Food Safety Education in England: A Report from the NEHA/CIEH Sabbatical Exchange Program.

Abstract

The author, a participant in the NEHA/Chartered Institute of Environmental Health (CIEH) sabbatical exchange program, provides a synopsis of her meetings with professionals and nonprofessionals involved in food safety education in England. The people she met with represent government agencies, trade associations, the food industry, and consumer activist groups. The comments and opinions they shared during these meetings helped her develop a "picture" of food safety education efforts directed toward consumers, school-aged children, and food industry employees. Also during her six-week stay, she gained a better understanding of the social and political climate in England. This insight helped her understand the roles and responsibilities, real and perceived, of government, consumers, the media, trade associations, and consumer activists in food safety issues. The overall goal of the sabbatical was to examine the methods used in the United Kingdom to deliver food safety education and resources to a variety of target audiences.

Editors note: This report has been condensed and edited for publication in the Journal of Environmental Health. The complete (original and unedited) report is available on NEHA's Web site at[less than]http://www.neha.org/awardinfo.html[greater than] (click on "Sabbatical Exchange Award Winner").

Background and Situation

In the past 15 years, the United Kingdom has experienced an increase in the number and severity of food safety incidents. In 1980, 12,700 incidents of foodborne illness were reported. In 1998, there were almost 100,000 such incidents.

For the purposes of this report, I divide the incidents into two categories--those that can be directly attributed to microbiological hazards (foodborne illnesses) and those I call food scares, whose causes and long-term impacts are unknown. The latter category includes outbreaks of bovine spongiform encephalopathy (BSE) and the use of genetically modified (GM) food ingredients.

Food safety incidents from microbiological hazards include an outbreak of Salmonella in eggs in 1988. The fallout from this outbreak involved the resignation of Junior Minister of Health Edwina Currie. Ms. Currie stated in December 1988 that most egg production in the United Kingdom was infected with Salmonella. The government ordered the slaughter of two million birds between 1989 and 1993 (Mintel Marketing Intelligence, 1999). In 1989, there were outbreaks of listeriosis in soft ripened cheeses and pate and of botulism in yogurt. In a December 1996 outbreak of Escherichia coli in Lanarkshire, Scotland, 500 people became ill, and 21 people died. Those events constituted the worst E. coli outbreak to date in the world.

There also has been increasing concern in the United Kingdom about the hygienic practices of consumers at home. Sally Bloomfield of Unilever and researchers under contract with the Ministry of Agriculture, Food and Fisheries (MAFF) are attempting to learn about consumer food-handling practices. The purpose is to determine the best method of reaching consumers with information that will help improve their food safety behaviors (S. Bloomfield, personal communication, March 10, 2000).

Current research by the Health Education Authority (HEA) indicates that almost three million children as young as seven years of age regularly prepare their own breakfasts, that 64 percent of children seven to 11 years of age do so, and that 65 percent also cook evening meals for their parents. Many of the children are not aware of good food safety practices or of foodborne-illness risks. Fifty-seven percent of the children questioned prepared food while pets were in the kitchen, and 46 percent shared food with their pets during preparation (Food and Drink Federation, 1996).

The incidents of most concern to citizens of the United Kingdom involve many unknown factors. In 1986, the first incidence of BSE in British cattle was reported. It was not until 1996, however, that U.K. scientists identified a possible link between BSE, a new-variant Creutzfeldt-Jakob disease (CJD), and 14 deaths. This discovery resulted in the slaughter of all beef cattle over 30 months old and worldwide bans on sales of British beef. The sale of beef on the bone also was temporarily banned. Research into the long-term impact of BSE in cattle and its; relationship to CJD in humans is ongoing. The British government is investing heavily in research to learn more about the long-term impact on the population.

In 1999, another food safety crisis was brought about by the introduction of GM food ingredients into the U.K. market. Because of public outcry led by activist groups such as the Food Commission and Greenpeace, and by the media, the government required in the fall of 1999 that all food products containing GM foods be labeled. According to Tim Lobstein of the Food Commission, the real issue was concern about the unknown effects on humans of GM foods (T. Lobstein, personal communication, March 6, 2000). Supermarket chains have been responsive to the consumer outcry and have in many instances removed all GM food ingredients from their shelves (A. Lacey, personal communication, March 6, 2000). Thus, the issue of GM foods became one of governmental policy. In 1999, Prime Minister Tony Blair endorsed the use of GM foods. In March 2000, he reversed this endorsement. Mr. Blair cited the need for more research into the long-term risks of GM foods as the reason for his change of opinion.

