Reflecting on CSTE’s 2010 Food Safety Epidemiology Capacity Report

Today the CDC MMWR published Food Safety Epidemiology Capacity in State Health Departments — United States, 2010. The report details the results of a survey sent to state and local health departments meant “to count and characterize the food safety workforce in local, regional, and state health departments and to measure and evaluate core capacity to detect, investigate, and respond to foodborne diseases and outbreaks.”

This research fascinates me and I tip my hat to the authors for a job well done. While I’ve not seen the questionnaire used in this survey, and I believe that some of the statistics are very difficult to interpret without more information, a few things do concern me, and should concern anyone interested in public health accountability and effectiveness.

  • 27 states do not prioritize foodborne disease outbreak investigations. How many of those 27 states have foodborne disease surveillance programs? What is contained in the mission statements of those programs? (It is the promise they make to the tax-paying public) How many of these states want more epidemiologists to reach full capacity?
  • 20 states do not have laws that allow them to pay epidemiologists overtime during investigations. Are these public health authorities relentlessly lobbying to have those laws changed? Do states restrict police and firefighters to responding to disasters between 8-5 Monday-Friday? No, because if they did, police and firefighters could not meet the needs of the tax-paying public. Foodborne outbreaks are similar to disasters with tremendous costs to the public’s health and the industry, however they are not typically thought of as disasters because they are geographically and temporally dispersed, and the responders are not from the emergency management discipline. How many of these 20 states reported they needed more epidemiologists to reach full capacity? Do we need more people to work 8-5 or do we need to be able to pay experts to work overtime when appropriate?
  • Only 27% of departments plan to implement the CIFOR guidelines to improve foodborne outbreak responses. How many departments that do not plan to vigorously review and implement the CIFOR guidelines, as well as other continuous quality improvement activities, report that they need more epidemiologists in order to reach full capacity? Do we need more people to do an inefficient process, or do we need to define an efficient process and plan for surge capacity?
  • Finally, how does reported capacity to investigate correlate with actual program timeliness and effectiveness outcomes and program quality as perceived by the tax-paying public?

I personally believe that foodborne disease surveillance programs exist, at the very least, to provide accurate and timely risk information to consumers in real time, not just to crank out annual summaries of data. If our nation’s foodborne surveillance authorities are divided about the importance of participating in outbreak investigations and informing the public, then public health is absolutely failing in it’s promise to the American people. In order to solve multi-state outbreaks in a timely and accurate manner, we absolutely need a shared understanding of the urgency of these outbreaks. We also need a shared understanding of how to investigate. The public relies on the efficient cooperation of state and local health departments and the CDC for actionable risk information. When our system’s vision is fragmented, our performance in terms of timeliness and accuracy will likely suffer! (See my latest post about Adm Thad Allen, USCG (Ret.))

I ask fellow public health professionals: Are we a service organization or a summary organization? Do we answer to the needs of the tax payers and other partners, or are we above public accountability because we believe deep in our hearts we are doing the right thing? Do we share information and provide services that meet the needs of the people that keep us in business?

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