SESSION 1D: Finance-Food Safety
Room: Thoroughbred 4
Tuesday, April 8, 2014, 2-3:15 pm
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AUDIO
KC14 Session 1D on Finance: Food Safety by NCC for PHSSR
MODERATOR
C.B. Mamaril, Ph.D.
PRESENTERS
Betty Bekemeier, Ph.D., M.P.H., B.S., RN
Local Public Health Food Safety expenditures and their impact health outcomes: Findings from PHAST
Co-Investigators: Michelle Yip, M.S.N., B.S., RN, Matthew D. Dunbar, Ph.D., Tao Kwan-Gett, M.D., M.P.H
Background: In connection with the Public Health Activities and Service Tracking (PHAST) study and in collaboration with Public Health Practice-Based Research Networks (PBRN), we examined annual Environmental Health (EH) Food Safety expenditures for 93 local health departments (LHDs) from 2000-2010.
Research Objective: Our objective was to investigate relationships between local-level Food Safety expenditures and related health outcomes.
Data Sets and Sources: Unpublished annual EH expenditures, obtained from state health departments in Washington (WA) and New York (NY), representing local-level Food Safety service provision were linked with control variables, including county-level socio-demographics, rural/urban setting, and per capita food establishments. Outcomes included annual infection rates for the seven most common notifiable enteric diseases.
Study Design: We used a multivariate panel time-series design to examine ecologic relationships between 2000-2010 local Food Safety expenditures on enteric diseases.
Analysis: Descriptive statistics were examined and analytic generalized estimating equation (GEE) models run for each enteric disease.
Principal Findings: With other factors controlled for, enteric disease rates were consistently in expected, beneficial directions across the sample of LHDs in both states. Preliminary findings from our models suggest that a significant beneficial inverse relationship between Food Safety expenditures and rates of two enteric disease (Salmonella and Cryptosporidiosis), indicating that higher LHD Food Safety spending was associated with lower incidence of Salmonellosis (WA) and of Cryptosporidiosis (NY).
Conclusions: Beneficial relationships appear to exist between local public health expenditures specific to Food Safety and certain related enteric disease outcomes.
Implications for Public Health Practice and Policy: Findings have policy implications suggesting that local public health expenditures on Food Safety services are important for their impact on certain health indicators. Our study also supports the need for detailed, program-specific public health service-related data to measure the cost, performance, and outcomes of public health prevention efforts to inform practice and policy-making.
Fanta Purayidathil, Ph.D., M.P.H., B.S.
Comparison of Mandatory Notifiable Disease Lists for Food Safety Reporting Across the Fifty States
Co-Investigators: None Listed
Background: Pathogens responsible for foodborne illness vary in their inclusion in state health department notifiable disease lists. There is currently no law requiring states to report cases to the Centers for Disease Control and Prevention, or that notifiable disease lists at a minimum include the same pathogens as the national list, resulting in a potentially overly-conservative estimate of morbidity and mortality.
Research Objective: To characterize state health department foodborne disease outbreak reporting systems; specifically, investigate how state health departments deliver essential public health services in the form of reporting foodborne illness to the Centers for Disease Control and Prevention.
Data Sets and Sources: The Council of State and Territorial Epidemiologists database of reportable conditions, the Centers for Disease Control and Prevention Nationally Notifiable Disease List. Study Design- Copies of the most recent version of 50 state’s lists were downloaded and compared to the 2011 Center for Disease Control and Prevention’s List of Notifiable Conditions for collection of data on pathogens responsible for foodborne illness.
Analysis: Analysis focused on identifying gaps in surveillance of pathogens related to foodborne illness across states; pathogens that were consistently missing from state-level lists were tagged to investigate regional trends among lists. Descriptive analyses were conducted on state and pathogen data; chi square tests measured relationship between state and the presence of a pathogen on a notifiable disease list.
Principal Findings: All 50 states maintain a notifiable disease list. 53% (n=27) of states have updated the list within the past 3 years. 51% (n=26) of states collect data on incidence of a food outbreak in general. Analyses are ongoing and will be completed by the conference date.
Conclusions: While there are some pathogens that are consistently present on lists across states, others appear more sporadically. This appears to be linked to geography. Final comments will be available upon completion of analysis.
Implications for Public Health Practice and Policy: Understanding the consistency between state and federal systems will help to understand the impact of structural capacity (SC) on food safety surveillance at the state level, and provide insight the data quality improvement.
Scott Frank, M.D., M.S.
The Influence of Public Health Spending and Staffing on Variation in Process and Outcome of Local Health Department Food Safety Inspections
Co-Investigator: Michelle Menegay, M.P.H, B.A.
Background: Investigation of Local Health Department (LHD) food safety inspections has identified important variations in outcome based on differences in LHD and Sanitarian characteristics; and the food safety inspection process. Financing research has typically focused on structure and outcomes with little emphasis on process.
Research Objective: Describe how LHD spending and staffing influence variation in process and outcome of LHD food safety inspections.
Data Sets: Original data gathered through direct observation of food service establishment (FSE) inspections in 20 LHDs by 77 Registered Sanitarians (RS) conducting 551 inspections. Ohio Annual Financial Report provides public health spending and staffing data.
Methods: This comparative case study utilizes mixed methods, including direct observation, survey, interview, and publicly available data. RS are shadowed during food service establishment inspections, with a structured and validated direct observation protocol completed by trained student observers.
Analysis: Includes multivariable data integration between original data and LHD Annual Financial reports with variables focusing on public health spending and staffing.
Results: Citations were issued in 67% of inspections (2.19/FSE inspection); and verbal corrections given in 80% of inspections (1.93/inspection). Sanitarians frequently discussed improvement plans (87%) and offered food safety education (69%). Variations related to public health spending and staffing were common and often counter-intuitive. Low budget LHDs produced more citations; greater thoroughness; greater job strain; more negative attitudes toward FSE; yet showed higher professionalism and fewer encounters with negative interactions. High budget LHDs offered more verbal corrections; more food safety education; and more effective checkouts. Lower staffing levels were related to more citations; greater thoroughness; less effective checkouts; more job strain; more negative attitudes toward FSEs; yet more positive attitudes about their jobs; and greater expression of gratitude from FSEs.
Conclusion: Meaningful, paradoxical differences are noted based on public health spending and staffing. Low budget/staff demonstrate better performance on some food safety inspection characteristics; while high budget/staff perform better on others.
Implications for Public Health Practice and Policy: Food safety inspection process and outcomes demonstrate important variation based on public health spending and staffing. Opportunities for cross jurisdictional communication and training may enhance performance in all LHDs.