The British press has a strong influence in determining which types of food safety issues are of concern to consumers. The issues featured in the different types of press reflect directly on the socioeconomic makeup of the readership. For example, the highly emotion al issue of genetic modification is heavily biased toward readers of the quality press (Mintel, 1999). The British public looks to the media to provide current information. In some instances the media have not provided scientifically based information, but information based purely on rumor, thus causing unnecessary public hysteria (A. Lacey, personal communication, March 6, 2000).

Several events have led to changes in food safety regulations in the past 10 years. The most important is a 1993 European Union (EU) directive aimed at creating "one Europe," including standardization of regulations across the EU. This directive led to the revision of food safety regulations in 1995. The regulations include provisions for training food service workers to the level of knowledge needed for their jobs and requirements for risk assessment systems.

During the political campaign for prime minister in March 1997, Labor candidate Tony Blair commissioned Professor Phillip James of the Rowlett Institute in Scotland to review the food safety situation and to make recommendations for change. The James Report was issued shortly after the Labor government came into power in May 1997. The report advanced a model for a single food standards agency. The Food Standards Agency (FSA) began operation on April 1, 2000. Its responsibilities include

1. setting standards based on sound scientific knowledge to reduce the risk from bacteria that cause food poisoning;

2. checking levels of chemicals in foods to make sure they are within safe limits;

3. setting rules for what should go on food labels so that they are clear and give the information consumers want;

4. advising on what constitutes a healthy diet;

5. monitoring and advising on any other food concerns as necessary; and

6. answering questions about the safety or quality of food (Joint Food Safety and Standards Group, 1998).

Governmental and industry officials have many missions for this new agency in addition to those listed. They see three important goals. The first and foremost goal is to restore public confidence in the government and the food industry. Those involved with the creation of FSA stress that it will be responsive to the public's concerns. FSA also will give advice to members of Parliament on food safety issues. This approach is viewed as a radical way of creating more openness in government (C. Day, lecturer, Kings College, London, personal communication, March 15, 2000; S. Wearne, board secretariat, FSA, personal communication, March 2, 2000; A. Lacey, personal communication, March 6, 2000). The industry hopes that FSA will "communicate rapidly, credibly and openly on any emerging food safety issue so food scares aren't media-led with rumor presented as scientific fact" (Lacey, 2000).

Another goal is consistency in enforcement of regulations by local authorities. FSA is currently addressing this issue by working with various groups to develop and implement training for local authorities. The Chartered Institute of Environmental Health (CIEH) has developed one-day training sessions for local environmental health officers. Also, the Local Authority Coordinating Body for Food and Training Standards (LACOTS) has been working on the issue of standardization with its membership (S. Wearne, personal communication, March 2, 2000).

Target Audiences

Consumers

Efforts to educate consumers on food safety issues have been undertaken by both industry and government. In the past, MAFF and the Department of Health (DOH) have each developed and implemented broad educational campaigns.

The Consumer Helpline, established by MAFF, is now part of the Joint Food Safety and Standards Group (JFSSG). In 1999, the help line answered 11,632 questions from all over the United Kingdom. About 20 percent of those questions were from consumers; the help line also serves as a resource for industry, using a variety of food safety fact sheets and pamphlets currently produced by JFSSG and DOH to assist in responding to inquiries.

JFSSG also currently produces and distributes a monthly publication, the Food Safety Report. It contains information on the results of current research, new educational materials, and reference articles. A study of this publication has just been completed. As a result of the study, the current publication will target local environmental health officers, dietitians, and educators. A quarterly publication will be developed to address more general food safety issues for consumers (R. Sinclair, JFSSG, personal communication, March 17, 2000).

