Safer and Healthier Foods

1. Milestones in Public Health: Chapter 7 Safer and Healthier Foods Lectures for Graduate Public Health Education January 2011

2. Learning Objectives Discuss the role of advocacy in raising awareness of food safety Describe the role of food fortification in public health Explain the U.S. public health food safety infrastructure Describe current U.S. food safety issues Discuss foodborne gastrointestinal infections Describe the causes, symptoms, and impact of E. coli on public health Identify the USDA food pyramid

3. Lecture Outline Looking Back The U.S. Food Safety System Current U.S. Food Safety Issues Nutrition Labeling and Food Packaging Looking Ahead

4. Safer and Healthier Foods Looking Back

5. Looking Back Pfizer Inc. (2006). Chapter 7: Safer and healthier foods. In Milestones in public health: Accomplishments in public health over the last 100 years. (p. 124). New York, NY: Pfizer Inc. Up until the dawn of modern medicine, people did not differentiate between food and medicine. Around 460 BC, Hippocrates recognized the essential relationship between food and health, and urged others to closely study the daily dietary regimens he associated with good health. Galen (AD 131-201), a Greek physician, warned about the common adulteration of food, and advocated moderation as the principal rule for a sound diet.

6. Looking Back (Cont.) During the Middle Ages in Europe, trade guilds regulated food products and oversaw: bakers, butchers, cooks, grocers, fruiters, poulters and salters Guilds had the power to search the premises and seize unwholesome products, regulating the marketing of food to the public

7. Looking Back (Cont.) In 1820, Frederick Accum published the treatise on “Adulteration of Food and Culinary Poison,” a milestone publication in exposing the nature, dangers and extent of food adulteration Accum may represent the first food-safety person to promote public education efforts through means of mass communication available at his time

8. Looking Back (Cont.) In 1879, Peter Collier, chief chemist at the Department of Agriculture, proposed the Pure Food and Drugs Act The legislature did not approve the act until 1906, following concerted advocacy by organized medicine, women’s groups, the press and state public health officials Upton Sinclair’s novel The Jungle, which exposed unsanitary conditions in the meatpacking industry, aided advocates in their efforts

9. Looking Back (Cont.)

10. Looking Back (Cont.) Food fortification – Iodized salt • Iodine deficiency can cause goiter, a swelling of the thyroid gland • In 1924, food fortification began in the United States with the introduction of iodized salt in Michigan • Following the nationwide introduction of iodized salt , iodine deficiency disappeared as a serious health threat by the 1930’s

11. Looking Back (Cont.) Food fortification – Vitamin B3 (Niacin) • Niacin deficiency can result in Pellagra, which presents with dermatitis, diarrhea, inflamed mucous membranes, and in severe cases, dementia • Niacin is found in a variety of foods such as chicken, beef, liver, fish, cereal, peanuts and legumes

12. Looking Back (Cont.) • Pellagra flares up when the skin is exposed to strong sunlight • In southern states in the late 1920’s pellagra represented a leading cause of death • In the 1930’s bakers began introducing Niacin into bread

13. Safer and Healthier Foods The U.S. Food Safety System

14. The U.S. Food Safety System In the current federal food-safety system, 12 different agencies enforce 35 different statues, which can lead to conflicts over turf that can potentially interfere with enforcement and prevention efforts

15. The U.S. Food Safety System (Cont.) • Food and Drug Administration (FDA), U.S. Department of Health and Human Services • U.S. Department of Agriculture (USDA) • Food Safety Inspection Service • Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services • Office of Homeland Security • U.S. Department of Transportation (DOT) • Federal Trade Commission (FTC) • State and local health departments

16. The U.S. Food Safety System:Federal Level U.S. Food and Drug Administration. (2009). Food Protection Plan. Retrieved June 7, 2010 from http://www.fda.gov/Food/FoodSafety/FoodSafetyPrograms/FoodProtectionPlan2007/default.htm The Food and Drug Administration (FDA) “FDA regulates $417 billion worth of domestic food and $49 billion worth of imported food each year—everything we eat except for meat, poultry, and some egg products, which are regulated by the U.S. Department of Agriculture.”

