A statistical study of federal and state food safety data confirms what most authorities have long believed–that some state health departments are dramatically better than others at detecting foodborne illness outbreaks.
The report released Wednesday by the Center for Science in the Public Interest (CSPI) uses 10 years of data from the Centers for Disease Control and Prevention to assess how well states detect and report outbreaks of Salmonella, E. coli and other foodborne illnesses.
The bottom line: During the years 1998 to 2007, an outbreak of foodborne illness was far more likely to be detected if it happened in Minnesota, Oregon, Washington, Florida, Maryland, Wyoming or Hawaii. CSPI awarded “A” grades to each of those states, meaning they reported eight or more outbreaks per million people per year.
The same outbreak was far less likely to be detected if it occurred in most southern or southwest states, CSPI concluded. Over the same period, each of 14 states in those regions detected just one outbreak per million population.
While fewer diseases were reported in those states, more people probably were being sickened, explains Carol Smith-DeWaal, CSPI food safety director and a co-author of the new report.
She acknowledged that the basis of the report is “counter-intuitive.” Essentially CSPI awards “A” grades to states that report far more people being sickened, and “F”s to states that report fewer illnesses.
“But the absence of an outbreak report doesn’t mean people aren’t getting sick,” she explains. “It simply means those illnesses are not being detected and reported.”
CSPI’s state-by-state grades were as follows:
“A”: Minnesota, Oregon, Washington, Florida, Hawaii, Maryland and Wyoming.
“B”: Colorado, Illinois, Kansas, Maine, Michigan, Ohio and Vermont.
“C”: Alabama, Alaska, California, Connecticut, Iowa, New Hampshire, North Dakota and Wisconsin.
“D”: Delaware, District of Columbia,Georgia, Idaho, Massachusetts, Montana, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah and Virginia.
“F”: Arizona, Arkansas, Indiana, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, Nevada, New Mexico, Oklahoma, South Carolina, Texas and West Virginia.
The report, titled “All Over the Map,” includes “outbreak profiles” for each state, providing the statistical basis for CSPI’s letter grade.
However, the report was greeted with some skepticism by some state officials, including epidemiologists from the states that scored at the top of CSPI’s report card.
Dr. Bill Keene, senior epidemiologist at the Oregon Health Department, said he appreciates the compliment, but is dubious of CSPI’s statistical method. “Their rankings are objective in only the crudest sense,” he said. “People measure stuff that is easy to measure, and then think it’s important because they don’t have any other measures.”
In particular, he said, the report focuses on outbreaks that occurred completely in a single state, while ignoring the large, multi-state outbreaks that have become common in recent years.
One major variable, Keene said, is funding–especially at a time when states are slashing budgets for health and other important services. Oregon, he said, has the distinct advantage of major federal funds that pay for most of its epidemiology and lab operations.
Similarly, Dr. Kirk Smith, supervisor of foodborne illness for the Minnesota Health Department, warned that the rate of reported outbreaks “is not necessarily a good predictor of the strength in foodborne illness investigation.”
“I do believe Oregon and Minnesota are among the strongest health departments in investigating foodborne illness,” he said. “But I also believe that some strong states got lower grades based on this simple measure, and vice versa.”
Smith-DeWaal said she recognizes the limitations of the report, but it is the first attempt to assess long-term efforts to deal with foodborne illness, state-by-state, she says.
And she is surprised by some of its findings. She expected, for example, that Oregon and Minnesota would score highest among the states. “But they have company,” she says. “There are five other states reporting foodborne illness at the same high level. And that’s good news.”
On the other hand, she’s discouraged by the low rate of reporting in most southern states– states where warm climates can actually favor Salmonella and other foodborne microbes.
“The CDC data shows that fewer outbreaks are being detected, and that suggests that citizens in those states are not well-protected,” she said.