As a direct result of the deadly E. coli outbreak in Scotland (which caused 21 deaths from a meal served in a community hall) a DOH unit in the JFSSG began a campaign in 1999 targeting community-based food service events. The materials were produced and distributed in collaboration with special interest groups. To date, more than 14,000 of the packets have been distributed. Local environmental health inspectors report seeing the information posted in community halls throughout the country (M. O'Neil, personal communication, March 7, 2000).

Large retail food chains are another source of food safety information for consumers. Sainsbury's, a multinational organization with 400 stores in the United Kingdom, maintains an active public-affairs office. This office provides educational pamphlets, hosts speakers, and updates a Web site with cur rent food safety information. All of these communications with consumers include information not only on public food safety issues, but also on the food safety policies and procedures Sainsbury's requires in its stores and of its suppliers. Sainsbury's also samples public opinion on a variety of issues through monthly consumer panels in each store. These panels have a direct influence on the chain's food safety policy (A. Lacey, personal communication, March 6, 2000; R. Wilson, Technical Communications Manager, Sainsbury's, personal communication, March 6, 2000).

One of the largest efforts to educate consumers about the causes and prevention of foodborne illness has been undertaken by the Food and Drink Federation. This trade association promotes the interests of the food-and-drink-manufacturing industry and works to improve the legislative, economic, social, and political environment within which individual companies operate. It also aims to inform consumers about current food safety issues. In 1993, the Food and Drink Federation initiated a public-outreach campaign called Foodlink.

The Foodlink campaign involves a partnership of the Food and Drink Federation with the Royal Environmental Health Institute of Scotland, the Department of Education and Employment, DOH, and MAFE. The goal is to encourage food safety practices at all stages of the food chain and to improve awareness of food safety practices in the home. The project comprises a variety of publications, consumer surveys, exhibitions, and conferences, as well as a Web site and an annual Food Safety Week.

Food Safety Week has provided a focus for messages designed to help people undertake basic precautions that reduce the risk of foodborne illness. Throughout the United Kingdom, hundreds of local authorities and environmental health departments, health professionals, and food companies have par ticipated. Events have included presentations to consumer groups and in-school pro grams by industry representatives (C. Elsasser, Food and Drink Federation, personal communication, March 1, 2000).

The campaign has, however, been publicly criticized by consumer activist groups. They perceive it as industry shifting the "blame and responsibility" for food safety from itself onto the consumer (S. Davies, personal com munication, March 21, 2000; T. Lobstein, personal communication, March 10, 2000). Because of this criticism, CIEH withdrew its support of the campaign in 1998.

Consumer activist groups have played a major role in informing the public about food safety issues. These groups include the Food Commission, Greenpeace, and the Consumers' Association, a 700,000-member organization whose goal is to provide unbiased information to consumers. The Consumers' Association publishes a series of books and monthly magazines on a variety of topics. These publications provide members with research-based information to assist in purchasing decisions. Sue Davies, principal policy advisor of the Consumers' Association, asserts that the central issue associated with GM foods, for instance, is freedom of consumer choice. Also, the BSE crisis of the late 1980s suggested that government might not be truthful with con sumers. This history has created an atmosphere of mistrust both of government and of industry. Ms. Davies hopes that FSA will "open up" government to consumers and make it more responsive. It is her opinion that food safety is a responsibility to be shared among government, industry, and consumers. The consumer, however, is at "the mercy" of government and industry, and therefore the consumer should not have to be as responsible for food safety (S. Davies, personal communication, March 21, 2000).

School-Aged Children

The results of the research conducted by HEA indicate that school-aged children lackan understanding of basic food safety principles. This lack of understanding can be attributed to a number of factors, including lifestyle changes and the current pressure on educational institutions to instruct students in the use of the latest technology.

In 1995, the United Kingdom initiated a National Curriculum that public and private schools are required to follow. The purpose of the National Curriculum is "to ensure that pupils develop from an early age the essential literacy and numeracy (math) skills they need to learn: to provide them with a guaranteed, full and rounded entitlement to learning; to foster their creativity; and to give teachers discretion to find the best ways to inspire in their pupils a joy and commitment to learning that will last a lifetime" (Department of Education and Employment, Qualifications and Curriculum Authority, 1999).

