This page provides
a text alternative for an article in the Winter/Spring
2007 issue (PDF Only, 5.4MB).
FIGHTING FOODBORNE ILLNESS
USDA Enlists Public Health, Medical Communities
By Matthew D. Baun
When you think of the work of the U.S. Department of Agriculture,
images of farmers and ranchers quickly come to mind. But there is
an ambitious effort at USDA's Food Safety and Inspection Service
to expand that circle to include the medical and public health professions.
Targeting the public health community is a growing necessity because
of changes in the nation's demographics.
For instance, there is a growing population
of people with weakened immune systems. This group is at greater
risk for contracting a foodborne illness that may result in dangerous
infections, hospitalization, or even death. Since all people are
dependent on food to survive, everyone, in theory, is at-risk for
foodborne illness. But in reality, certain people are more vulnerable
than others and thus are known as "at-risk." The distinction
is important. A healthy individual may suffer only minor effects
from eating undercooked food, resulting in an upset stomach. Others,
however, can suffer far worse conditions, such as acute kidney failure.
But as they look to enlist the help of professionals who have a
direct relationship with those who are "at-risk," many
USDA officials see signals that the medical community is ready and
willing. Some physicians are talking to their patients about food
safety just as they would about stroke or heart-attack prevention.
And for USDA this spells good preventive medicine and protects the
"As a general rule, we don't give patients food
safety information in our program," said Dr. Sam James, Director
of Kidney/Pancreas Transplant Program, University Medical Center,
Tucson, Ariz. "Now that I've become a little bit more aware
of the food safety issues, I think that we should include food safety
information in our patient packet."
Those who fall in the "at-risk"
category are people who we know and see every day — an older parent,
a young child, a pregnant woman, people with diabetes, or even those
with high blood pressure. Patients with weakened immune systems
like transplant recipients, and those with HIV/AIDS, cancer, and
diabetes are also at higher risk than healthy individuals for severe
illness or death due to foodborne illness.
USDA is also reaching out to those who may not have a medical condition but are nonetheless
considered "at-risk" — older adults and young children.
Surveys conducted by USDA show that individuals in these demographics,
or their caregivers, are often more receptive than other people
to actually adopting safe food handling behaviors.
Jennifer Doe, a Chevy Chase, Md., pediatrician who is part of a practice that
treats about 500 people each week, makes it a point to address foodborne
illness with the parents of her young patients.
"We see a wide spectrum of illnesses that can develop as a result of foodborne
pathogens, from mild to serious," said Doe. "Foodborne
illness is super important to [parents of] infants and young children
because the young ones do not have completely developed immune systems,
so they're not able to fight off things that you and I can."
A Public Health Mission
Targeting "at-risk" populations
is just the latest evolution of health maintenance at USDA. Agriculture
officials have talked about food safety in terms of public health
for years. Food safety educators throughout the United States, and
allies from state and local government as well as industry and consumer
groups, have added their voice to the cause of raising food safety
But what USDA and FSIS officials want is this call to
action to grow louder so more people can hear and then heed the
food safety messages being espoused. Over the next few years, FSIS
hopes to strengthen its network of food safety partners by forming
relationships with county and city public health officials,
physicians, nurses, hospice workers, and other caregivers. These
stakeholders are viewed as untapped resources that are potentially
able to deliver key food safety messages to people who need them
The idea is a simple one that carries a lot of potential.
If a doctor, for example, will take the time to explain the impact
foodborne pathogens have on people with weakened immune systems,
then these patients will be empowered to prevent it from occurring.
As a measure of how important USDA officials are taking this effort
to reach out to the medical and public health communities, FSIS
last fall sponsored a two-and-a-half day conference (see related
article) that brought together the medical and public
health communities with food safety educators from all areas of
The idea behind the conference was to have attendees
discuss various strategies for communicating the food safety needs
of "at-risk" individuals. Agriculture Secretary Mike Johanns,
a keynote speaker, endorsed the mission of the conference and saluted
the more than 600 attendees for their work to improve public health
through food safety.
