 We're going to talk a little bit about building on what Helen had to say, what an excellent overview. I really appreciate the depth in which she covered this topic, because for many folks who don't understand the connection between the two, it's kind of a foreign territory. But it has been something that's been increasingly important, not only in the work that I do in various parts of the world, but I think everyone, particularly funders, are now starting to realize that without the connections, we are not going to be successful in the project work that we do. So I'm going to go ahead and proceed and hope everything moves smoothly, talking about what are the connections between gender and one health, particularly from an applied perspective and very much focused on working in East Africa. So we've talked a little bit about the fact that gender is very important. We've talked a little bit about what gender is. We need to start to think about what are some of the issues associated with particularly working within farming systems with men, women, boys, and girls. And for those of us who work in these types of systems, we recognize that women and children are very involved in particularly working with small livestock, poultry, and also sheep and goats, shouts, as Helen mentioned, which is a unique term really to East Africa, and working with dairy. So it's important for us to understand who is actually doing these different activities. We also talked a little bit about what gender means. It means that we are basically looking at the sociocultural aspects of what is assigned to you as a role based on the sex you were born as a child. We also need to talk a little bit about where do we typically see men and boys and women and girls in different types of livestock value chains? And usually what we're going to see, and this is a general statement, is that men are much more involved in production and management of large animals such as dairy, such as equine species, such as buffalo. And women are more responsible for the smaller types of livestock, as well as very specifically involved in certain aspects of the dairy value chain associated with only the production aspects, but also the processing of dairy products. So I'm going to talk about that a little bit more detail later on as we move through the presentation. One thing I want to mention, though, for those of you who may not be familiar with some of the issues that we think about when we start discussing foodborne diseases and food hazards and food safety aspects, if we look at the slide on the left and we start to look at what is some of the global burden of foodborne diseases. And we think about worldwide, one in 10 people will fall ill to some aspect of foodborne diseases. And this can be a variety of different things. But we also realize that we lose what are called healthy life years lost because of this aspect of falling ill to foodborne diseases. And when I talk about a healthy life year, I mean your ability to actually function productively in society. So it's very important to realize also that a third of all children, we're talking about children under five, die from some aspect of foodborne diseases, usually associated with extreme diarrhea or loss of fluids in their system dehydration. If we look at the slide on the right, we look at specifically the African region. And this is data by the World Health Organization. And we look at the fact that a third of all global death toll associated in the African region is associated with foodborne diseases. And this is a very, very high number. And specifically, we're looking at certain bacteria associated with non-typhotal salmonella, as well as E. coli, as well as cholera. And so I'll be talking a little bit about some of the bacterial diseases associated with foodborne hazards. But it's really important to recognize that this is a very significant problem in different parts of the world. And it particularly has a gendered aspect to it. So I mentioned that there are more than just biological hazards when we talk about food safety and foodborne issues. We can talk about bacteria, such as E. coli, such as salmonella, such as cholera. And we can talk about parasites, such as tanius, sodium, and some of the other parasites that those of us who are working with livestock are dealing with. But we also need to recognize that there are chemical hazards associated with food safety issues, particularly if we're looking at aspects of hygiene, if we're looking at aspects of cleaning products, et cetera, et cetera. So it's really important when we are doing visits to farms and we're looking at issues associated with foodborne and food safety issues that we consider not only the biological but also the chemical and on occasion also the physical. Do we see aspects of actual dirt or wood or slivers of glass or different things associated with actually transmitting food hazards that are not necessarily biological or chemical? As I mentioned previously, very high percentages of the populations in not only developed, but developing countries are affected by foodborne diseases, food safety hazards. And particularly when we start looking at things associated with diarrhea, because dehydration is one of the most common aspects of foodborne diseases and it kills an estimated 2.2 million people annually, most of whom are children under five. And as I mentioned, this is not only a major issue associated with dehydration and possible death, but also long-term complications that can be debilitating to the individual and affect their daily life years that they can contribute to the planet. So some of the challenges faced in the African region specifically, and these are not uncommon and not unknown to many of us that work in these areas, unsafe water and poor environmental hygiene. When we start looking at issues around potable water, and particularly do people have running water period? This becomes one of the most major issues that we are confronting when we work in villages, when we work in rural areas, and even when we work in urban areas. We also need to recognize that in many places that we work, there's very weak foodborne disease surveillance or processes in place whatsoever. So I work in a variety of different places where they don't have standards associated with foodborne disease. And this really presents a problem when we start to look at how can we actually inspect places that do not have any standards to begin with. When we look at the small and medium scale producers that we work with in various parts of the world, it's very difficult for them to be able to comply with regulations if they do exist. And if they don't have safe running water in their facilities or they don't have stainless steel or they have porous surfaces, et cetera, et cetera, we start looking at all of the different issues that are associated with trying to provide