The National Curriculum dramatically changed Family and Consumer Sciences (FCS) education. Previously, FCS was taught at all grade levels. The focus was on life skills development and included food preparation and nutrition, clothing and house hold-textiles construction, personal growth and development, and financial management. In the new curriculum, all of these areas were combined under one topic Design Technology. Only two areas of the old FCS curriculum were included-Textile Technology and Food Technology.

The year 2000 brought another challenge to the Food Technology area of the curriculum. Teachers across the country had been surveyed as part of the evaluation of the National Curriculum. The survey results indicated that 96 percent of the schools responding taught some form of Food Technology Seventy-three percent indicated that the subject area should be mandatory, even if making it so would require taking resources from other areas of the curriculum (L. Davies, Qualifications and Curriculum Authority, personal communication, March 9, 2000). In spite of efforts from a coalition of professional and consumer organizations, David Blunkett, secretary of state for education and employment, determined that food technology should not be mandatory (Department of Education, 1999).

The design and technology programs of the National Curriculum are divided into four stages. Each stage focuses on applying knowledge and understanding in developing ideas, planning, making products, and evaluating them. Programs of study build upon what has been previously taught.

Curriculum materials developed through partnerships of government agencies and nonprofit educational institutions and organizations support the goals and objectives of the National Curriculum. The British Nutrition Foundation, with funding from MAFF, has produced numerous curricula and resource materials. Private textbook companies like Hodder & Stoughton, in cooperation with the Royal College of Art Schools Technology Project and the Department for Education and Employment, have also developed resource materials (L. Davies, personal communication, March 9, 2000).

In 1997, the EU awarded funds to HEA for the development of food safety curriculum materials. Two curricula were developed and distributed to schools in England and Scotland. The content was based on the results from a random sampling of English households, a national food safety survey that had been previously conducted by MLAFF, and focus groups of students and teachers.

In September 1999, the first curriculum, "Aliens in Our Food," was sent to all secondary and middle schools in the United Kingdom. The curriculum package features an alien named Doof who crash-lands on Earth and teams up with a computer robot named Mic-Robe to learn about food hygiene. Informal evaluation of the curriculum reports that teachers like it and find it easy to use. Also, students have improved their food safety knowledge and practices ("Food safety teaching made easy," 1999; K. Paterson, HEA, personal communication, March 21, 2000; K. Peploe, personal communication, February 16, 2000).

The second curriculum, "The Adventures of Safe-T and the H Squad," was launched on March 8, 2000, and targets students in primary schools. The teacher's guide provides activities to be used in the classroom to build knowledge, understanding, and skills that students need in relation to food hygiene. It also addresses statutory requirements in science, food technology, literacy, and numeracy.

I participated in the launching of "The Adventures of Safe-T and the H Squad," which was held at a London primary school with Food Safety Minister Baroness Hayman and Lesley Waters, a television chef from the BBC's Ready, Steady Cook show. Baroness Hayman stated, "Knowing how to handle and prepare food safely is a skill we all need. There is no better time to learn than in childhood, and this new teaching resource for all primary schools in the country provides an effective means to help children learn. I warmly welcome it."

The launch did not escape some negative press coverage. In a column in the Guardian, Ros Coward suggested that children following "The Adventures of Safe-T and the H Squad" would develop a fear of food and food preparation. She also suggested that the curriculum was counter to governmental support of organic foods and farmers who choose to engage in organic methods of production (Coward, 2000).

The future of activities like the development and distribution of the two curricula described here was, at the time of my visit (February to March 2000), unknown because of the reorganization of governmental agencies supporting food safety education. During the launch of "The Adventures of Safe-T and the H Squad," I asked Dr. Richard Harding, head of the Food Hygiene Division and part of JFSSG, what the future held for the food safety education of school-aged children and consumers under FSA. He indicated that the agency was committed to food safety education. My impression from other conversations with representatives of JFSSG was that if FSA identified an educational need, it would hire an outside organization to develop and implement an educational activity to address the need. Also, the issue of education was not high on the agenda at that time and would possibly be addressed as the new agency evolved (S. Wearne, personal communication, March 2, 2000).