Johanns said that while certain groups of people
are "at-risk," the degree of risk can change through concentrated
education efforts. "Who better to deliver the message than
some of the most trusted people in the world, our doctors, our nurses,
and our public health professionals? You have tremendous credibility
and influence; you can make a difference."
"At-Risk" — A Familiar Face
Those who are considered "at-risk" may
never actually encounter foodborne illness. But because there is
some degree of risk every time food is eaten, 'at-risk' individuals
always have to take extra precautions. The simple act of eating
lunch or dinner at a restaurant is a challenge in and of itself.
"I have no immune system, so something that wouldn't bother
someone else could make me very sick," said Jane Sanchez, a
lung transplant patient in Milton, Fla.
As a consequence, Sanchez
is extremely careful in the way she goes out to eat. In order to
handle salt and pepper shakers, napkins and other rudiments of the
dinner table she wears plastic gloves. She'll even wear gloves when
she prepares meals in her own home, in addition to frequently washing
USDA officials believe that engaging the public health
and medical communities on food safety issues will reduce the rates
of human foodborne illness cases. They hope patients like Sanchez
will get the food safety messages they need to help them enjoy a
better quality of life and protect them from foodborne illness.
Uniting the Stakeholders
To help make inroads into the world of
physicians and public health officials, USDA officials don't have
to look very far for help. Richard Raymond, M.D., Under Secretary
for Food Safety at USDA, is the nation's highest ranking food safety
official. Raymond's perspective is unique. As a practicing family
physician he treated patients and is fully aware of the vulnerabilities
and physical toll foodborne illness has on people. Raymond has also
been at the forefront of many public health issues, having served
as Nebraska's chief medical officer as well as serving as President
of the Association of State and Territorial Health Officials.
In his role at USDA, Raymond has a clear vision for reaching what
some might consider non-traditional stakeholders for USDA.
"It's just high time we began to remind people the 'and' in Food
Safety and Inspection Service means we have a bigger role than just
inspection," said Raymond. "We do want to become known as the
public health branch of the USDA."
In addition to sponsoring last fall's food safety conference, which
drew attendees from nearly every U.S. state and eight countries, FSIS
unveiled a new series of brochures that can be used by medical and
public health professions as well as other caregivers. These brochures
offer food safety recommendations to people with specific medical
conditions like HIV/AIDS, cancer, diabetes and transplant recipients
as well as older adults. (see "Equipping the At-Risk")
Inspection and Education
All this talk about education isn't to say that Raymond is placing
less of a priority on inspection - quite the contrary. Raymond believes
the food safety education programs and the meat, poultry and egg
product inspection programs at USDA work in lock-step. Both are
integral to meet the goal of seeing a sustained decrease in the number
of human foodborne illness cases.
Raymond explains that just as FSIS targets its food safety education
efforts toward those who are considered "at-risk," the agency also
focuses its inspection resources on the products and facilities that pose
the greatest risk to public health. This is called "risk-based inspection."
"What we're after is a commonsense, cost-effective public health
strategy that best serves the American consumer and the meat and
poultry industry by preventing human illness and, in turn, protecting
those most at-risk from foodborne illnesses."
To make it work, Raymond is a firm believer in the farm-to-fork
approach. The traditional group of players in the farm-to-fork
continuum included the usual USDA players: ranchers, food processors,
food distributors, grocers, food service professionals and consumers.
But Raymond wants to invite more to the table — physicians, nurses,
hospice workers, state and county health officials and, really, any other caregiver.
So how will these "new" stakeholders benefit from USDA's work on behalf of food safety?
Reflecting back to his days as a practicing physician, Raymond is
quick to assert that foodborne illness is among the most under-reported
diseases in the nation. The first step, he says, is for doctors and public
health professionals to develop a more accurate system for reporting of
foodborne illness. He notes that milder cases of food-related illness are
often not detected through routine surveillance.
"This has serious negative consequences on our ability to understand
the food safety environment we are operating in and our ability
to obtain the support for the funding needed to combat foodborne
illnesses. This information is absolutely necessary in order to create
and guide prevention efforts and assess the effectiveness of our food
safety regulations." (Cmdr. Janice Adams-King contributed to this article.)
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