So if we wanted to reduce the danger of pathogens passing to people via food — not just drug-resistant bacteria, which are an increasingly significant problem, but all disease-causing ones — where to start?
Formulating a strategy is more difficult than it seems. In the US, policing food safety is divided among several federal agencies: the FDA, USDA and CDC. The FDA has responsibility for most of the food supply, including seafood, produce, processed food and fresh eggs. The USDA’s Food Safety and Inspection Service (FSIS) regulates fresh meat and poultry and egg products. The CDC surveys the illnesses that result from any of them, estimating most recently that one in six US residents, or about 48 million people, get sick each year, 128,000 are hospitalized and 3,000 die.
But most of those illnesses are never investigated, because a substantial portion of them occur individually or in small clusters, not in major outbreaks. Many of them have long-term consequences that are never recorded by any federal counting mechanism. And there’s currently no surveillance system that links pathogens and food — which means there’s no way to target which foods, or food-raising practices, pose the greatest risks.
The new food-safety bill, signed in January, addresses at least some of those barriers, by requiring a risk-based approach to foodborne illness — meaning, you look at what is causing the greatest problem, and aim your efforts and funding in that direction. But the bill — which certain Congressmen have threatened to starve of funding — covers primarily the FDA. And a new analysis suggests that’s not where the greatest problems lie.
A study put out today by the University of Florida’s Emerging Pathogens Institute, and funded by the Robert Wood Johnson Foundation, makes an attempt to do what the federal agencies have not yet done: match the greatest foodborne-disease burdens with the foods that carry the most dangerous bugs. It shows that the biggest offenders, in costs and in burdens to public health, are meats and poultry — which are regulated by USDA’s FSIS, not by the FDA.
To come up with their estimates, the institute cross-matched data to figure out how much foodborne illnesses cost quantitatively, in strict dollar terms, and how much they cost qualitatively, using a measure called “quality of life years” to indicate the long-term impact. They paired those estimates with data about the involved foods, using both federal outbreak statistics and academic research addressing illnesses outside outbreaks.
Putting all that together, they came up with this top 10 (tables snipped from the report, p.42):
Portraying the offenders this way gives you a better sense of the top 10’s relative importance:
- The top 10 cost the US about $8 billion each year in direct health care costs, and tens of thousands of foregone years of healthy living.
- Foods not regulated by the FDA cost $5.7 billion and 30,000 healthy years of life every year.
- Contaminated poultry alone costs an estimated $2.5 billion and 15,000 healthy years.
To be fair, the USDA has proposed new regulations recently that would attempt to cut back on foodborne pathogens in meat and poultry, by doing a better job of holding back contaminated foods at processing plants. But the authors are dubious that will make much difference. Among other recommendations, they call specifically for tougher USDA safety standards for chicken and turkey, and for a joint FDA-USDA effort on Salmonella, which appears in multiple foods from poultry to produce.
In a Q&A on RWJF’s website, lead author Michael Batz of the Emerging Pathogens Institute said:
…We hear about outbreaks all of the time associated with various products and it lends a perception that there’s just contamination lurking in every corner. And what we find is that despite these problems that happen, that a relatively small number of these hazards account for a significantly large portion of the overall burden. If we want to do anything about reducing those illnesses, we have to address those pathogens in specific foods.
Cite: Batz MB, Hoffman S, Morris Jr., JG. Ranking the Risks: The 10 Pathogen-Food Combinations with the Greatest Burden on Public Health. University of Florida Emerging Pathogens Institute, published April 28, 2011.
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Image: salmonella, Public Health Image Library/CDC