safe foods in the first place. As I mentioned previously, we often don't have standardized processes or regulations and there's very weak enforcement because there's no regular inspections. A number of the places that I work in Ethiopia are definitely part of this problem. An adequate capacity for food safety, not only in processing facilities where I've spent time, but also when we start to look at issues associated with individual small scale production, very much a problem. Very often we don't have a systematized cooperation between the stakeholders that are involved in different livestock value chains associated with not only production and transportation, but processing and regulations. And as I mentioned previously, the adjusted disability life years that will be lost because of the fact we don't have many of these factors I just described, but also because of the fact that it's just an overwhelming problem. We have a very high incidence of lost disability life years, particularly in Africa. So if we take a look at animal source foods, which I'm really gonna be focusing on in this presentation, and we start to look at what are the life years lost associated with all foods per 100,000. And then we look at specifically animal source foods and we realize that over a third of the global burden of disease is associated with animal source foods, particularly when we look at issues with non-typhotal salmonella. We look at taniasolium, which is tapeworms. We look at campylobacter, paragonumus, et cetera, et cetera. We see that we have a very high incidence, particularly of salmonella, tania, and campylobacter. And I have been working on projects in Ethiopia and now soon to start in Kenya, associated specifically with these organisms because they are such a problem. But just recognize that when we are working with different kinds of animal source foods, meat, eggs, milk, dairy products, et cetera, we have a very high percentage of global disease transmission. So going back to linking what Helen was talking about in her presentation, the issues around gender, around social systems, around farming systems with the issues of one health and foodborne disease. We have to really think about so who is most affected in the family by foodborne disease? How do we know, why do we know and what can we do about it? So if we start to think about how we're gonna be actually able to determine this, for those of you who have actually participated in or conducted a gender analysis, it is probably one of the fastest ways to really begin to determine who do we need to zero in on as an audience or a populace associated with specific foodborne disease hazards. And I should just mention, for those of you who may not recognize this photo on the right, this is a clay pot that is used in Ethiopia for milk collection and storage. And we can talk about devices that people use to collect milk and different kinds of animal source food products as we go through the presentation, but there are obviously issues associated with this. So when we think about agenda analysis, we really need to think about a number of different things. And I always say to people, just start thinking about the W's. Think about basically who does what in the value chain? When we start looking at a value chain, we start looking at issues around production. We look at issues associated with inputs into that production aspect and all the different steps that are associated with beginning to produce a product. And if we're talking about dairy, which I'm gonna focus on in this presentation, we talk about the feeding of the cow, the grazing, the watering, the cleaning, the stall cleaning, who's responsible for doing all that? And then specifically, what are they doing? Are they feeding the animal? Are they giving the animal water? Are they taking care of it from a veterinary perspective? Are they milking it? Who is doing it? And what are they actually doing? When they do it, what time of the day they do it is also important. Are they doing it in the morning? Are they doing it in the evening? Do they do it every day? Do they do it multiple times a week? When they do it really will affect the storage, particularly of the products that we're looking at. So again, we think about dairy products. We think about fluid milk. We think about yogurt, butter, cheese, et cetera, et cetera. If they are milking early in the morning and then they are putting their milk into a storage container like we see on the right with no refrigeration and no pasteurization, we have to start thinking about what are the aspects associated with that? Okay, I'll keep moving. Where are they doing it? When we think about where is the milking taking place? Where is the food processing taking place? And if we think about rural communities and we particularly think about are women doing the milking? Are they doing it out in the stable? As the cow got clean environment to be able to do what they need to do? Or are they standing in manure and there is potential for disease infection associated with milking the cow? And then we need to decide who is deciding about this activity. Is it the woman that's deciding what to do with the milk or how long to pasteurize it or to sell it? Or is it the man that is doing that? Okay, I'm gonna keep moving here. All right. Who controls the inputs? For example, when we think about production in a dairy value chain and we're thinking about the dairy cows, we're thinking about who is going to determine what is being fed, when it's being fed and if the milk is produced, the fluid milk, is it being consumed in the household or is it being sold in the market to pay for other types of household needs? So these kinds of things are the questions you're gonna ask and think about when you begin to look at ways to integrate gender into different value chains, particularly as I say, we're focusing on dairy but you can do the same thing with poultry, with beef cattle, with sheep and goats, et cetera, et cetera. Okay, so when we look at doing a gendered value chain analysis and we think about some of the production activities that are associated with basically a dairy value chain looking at ways that we are going to be producing and either selling or consuming milk. We need to think about these different activities. For example, who is responsible for calving? Who feeds the calf? Who cleans the stall? Who feeds the cow? Who grazes? Who gathers for us, et cetera, et cetera, et cetera. So we go through and we apply the questions that I just discussed to each one of those production activities and there may be more than what we're seeing on the left side. It's important when you do an analysis of a value chain that you really understand what are all the steps that are involved. So we think again about how do we apply these questions? Who, what, when, where? Who decides and who controls to each one of those