As mentioned above, Foodlink sponsors a National Food Safety Week. Since 1997, school involvement in the activities of National Food Safety Week has been encouraged. In 1999, the focus was on issues of crosscontamination, and more than 1,000 schools participated in activities ranging from practical demonstrations of handwashing to kitchen road shows that emphasized good food hygiene practices (Elsasser, 2000). The theme of the 2000 campaign was "Keep It Safe" and encompassed all aspects of food safety.

Industry

The 1995 Food Safety Regulations state: "The proprietor of a food business shall ensure that food handlers engaged in the food business are supervised and instructed and/or trained in food hygiene matters commensurate with their work activities." The regulations also indicate that food workers must be trained to the level of the actual job they perform and to the type of food they handle. The regulations define three categories of food workers. Category A workers handle low-risk or wrapped food only. Category B workers pre pare and open high-risk foods. Category C workers may have some supervisory role (Chadwick House, 1995).

The training required by these regulations may be offered through local authorities, community colleges, professional organizations, or the industry. CIEH, through its trading company, Chadwick House Group, is one of the leading providers of food safety education for workers worldwide. Three levels of worker training are provided: basic hygiene, intermediate food hygiene, and an advanced course on food hygiene designed for individuals in supervisory positions. The program also offers hazards analysis critical control point (HACCP) courses at levels two and three.

The food service industry, as in the United States, is probably one of the largest employers in the country. It faces similar challenges with workers who come from a variety of cultures and may have a low level of literacy. Trainers, whether employed by private industry or professional organizations, are challenged to develop and implement meaningful training for this varied audience (D. Waite, Chadwick House, personal communication, February 15, 2000).

Harrods

Harrods-London employs several hundred individuals in its food operation. This operation includes the well-known Food Halland 21 different restaurants. Harrods is almost a city unto itself, with its own water treatment plant, fire department, emergency response team, post office, and bank. It has a well-organized training program for food service employees. All new employees receive food safety training as part of their orientation training.

Harrods' emergency care officer, Edwina Beckley, is responsible for the development and implementation of employee training. My visit with Ms. Beckley included a tour of the Harrods food service operation. This operation may serve up to 5,000 meals a day in a variety of settings--from fine dining in a lavish banquet room to small soda-fountain operations. A team of food safety advisers oversees all aspects of the operation. They ensure that HACCP principles are followed for worker hygiene, sanitation, and temperature control (E. Beckley, personal communication, March 16, 2000).

Sainsbury's

I gained perspective on another aspect of the food industry when I visited Alan Lacey, the technical liaison manager for Sainsbury's Supermarkets, Ltd., and his staff. This 400-store chain provides extensive training to employees at all levels of operation. The Technical Division has developed numerous training materials and manuals that are used throughout the chain by in-store trainers. The focus is on the application of HACCP principles. The Technical Division has developed standards over the years, not only for Sainsbury's own stores, but also for its suppliers (A. Lacey, personal communication, March 6, 2000; S. Kennedy, Hazard Analysis and Retail Procedures, Sainsbury's, personal communication, March 6, 2000).

The Airline Industry

Castle Kitchens is a small catering company that provides meals and other foodstuffs to private and business aircraft. Its sales director, Erica Sheward, is a leader in promoting the practice of sound food safety principles in the airline industry.

According to Ms. Sheward, this industry does not commonly address food safety issues. Legislation has made the caterer responsible for food safety up to the time when food is delivered to the aircraft. When, however, the flight attendant does not follow procedures of due diligence with respect to the goods received, the flight attendant will be held responsible if a passenger becomes ill from food eaten on the aircraft. Sheward has undertaken a personal campaign to educate flight attendants about this legislation. Her efforts include presentations at international and national meetings, a food safety column for the monthly newsletter of the Flight Attendants Association, a video, and a pamphlet titled Your Passport to Food Safety (E. Sheward, personal communication, February 28, 2000).

Conclusions and Observations

My time in England included conversations and formal meetings with academics, food industry representatives, government officials and employees, and consumers. Also, I was able to learn about the culture of food safety education through personal observations, reading the newspapers, watching television, and daily living--purchasing food in the local grocery store, walking to the Underground station, and visiting various cultural and historic attractions.