17. The U.S. Food Safety System: Federal Level (Cont.) U.S. Food and Drug Administration. (2009). Hazard Analysis Critical Control Points. Retrieved June 7, 2010 from http://www.fda.gov/Food/FoodSafety/HazardAnalysisCriticalControlPointsHACCP/default.htm The Food and Drug Administration (FDA) Hazard Analysis and Critical Control Points (HACCP) “A management system in which food safety is addressed through the analysis and control of biological, chemical, and physical hazards from raw material production, procurement and handling, to manufacturing, distribution and consumption of the finished product”

18. The U.S. Food Safety System: Federal Level (Cont.) U.S. Department of Agriculture. (2010). Food Safety and Inspection Service. Retrieved June 7, 2010 from http://www.fsis.usda.gov/About_FSIS/index.asp The U.S. Department of Agriculture (USDA) “The Food Safety and Inspection Service (FSIS) is the public health agency in the USDA responsible for ensuring that the nation's commercial supply of meat, poultry, and egg products is safe, wholesome, and correctly labeled and packaged”

19. The U.S. Food Safety System: Federal Level (Cont.) Pfizer Inc. (2006). Chapter 7: Safer and healthier foods. In Milestones in public health: Accomplishments in public health over the last 100 years. (p. 144). New York, NY: Pfizer Inc. USDA, The Food Safety and Inspection Service (FSIS) • Presently the FSIS lacks a comprehensive national regulatory program that governs the handling of poultry, egg, and meat products once they leave the leave a regulated plant • ”As of now, a mishmash of state and local regulations govern the transportation of these perishable foods from the time they leave the plant to the time they reach the consumer”

20. The U.S. Food Safety System: Federal Level (Cont.) The U.S. Department of Agriculture (USDA) Under the 2002 Bioterrorism Act, the USDA collaborates with the Department of Homeland Security in protecting the public from suspect foods and in securing the U.S. food infrastructure.

21. The U.S. Food Safety System: Federal Level (Cont.) The Centers for Disease Control and Prevention (CDC) Surveillance Systems: • FoodNet • PulseNet • Environmental Health Specialists (EHS-Net)

22. The U.S. Food Safety System: Federal Level (Cont.) Centers for Disease Control and Prevention. (n.d.). Foodnet Brochure. Retrieved June 8, 2010 from http://www.cdc.gov/foodnet/foodnet_brochure.pdf FoodNet, CDC – “an active surveillance system providing comprehensive and timely data on 9 foodborne diseases. Routinely contacts all clinical laboratories in the 10 Foodnet sites to collect information on every laboratory-confirmed case under surveillance” Monitors trends and illness to specific locations and foods, permitting Foodnet and its partners to implement and assess interventions at many points in the “farm to table” continuum

23. The U.S. Food Safety System: Federal Level (Cont.) Centers for Disease Control and Prevention. (2009). CDC Pulsenet.Retrieved June 8, 2010 from http://www.cdc.gov/pulsenet/ Pulsenet, CDC – “a national network of public health and food regulatory agency laboratories coordinated by the Centers for Disease Control and Prevention (CDC) consisting of: state health departments, local health departments, and federal agencies (USDA/FSIS, FDA)” “PulseNet participants perform standardized molecular subtyping (or “fingerprinting”) of foodborne disease-causing bacteria by pulsed-field gel electrophoresis (PFGE). PFGE can be used to distinguish strains of organisms such as Escherichia coli O157:H7, Salmonella, Shigella, Listeria, or Campylobacter at the DNA level”

24. The U.S. Food Safety System: Federal Level (Cont.) Centers for Disease Control and Prevention. (2009). CDC EHS-Net.Retrieved June 8, 2010 from http://www.cdc.gov/nceh/ehs/EHSNet/ Environmental Health Specialists Network (EHS-Net), CDC “A collaborative forum of environmental health specialists whose mission is to improve environmental health. These specialists collaborate with epidemiologists and laboratorians to identify and prevent environmental factors contributing to foodborne and waterborne illness and disease outbreaks”

25. The U.S. Food Safety System: Federal Level (Cont.) Environmental Health Specialists Network (EHS-Net), CDC Centers for Disease Control and Prevention. (2009). CDC EHS-Net.Retrieved June 8, 2010 from http://www.cdc.gov/nceh/ehs/EHSNet/

26. The U.S. Food Safety System: Federal Level (Cont.) The U.S. Department of Transportation (DOT) Regulates conditions for the transport of eligible products In 1994, Congress approved a transportation bill that contained provisions addressing the sanitary transportation of food (e.g. the proper temperature of refrigerated trucks transporting food)

27. The U.S. Food Safety System: State Level Mandatory certification for managers of food service operations is present in some states, not all • According to CDC and FDA, establishments without a certified manager are more likely to be associated with food-borne outbreaks