production activities? We do the same thing with processing and if we're thinking about using again the cattle example who is going to be slaughtering the cow? Who is going to be processing the meat? Who might be transporting the meat to an abattoir or if we're dealing with dairy products to a dairy processing facility? Who will be responsible for pasteurizing or preserving the milk product and or making the meat or dairy products? So again, we apply these questions to all those different stages to think about who is doing what, when, where, why and who's controlling and deciding. Same thing with transportation. Many times when I am looking at a value chain analysis particularly associated with different types of livestock products and we start on the farm with production and then we move into how is that product being transported? Is it on bicycle? Is it in a refrigerated truck? Is it in, you know, on a donkey? There are a variety of different ways that food products are being transported and if they're not being transported in sterile environments and under controlled circumstances we may have real issues associated with food safety concerns. And we think again about who is doing the transporting? Who is pricing the dairy product? Who is determining where the sales are going to take place? What are they doing? When are they doing it? Where are they doing it? Who decides and who controls? And this is particularly important. Again, if we're dealing with unsterile environments where products are not being processed and or stored and or transported under ideal circumstances where we have controlled temperatures and we have sterile containers. We think about food safety and this is where I really start to zero in on some of the issues associated with gender and one health. We think about the dairy products storage and our preservation. We think about who is consuming or disposing of the meat or dairy product if they consider it to be unsalvageable or inedible. What are they doing? Again, when are they doing it? How long is that product being stored? Or how long is it being consumed? Under what circumstances is it being consumed? If we do an observation of the cooking area, what do we see in the cooking area? Do we see utensils being stored in the ground? Do we see them being cleaned with potable water or boiled water? We have to really think about what are the circumstances of the environmental conditions that we're looking at associated with the handling of that animal source food product? Is it being chopped up on a block of wood there are lots of different things you need to observe when we're thinking about food safety issues. Not only what is being taken place, but who is doing it and who is most affected by handling that product. So one of the projects that have been involved in Ethiopia particularly looks at dairy value chain gendered issues and particularly looking at food safety issues. And we have a lot of conversation around not only the milking of the product and how that product is handled but whether or not that product is being pasteurized. And when we talk about pasteurization we're talking about heating the milk to a certain temperature for a certain period of time to destroy microorganisms. And one of the things that I discovered is that obviously women are much more involved in dairy processing aspects than men. They're also very much more involved particularly in Ethiopia in caring for the cow and milking the cow. But when it came to talking about how do you preserve the product if you're gonna be consuming fluid milk people will say they do or don't boil the milk and many instances they don't. And if they do boil the milk, what's the temperature? There's no thermometer so no one really knows the temperature and they don't really know how long they boil it for. So this is a really important aspect to think about. And then if you go a little deeper and ask why do you boil your milk in the first place? Some people actually recognize that it's unhealthy to consume milk that has not been boiled or pasteurized. But many people have no idea why they're boiling milk. They think it's because it's tradition. They think maybe there's a reason that we need to do this but they don't really understand. And so if you think about refrigeration we think about how many people actually in the rural areas have electricity how many people have functioning refrigerators. And in most cases they're preserving their milk using traditional means either storing in containers that I showed previously or in other types of potentially in sterile containers. And if they're preserving their products how are they preserving it? Under what conditions and what are they actually doing? And when do they do it? If they're milking in the morning are they storing the milk throughout the day to be consumed in the evening? Are they selling that milk immediately? Which I have seen in many instances where people just drag their milk containers out to the road and then it's picked up by a cooperative but if it's sitting there for hours in the hot sun obviously with no refrigeration we have to be concerned again about food safety hazards. And the other interesting question that I asked sometimes with people when we were talking about handling of animal source food products is what kinds of issues do you need to think about in your family about who consumes this product? And if we're particularly looking at issues around malnutrition with young children or with pregnant or lactating women the answers that come back are fascinating. In most instances milk will be if it is consumed in the household given to young children first or elderly or sick people. It's not often that pregnant lactating women will drink milk it's more often they will sell it particularly associated with purchasing other things like school fees. So it's really interesting to ask these questions if you don't consume the milk what happens to it? Who gets to consume it? Why don't you consume milk? And sometimes we get these incredible stories about why people particularly women are not allowed to consume animal source food products. That is a whole another discussion at a whole another seminar. So this is a graphic basically to kind of illustrate the dairy food chain particularly looking at production, processing, transportation and consumption. And if we look at who is most at risk at these different stages in the dairy value chain we look particularly at production and we see women. We look particularly at processing issues and we see women. When we talk about transportation and or marketing usually the men are doing the transporting if it's a larger commercial operation the men will be doing the marketing if it's a smaller operation the women will be doing the marketing usually associated with either small amounts of fluid milk or with dairy products such as cheese and or butter. And