There was a great deal of optimism about FSA on the part of the representatives from various agencies. They all stressed that FSA would be a form of "open government" and would include many scientific and consumer advisory committees. At the time of my visit, however, it was not apparent what role such committees would play in food safety education. From the U.S. perspective, it appears that someone needs to bring "the players" together to develop a plan. Karen Paterson, the 1999 CIEH Sabbatical Exchange Program visitor to the United States, writes in her October 1999 report that FSA needs to convene a working group to examine the issue of food safety education for consumers. She further suggests in her report that a group of new health professionals be created whose sole role is to educate the public about food safety. Although counter to the current cul ture in the United Kingdom, partnerships among industry, government, and academia can be very successful (Paterson, 1999). From my limited observations and time in the United Kingdom, I concur with Ms. Paterson's recommendations.

It also appears that, as in the United States, the issue is who is responsible for the education. A study commissioned by the U.S. Department of Agriculture (USDA) and the Food and Drug Administration (FDA) in 1998 found that food safety education was best accomplished in science classes and family-and-consumer-sciences classes at the middle-school level. In addition, the topic should be incorporated into other subjects at other grade levels (Macro International, 1998). The Design and Technology section of the U.K. National Curriculum provides an opportunity for doing so, and the effort to include food safety principles in the National Curriculum should continue. Who will create the curriculum and how will it be funded? FSA needs to address this issue in cooperation with the Department of Education and Employment, the Qualifications and Curriculum Authority, and the professional organizations and academic institutions that provide formal and in service education for teachers.

In conclusion, some kind of national partnership involving all those with an interest in food safety education should be developed. The partnership would provide a forum for sharing ideas and making cooperative efforts to provide both formal and informal food safety education for school-aged children and consumers. There are lots of "good things" happening in various sectors; they just need to be brought together. Possibly some kind of working conference would be the first step.

Corresponding Author: Martha Smith Patnoad, M.S., C.F.S.P., Cooperative Extension Associate Professor, Food Safety Education Specialist, Department of Nutrition and Food Sciences, University of Rhode Island, 106 Ranger Hall, Kingston, RI 02881-0804.

Acknowledgments: I would like to acknowledge the support of several individuals who assisted me in making contacts in England and provided a "home base" during my stay. Norman Parkinson at the University of Sciences at Kings College provided me with staff privileges, including office space, use of telephone, and use of e-mail. The latter proved useful in making contacts, confirming appointments, and staying in touch with colleagues and family in the United States. Peter Wright served as my contact/sponsor with CIEH. He, too, provided contacts and introduced me to the "inner workings" of CIEH. Karen Paterson hosted my family for a wonderful dinner and also provided valuable contacts.

In addition, I would like to acknowledge my husband, Edward, and my daughter Aimee, who supported me in this endeavor as they have throughout my career. Thanks also are due to my colleagues at the University of Rhode Island Department of Nutrition and Food Sciences-in particular Lori Pivarnik, who took on extra responsibilities during my absence. Finally, I am grateful to NSF International and the Rhode Island Environmental Health Association, whose financial support helped make a dream a reality.

REFERENCES

Chadwick House Limited. (1995). Industry guides to good hygiene practice: Catering guide. London: Author.

Coward, R. (2000, March 14). In fear of fruit and veg. The Guardian, p. 18.

Department of Education and Employment, Qualifications and Curriculum Authority. (1999). Design and technology: The National Curriculum for England: Key stages 1-4. London: Author.

Elsasser, C. (1999). Raising food safety awareness. Moodus, 17(4), 118-121.

Food and Drink Federation. (1996). National food safety report. London: Author.

"Food safety teaching made easy." (1999) Moodus, 17(6), 180-185.

Joint Food Safety and Standards Group. (1998). Food law. London: Author.

Lacey, A. (2000) The Food Standards Agency: A 'new approach' or more of the same? Our Business. Sainsbury's In-house Publication, 16.

Macro International. (1998). USDA/FDA: Education initiative: Evaluating the placement of food safety education in American schools. Washington, DC: Macro International.

Mintel Marketing Intelligence. (1999). Special report: Food safety, 1999. London: Mintel International Group.

Paterson, K. (1999). Impression of the U.S. food safety system: What lessons can be learnt for a food safety strategy for the U.K.? Unpublished report submitted in partial fulfillment of the requirements of the 1998-99 CIEH/NSF Sabbatical Exchange Program.