rivalled by the appetites of their southern neighbour. With 27 kg of pork eaten per person per year, Vietnam is one of the world’s most robust pork markets.

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China’s pork consumption is larger still at 44 kg per person annually.

Most pork in Vietnam is produced nationally, and 83 percent of it comes from small farms, the World Bank report’s authors observed.

The report stopped short of ringing a public health alarm bell because the observations don’t have a larger body of public research with which to understand these data points and standards of enforcement.

The report also cited that Vietnam’s food producers were failing to win consumer confidence, arguing stiffer enforcement might help broker that relationship.

Loss of Trust

Vietnam’s food producers will also have to win the confidence of the public health experts and businesses that have publically cast aspersions on the nation’s food safety architecture.

“I don’t believe there are clean vegetables (in the market) anymore,” Nguyen Lan Dung, chairman of the Vietnam Biotechnology Association, said at the conference, remarks reported by VNExpress.

In August 2016, Mr Nguyen and other food safety experts met with business actors in Hanoi to talk about the state of the country’s food safety. He said the thousands of pesticides and chemical additives—“90 percent of which come from China,” Mr Nguyen added earnestly—posed a danger to consumers in Vietnam due to a lack of consistency in usage methods.

The conference was abuzz with the findings of a National Institute for Food Control report that found excessive pesticide levels in nearly half of the 120 samples tested.

About 60 percent of the meat the regulator’s inspectors tested was unsafe for human consumption.

“It’s impossible to control how our farmers use [pesticides],” Mr Nguyen observed at the conference.

The National Institute of Food Control is one of several federal regulatory agencies working with the Ministry of Health and the Ministry of Industry and Trade to create and enforce food safety standards. Each reports to the vice-prime minister.

The experts at the Hanoi conference commented that customers’ fears of food handling that puts cost efficiency over safety are mostly founded.

For the business actors in the room, the blame for the state of food safety and consumer confidence fell to the regulators and their lack of coordination. “There are inspection teams from the health and agricultural sectors. Then there are teams from the ward, district and even inter-agency teams from a municipal level. Why can’t these teams share their test results to save costs and cut the onerous red tape?” said seafood store chain Director Tran Quan.

A Tough, Unsexy Problem

Food safety is important, but perhaps some of the passivity it engenders is due to an inability to properly contextualise its failures.

About halfway through the World Bank’s report is a section on the health risks of foodborne illness. The report’s authors first confess the difficulty of honestly assessing the industry’s real level of risk. “ … risk analysis is still not well understood and not much applied in the developing world, including Vietnam,” citing a lack of human and monetary capital. The writers note that outbound food from Vietnam is rigorously checked, while food grown and consumed domestically receives a “low systemic application of risk-based approaches to food safety due to lack of…resources….”

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But if there’s something serious to worry about from that kind of hazard, the report doesn’t clearly state it. The report instead follows the pork salmonella datapoint with a page of worrisome-sounding findings from people who’ve studied Vietnam’s food: the salmonella risk is mentioned within a laundry list of other health violations including incidents of intestinal disease-causing Cyclospora and E. coli, which was found in at least 16 percent of vegetables tested in a two-year period ending in 2014.

In the conclusions section, the authors state that foodborne microorganisms, pesticides and antibiotic residues “appear to be much higher [in Vietnam] than those in developed countries,” and “the status of antibiotic residues and reported resistance is alarming with an increasing trend over time,” but more study is needed.

The C-Word

The 2017 World Bank report does, however, include a note about a lingering and easy to understand concern widely believed to emerge from unsafe food: cancer.

There are 10 mentions of the C-word in the World Bank’s study. Most are cagey observations noting some of the health hazards observed in the research as connected and potentially related to cancer, but it stops short of saying anything conclusive about the relationship.

That’s a strong contrast with public perception about cancer’s relationship with unsafe food.

Unsafe food is the top cause of cancer in Vietnam,” a Vietnamnet Bridge story wrote in 2016. The bombshell claim came from the deputy chair of the Vietnam Cancer Association who said unsafe food was responsible for 35 percent of cancer cases.

The news came as health officials were reporting an explosion of cancer diagnoses: cancer infections nearly doubled from 2000 to 126,307 in 2010. The upward trend is expected to continue to 190,000 in 2020.

Because most cancer diagnoses come late—nearly 75 percent of diagnosis come after the second stage—a diagnosis is almost certainly a death sentence. Vietnam has about 70,000 cancer-related deaths annually.

The science on the connection between food and cancer has, however, not reached a consensus yet.

The claim was questioned in a paper aptly titled Food safety in Vietnam.

“There is a very common belief that eating foods contaminated with pesticides or other chemicals is an important cause of cancer. However, the proportion of cancers caused by contaminated food in Vietnam is unknown,” the study’s five authors, two of them Vietnamese researchers, said.

“Generally, there is far more concern about the carcinogenic impact of food than the evidence to support this,” they write.

If the increase in cancer rates is due to an increase in diagnoses and longer lives, does food play a role in that? The science doesn’t have a firm answer on that question, the authors state.

“Undoubtedly, some cancers are associated with diet, but risky behaviours (e.g. smoking, alcohol abuse)…,” they write. “However, there is much that is unknown about the long-term effects of chemicals in food.”

The Best Answer

So maybe not cancerous, but is food safe?

The question is frustratingly hard to answer because the efforts to clarify it are largely uncoordinated. The most complete picture comes from the Ministry of Health’s data, information that the World Bank says is likely incomplete, but is nonetheless the most comprehensive information set in existence.

Acknowledging that “safe” is a relative term, the Ministry of Health’s data suggest Vietnam’s food is relatively safe compared to another common consumer behaviour, riding a motorbike.

Motorcyclists make up about half of the approximately 14,000 road fatalities that Vietnam reports to the World Health Organization annually.

The number of people who have died of foodborne illness in Vietnam: about 40 each year.

The safest food according to the Ministry of Health is the meal served at a restaurant or school; only eight foodborne disease outbreaks were recorded in 2015 at these locations.

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Street food ranked remarkably well in these statistics. Only 12 of the 129 food disease incidents occurred from a street food vendor.

The most serious offender was the private kitchen. Of the 179 food disease outbreaks recorded in 2015, 85 were traced to food that was prepared in the home.

Fear Factor

If that’s an unsatisfying note on which to end, know that the question of food safety is generally a sticky one.

Acknowledging that some of the data is awful and cemented public perception may be difficult to shift, the question of food safety is just hard to answer in general because “[f]ood technologies often involve ‘fear factors’ that make them seem more worrisome than other risks—for example, eating pesticide-contaminated vegetables is (incorrectly) perceived as being more risky than riding a motorbike,” the Food Safety in Vietnam authors point out.

In lieu of certainty, some have gone to satire. The Vietnamese tell a joke about their food’s safety: “If you don’t eat, you’ll die; if you eat, you’ll die slowly.”


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