consumption obviously the entire family consumes but if the woman and the girls are responsible for doing the handling they may be the most exposed to contamination from the different sources that we have mentioned. Okay, so why do we care? Why do we care about integrating gender issues associated with food safety hazards and particularly associated with livestock value chains? Well, this illustration that I'm using on the left on the right is actually a picture that I took when I was working in Ethiopia pre pandemic when we could actually get out in the field. And this is a woman who has milked her cows and she is getting ready to strain the milk through an old scarf and that was how she basically purified the milk before she sold it. So obviously you can see there are numerous things that we need to be concerned about when we look at this picture but it's just something that you should be aware of when you start to ask questions from a gender perspective and you're particularly talking to the people that are responsible for producing the product is how do we actually handle it afterwards? So women, as I mentioned play a very critical role in production, processing and ensuring the safety of milk and milk products but they are also more highly exposed to food board pathogens. So this is something we need to be very concerned about. They pasteurize or dump the milk before feeding it to their families which increases the likelihood of childhood diarrhea. So this is something we really need to be aware of particularly as I mentioned in the products that have been involved in Ethiopia in many instances I think it was about 60% of the time the milk was not pasteurized or heated at all and family members were consuming it raw. So obviously there's very limited refrigeration for raw milk and dairy products and when night milking occurs frequently is stored in unsanitary containers and unrefrigerated until the next morning whether it's either consumed or it's sold on the market. So these are issues we need to consider particularly not from a gender perspective but also from a food safety perspective. Poorly preserved milk as we all know has a high risk of disease transmission including many of the microorganisms that I discussed previously. As I mentioned I've been doing a lot of work in Ethiopia and one of the questions that we asked about preservation of dairy products and about sanitizing the containers that milk is captured in is an interesting traditional practice called Chorasma which basically involves fumigating the inside of the container that the milk is captured in and stored in and this is done with a heated stick so smoke basically is involved in helping to quote-quote sterilize inside the container. Now this picture on the right is a woman that is demonstrating for us how they actually do this fumigation but the container that she's using is a recycled paint pot and so we were very concerned when she told us that that was I concerned about the sterilization technique but also the fact that she was using a recycled paint container to collect her milk in. So when we ask the question about how do you determine whether or not you dispose of a dairy product most people say well we look at it and if it doesn't look good or it doesn't smell good we throw it out but many people indicated that they were happy with keeping their dairy products without refrigeration for multiple days before consuming which obviously again also has the potential to create foodborne disease hazards. So why do we care? As I mentioned we talked a little bit about preferences or abilities to pasteurize dairy products. We note that about 41% of the people that were interviewed restricted themselves to drinking boiling milk, boiled milk which means the other 60% do not which again contributes to the possibility of foodborne disease pathogens. Many of you who have worked in or live in Ethiopia recognize that raw meat is eaten regularly by a variety of different people not only at social events but also at restaurants, et cetera and this is a photograph obviously on the right of a restaurant that we went to associated with raw meat consumption but it also contributes to much higher incidences of salmonella, E. coli and campylobacter. When we look at it from a gender perspective men are responsible generally for performing slaughter associated with cattle and women are responsible for processing the raw meat and frequently this is occurring not only in unsanitary conditions but with minimal or no running water and particularly we are concerned about the potability of the water whether or not it's actually safe in the first place. So these are other issues that we need to consider when we look at the intersections between gender and consumption of animal source food products. What can we do about this? Well, we've talked about this, Helen talked about this and we need to think about what can we do? Well, the first thing that I really say aside from doing a gender analysis we need to decide who is gonna be most affected in the selected value chain we're working in is it gonna be men, women, boys or girls? And we need to target them for our interventions not only for potential capacity to building but also about really helping them to understand why and how foodborne disease hazards take place and what they can do to actually minimize these things. We also need to determine who's making the decisions related to food safety practices. And again, I mentioned that particularly women are very much involved in this because they're involved in not only production but also processing and storage and then household consumption of the product. So frequently women are gonna be our primary target associated with any kind of capacity development with associated with foodborne disease hazards. And we really need to think about if we're really working with women and we're working with rural women in situations where there's minimal infrastructure and minimal refrigeration, et cetera, et cetera. We need to think about not only what their literacy and numeracy skills are but how can we make all of the trainings that we do very practical, very hands-on, minimal handouts and texts and really help them to understand from a practical perspective why foodborne disease issues are a problem and what they can do about them in their own environment. And we also need to work with local veterinarians, extension providers to understand the gender aspects of the work that they do and particularly as it relates to food production and processing. So those of us who are involved in this field or have the interest in this field really need to be able to provide guidance, technical support as well as other types of materials that can be made available to people that are working in this area. So that is all I have to say for now and I think if anybody's interested feel free to please contact me.