28. Safer and Healthier Foods Current U.S. Food Safety Issues

29. Current U.S. Food Safety Issues • Importing of foods from countries with less stringent food safety standards • Overabundance of sugar, salt, and hydrogenated oils; over-indulgence in processed foods; and control of portion size • Combined with a sedentary lifestyle, leads to increased incidence of chronic disease that disproportionately affects vulnerable populations

30. Current U.S. Food Safety Issues:Food-borne Illnesses National Digestive Diseases Clearing House. (n.d.). Bacteria and Foodborne Illness. Retrieved August 29, 2010 from http://digestive.niddk.nih.gov/ddiseases/pubs/bacteria/ Food-borne Illnesses Symptoms: Ranging from mild to serious, in many cases resemble intestinal flu and may last a few hours or even several days • abdominal cramps • fever • dehydration • nausea • vomiting • diarrhea, which is sometimes bloody

31. Current U.S. Food Safety Issues:Food-borne Illnesses (Cont.) National Digestive Diseases Clearing House. (n.d.). Bacteria and Foodborne Illness. Retrieved August 29, 2010 from http://digestive.niddk.nih.gov/ddiseases/pubs/bacteria/ Food-borne Illnesses Vulnerable Populations, including young children, pregnant women and their fetuses, and older adults, are at greatest risk due to age and/or state of immune system.

32. Current U.S. Food Safety Issues:Food-borne Illnesses (Cont.) National Digestive Diseases Clearing House. (n.d.). Bacteria and Foodborne Illness. Retrieved August 29, 2010 from http://digestive.niddk.nih.gov/ddiseases/pubs/bacteria/ Food-borne Illnesses Public Health Impact: • Each year approximately 76 million cases of food-borne diseases occur in the U.S. • Each year, food-borne illnesses causes more than 300,000 hospitalizations and an estimated 5,000 deaths

33. Current U.S. Food Safety Issues:Food-borne Illnesses (Cont.) National Digestive Diseases Clearing House. (n.d.). Bacteria and Foodborne Illness. Retrieved August 29, 2010 from http://digestive.niddk.nih.gov/ddiseases/pubs/bacteria/ Raw foods are the most common source of food-borne illnesses • Raw meat and poultry contaminated during slaughter • Seafood contaminated during harvesting/processing

34. Current U.S. Food Safety Issues:Food-borne Illnesses (Cont.) National Digestive Diseases Clearing House. (n.d.). Bacteria and Foodborne Illness. Retrieved August 29, 2010 from http://digestive.niddk.nih.gov/ddiseases/pubs/bacteria/ Food-borne illnesses Causes: • Caused by eating food or drinking beverages contaminated with bacteria, parasites, viruses or harmful chemicals

35. Current U.S. Food Safety Issues:Food-borne Illnesses (Cont.) National Digestive Diseases Clearing House. (n.d.). Bacteria and Foodborne Illness. Retrieved August 29, 2010 from http://digestive.niddk.nih.gov/ddiseases/pubs/bacteria/ Food-borne Illnesses Causes: • Bacteria are the most common cause of foodborne illnesses • Contamination can take place during growing, harvesting, processing, storing, shipping or final preparation

36. Current U.S. Food Safety Issues:Food-borne Illnesses (Cont.) National Digestive Diseases Clearing House. (n.d.). Bacteria and Foodborne Illness. Retrieved August 29, 2010 from http://digestive.niddk.nih.gov/ddiseases/pubs/bacteria/ Food-borne illnesses Causes: • Bacteria: O157:H7 (E. coli), Campylobacter jejuni, Staphylococcus aureus, Vibrio vulnificus, Shigella, Salmonella • Parasites: Entamoeba histolytica, Trichinella • Viruses: Hepatitis A, Noroviruses

37. Current U.S. Food Safety Issues:Food-borne Illnesses (Cont.) National Digestive Diseases Clearing House. (n.d.). Bacteria and Foodborne Illness. Retrieved August 29, 2010 from http://digestive.niddk.nih.gov/ddiseases/pubs/bacteria/ Food-borne Illnesses Diagnosis: • Food intake history • Examination of the feces • Examination of the suspected food (bacterial toxins, viruses and parasites)

38. Current U.S. Food Safety Issues: Food-borne Illnesses (Cont.) National Digestive Diseases Clearing House. (n.d.). Bacteria and Foodborne Illness. Retrieved August 29, 2010 from http://digestive.niddk.nih.gov/ddiseases/pubs/bacteria/ Food-borne illnesses Sources: • Bacteria: O157:H7 (E. coli), Campylobacter jejuni, Staphylococcus aureus, Vibrio vulnificus, Shigella, Salmonella • Parasites: Entamoeba histolytica, Trichinella • Viruses: Hepatitis A, Noroviruses

