Year 2000 goals - EFR 6-1

Food and nutrition goals set for the year 2000 have only 4 years left. The following is an interim report on how we are doing. The major emphasis is that education of the public is the key.

Excerpted from: FOOD CHEMICAL NEWS, October 23, 1995, Pages 8-10

The food portion of the Healthy People 2000 plan is a shared responsibility of FDA, the Agriculture Department and the U.S. Centers for Disease Control and Prevention (CDC). In an interim report these government groups noted that, with only four more years until its deadline date, significant progress has been made in the reduction of listeriosis and Salmonella enteritidis.

Salmonella and Listeria monocytogenes were two problem bacteria which have shown positive reductions. In 1994, Salmonella occurred at a national rate of 15 cases for 100,000 people, according to CDC's National Reporting System. The goal for the year 2000 is 16 cases per 100,000. Between 1989 and 1993 (from 1,965 cases and 481 deaths to 1,092 cases and 248 deaths, respectively), illness from Listeria monocytogenes infection was reduced by 44% and deaths were reduced 48% according to data published in the April 1995 issue of the Journal of the American Medical Association by the Listeriosis Study Group. This would also place L. monocytogenes as being lower than the goal rate of 0.5 illnesses per 100,000 people by 2000, it said.

Salmonella enteritidis outbreaks increased dramatically in the 1980s, but improvements were noted for the 90s. Although still far above the goal of 25 illnesses per 100,000 in the year 2000, the 1994 rate of 44 per 100,000 had declined from 1989, when the incidence was 77 per 100,000.

The report noted that part of the reduction in the S. enteritidis rate may be due to on-farm Salmonella reduction programs such as the Pennsylvania Pilot Project. "According to recent surveys, products containing raw eggs or partially cooked eggs are still consumed by over half of the public," the report stated, adding: "If education efforts are successful in convincing the public to thoroughly cook or use pasteurized eggs then the incidence of S. enteritidis will decrease."

While the successes were lauded the report cautioned that reductions with other bacteria or even maintaining the reduction of Listeria monocytogenes may be difficult. Forces working against further reductions include:

- an increase in at-risk people: the number of elderly and immunocompromised people is increasing.

- declining safe preparation practices: "Consumer research suggests that prior to the Escherichia coli O157:H7 outbreak in 1993, the number of people following safe food preparation practices was declining."

- an increasingly diverse food service industry: problems include high turnover, language and literacy barriers, and non-uniform systems among states for training and certifying such workers.

- evolving pathogens: the rapid evolution of pathogens, including an increase in virulence of many species, has caused the emergence of previously unknown human pathogens.

Information on other food safety practices related to individual behavior provide a mixed image of how well food safety education programs may be working:

- A non-statistically significant increase (from 70% in 1989 to 72% in 1993) was found in the number of people who routinely refrain from leaving perishable food out of the refrigerator for more than two hours (the Year 2000 goal is 75% by 2000).

- The number of people who reported washing cutting boards with soap after contact with meat and poultry actually dropped slightly (from 66% to 65%--the goal is 75% by 2000).

- "Responses to the questions about consumption of raw protein foods suggests that risky food consumption was common, ranging from over 50% who said they eat raw eggs to 55% who said they eat raw meat, such as steak tartare"

- The report noted that 75% of those surveyed had heard of Salmonella and botulism, but only 10% had heard of Listeria and Camplyobacter.

The report noted that the survey was done in 1993 and since that time the publicity surrounding E. coli and the need for thorough cooking has been extensive. The report suggested:

"The publicity and education programs may increase public awareness of the dangers of foodborne pathogens and may eventually lead to behavioral change. However, past experience in changing public behavior in more healthful directions suggests that the campaigns need to be continued for years in order to make a significant difference."

While detailing a number of food safety programs offered by government agencies, the report listed a number of "barriers and challenges" to the ultimate success of the food portion of Healthy People 2000. These were:

- Reductions in budget and people while programs are maintained and expanded.

- Gaps in information on the current incidence of foodborne illness and the exact modes of transmission.

- The elusive and changing nature of microbial pathogens.

- "The public's distrust of new technologies, such as food irradiation, and regulatory constraints on the use of new technologies and chemicals. Like pasteurization, irradiation can be used to kill pathogens or to sterilize food to yield a safe food product."

- "The increasing proportion of the domestic food supply which is distributed widely, and an increase in food imported from foreign countries. The food supply has become more global, making it difficult for agencies to monitor the safety of the food supply. For example, about 135 different countries now supply seafood to the United Sates. Within the United States, wide distribution of contaminated food products has resulted in widespread outbreaks."

- The percentage of the population that is older than 65 will grow from about 12% in 1980 to over 22% in 2004. This will increase the number of people who may be susceptible to foodborne disease.

- "The difficulty of motivating all those who prepare food to follow proper food preparation practices. Effective education does not simply provide more information. The education challenge is to tailor the kind of information, the channel of communication and the educational approach to each of the different audiences. For example, we are not yet sure how to change the behavior of someone who knowingly eats raw animal protein products or how to target our message to specific consumers, such as those who inadvertently undercook high-risk foods."

- "The increasingly diverse population impacts the effectiveness of food safety education materials. With limited resources it is difficult to target people of different cultures who may speak different languages and eat different food prepared in different ways."