Evaluating Environmental Health Agency-Level Interventions for Foodborne Illness Outbreak Prevention and Surveillance

Abstract

Protecting the safety of food is an integral public health function involving a continuous cycle of foodborne illness prevention, surveillance, and investigation. It is by conducting surveillance that public health can detect and investigate outbreaks. Investigation of these outbreaks enables public health to learn and adapt methods to better prevent illness. Environmental health (EH) professionals play critical roles in each of these stages beginning with their efforts in illness prevention through restaurant inspections. Chapter 2 illustrates the importance of the data collected by EH agencies, an underutilized data source for public health hazard surveillance. Efforts to standardize restaurant grading and disclosure practices have been hindered by the inability to compare their effects across multiple jurisdictions. Using national outbreak data and standard outcome metrics, Chapter 3 determines the effect of restaurant inspection agency practices in foodborne illness outbreak prevention by distinguishing inspection grading and disclosure practices that reduce foodborne outbreaks.If foodborne illness is not prevented, detection of illness relies on public health surveillance methods. Complaint-based surveillance has traditionally been conducted via phone calls from the public to local EH agencies housed within health departments. This method, while effective, can be limited by hours of operations of EH agencies or discomfort of the public to place a call. Advancements in complaint-based surveillance by using online complaint forms managed by public health agencies can expand the reach of current surveillance efforts and improve timeliness of reporting. Chapter 4 investigates the impact of expanding complaint reception capability through online complaint forms as a means of enhancing complaint-based surveillance. The robustness of a complaint-based surveillance system can be measured by its ability to detect foodborne outbreaks. However, while an increase in outbreak detection is beneficial for understanding risk factors involved in foodborne illness, it can also indicate deficient prevention measures upstream. Chapter 5 develops a novel framework that can be used to assess the interplay between the prevention interventions of grading and disclosure and surveillance system effectiveness. Successful outbreak detection and investigation relies on combinations of policies and practices targeting illness prevention practices and surveillance systems in place to detect outbreaks (Chapter 6). By examining agency-level interventions that strengthen foodborne illness prevention efforts, and distinguish effective surveillance methods, the findings from this dissertation will be useful in influencing food safety policy standards that can reduce foodborne illness burden in the U.S.