39. Eschirichia coli O157:H7 • Rangel, J.M., Sparling, P.H., Crowe , C., Griffin, P.M., & Swerdlow, D.L. • (2005, April). Epidemiology of Escherichia coli O157:H7 outbreaks, • United States, 1982–2002. Emerging Infectious Diseases. • Retrieved from http://www.cdc.gov/ncidod/EID/vol11no04/04-0739.htm First recognized as a pathogen in 1982 during an outbreak investigation of hemorrhagic colitis Between 1982 and 2002, 49 states reported 350 outbreaks, representing 8,598 cases, 1,493 (17%) hospitalizations, 354 (4%) hemolytic uremic syndrome cases, and 40 (0.5%) deaths Transmission route for 183 outbreaks (52%) was foodborne 75 (41%) of the foodborne outbreaks were due to contaminated ground beef, and for 38 (21%) outbreaks, produce

40. Eschirichia coli O157:H7 (Cont.) • Rangel, J.M., Sparling, P.H., Crowe , C., Griffin, P.M., & Swerdlow, D.L. (2005, April). • Epidemiology of Escherichia coli O157:H7 outbreaks, United States, 1982–2002. • Emerging Infectious Diseases. Retrieved from http://www.cdc.gov/ncidod/EID/vol11no04/04-0739.htm Virk, A., Orenstein, R., Estes, L., Wilson, J.W., & Virk, A. (2008). Infectious Diseases. In Ghosh A., (Ed),Mayo Clinic Internal Medicine Review, (8th ed.). (pp.619). Rochester, MN:Informa Healthcare Annually causes 73,000 illnesses in the U.S. Majority of reported U.S. cases transmitted through food Majority of food-borne outbreaks attributed to ground beef Symptoms: bloody diarrhea, severe abdominal cramps, fever, profound toxicity May produce hemolytic uremic syndrome Antibiotics not known to be effective

41. Eschirichia coli O157:H7 (Cont.) Meat becomes contaminated from cattle feces and cattle intestinal tract which contain E. coli

42. Eschirichia coli O157:H7 andFood Safety Inspection • FDA’s Hazard Analysis and Critical Control Points (HAACP) • requires microbial testing to detect E. coli and Salmonella • PulseNet, CDC • Network of state public health laboratories throughout the country that “fingerprint” E. coli O157:H7 • Matching “fingerprints” among different victims of an outbreak permits a focused investigation

43. Preventing Eschirichia coli O157:H7 • Consumers: • urged to cook hamburgers well-done, with internal temperatures over 155 degrees Fahrenheit • Meat industry: • sprays cattle with milk-based substance that appears to kill E. coli • passes meat through steam cabinets in bags of hot water to kill bacteria • irradiation

44. Preventing Eschirichia coli O157:H7 (Cont.) Pfizer Inc. (2006). Chapter 7: Safer and healthier foods. In Milestones in public health: Accomplishments in public health over the last 100 years. (p. 136). New York, NY: Pfizer Inc. • Researchers • Dr. James Russell recommends feeding cattle hay in order to change pH balance of cattle stomachs to prevent growth of E. coli • Meat industry resists feeding cattle due to increased cost from hay in comparison to corn

45. Safer and Healthier Foods Nutrition Labeling and Food Packaging

47. USDA Food Pyramid

48. Safer and Healthier Foods Looking Ahead

49. Looking Ahead: How to Ensure a Safe Food Supply National Digestive Diseases Clearing House. (n.d.). Bacteria and Foodborne Illness. Retrieved August 29, 2008 from http://digestive.niddk.nih.gov/ddiseases/pubs/bacteria/ Irradiation • The treatment of food with x-rays, gamma rays or electron beams as a means of cold pasteurization • This process destroys living bacteria to control foodborne illnesses

50. Looking Ahead: How to Ensure a Safe Food Supply (Cont.) National Digestive Diseases Clearing House. (n.d.). Bacteria and Foodborne Illness. Retrieved August 29, 2008 from http://digestive.niddk.nih.gov/ddiseases/pubs/bacteria/ Irradiation • The U.S. employs gamma rays, which are similar to microwaves and ultraviolet light and pass through food with no residue • Food irradiation is approved for dry or dehydrated products, whole fresh fruits, potatoes, wheat, seasonings, spices, poultry, red meats and pork