What we know and what we do: the gap in food safety. (Learning from Experience).

In February 4th, 2002, Dr. David Satcher, the Surgeon General, delivered a remarkable speech on public health issues at the Press Club in Washington, D.C. He addressed the health disparities among ethnic populations. Satcher argued that while many gains have been made in closing the gap between whites and minority groups, there is still much work to do. After I enjoyed listening to him, my mind was engaged with environmental health issues, especially food safety in our restaurants. We have gained so much knowledge about food protection and safety, yet we have not closed the gap between what we know and what we do. To illustrate this long journey, I have been exploring experiences from the past and present to share with my fellow environmental health professionals concerning the issue of food safety in restaurants today.

Times of Yore

We should be very grateful to pioneers like C.E.A. Winslow, one of the leading figures in the history of public health, for the wisdom and knowledge that laid the ground for further improvement and achievement. Winslow asserted that public-health practice should be based on the science of preventing disease, prolonging life, and promoting health and well-being. He felt that community organizations should work toward sanitation of the environment, the control of communicable diseases, and the education of individuals for personal health.

In the old days, with the assumption that "no normal person wants to consume dirty or decomposed food," health inspectors began a crusade in New York, which was followed by efforts in other major cities around the country, as a way to protect the health of the public who were dining in restaurants.

When we search through the past literature on public and environmental health, we realize that pioneers paved the ground for us and that we have resurfaced the ground step by step. Also, we learn that they managed to perform impressively with minimal knowledge. With limited information, tools, and technology, pioneers in public health established local health departments in many states around the country. They devised food safety regulations for eating establishments and gave priority to control measures and inspections. Their concerns were centered around Salmonella infection, viral hepatitis, amebic dysentery, and typhoid fever that could result from eating in restaurants. In this respect, old-timers devoted themselves to the perception that the public is entitled to sanitary conditions and safe food when eating in a public dining establishment.

The Current Scenario

Through the years, we have achieved a great deal in terms of improved sanitation, eradication of many viral and bacterial diseases, and behavior change in food-handling procedures; however, the gap between what we know and what we do is still wide.

Local health departments, drawing on the experiences of their environmental health divisions and sanitarians, are fully aware of what is going on in restaurants nationwide. A person who walks into a public food establishment--either a fast-food restaurant or a fine dining establishment--may have no qualification or any interest in judging how sanitary the place is. He or she trusts public-health officials and environmental health specialists to exercise care and expertise.

In one of my routine inspections a few years ago, I had to deal with an arrogant restaurant owner who did not care about the health and safety of his customers. The restaurant was not an immediate threat to the public, but the practices were far from acceptable according to environmental health standards. After I'd spent weeks educating this elderly owner and patiently trying to change his food-handling behavior, he finally confessed that he was absolutely off track and that he was lucky none of his dear customers had gotten sick. Pest control, acceptable cleanliness, the sanitary levels of kitchen and equipment, and the personal hygiene of his personnel were among the situations we had to correct to bring this restaurant up to minimum environmental health standards.

A fine-dining restaurant presented another health risk to the public; our environmental health team found many serious violations, which resulted in the closing of the business until all necessary corrections were made. Lack of a backflow prevention device, evidence of rodents, an unsanitary kitchen, failure to follow bandwashing procedures, and problems with the general personal hygiene of the workers were among the significant points of bad practice.

Workers at this restaurant, as at many others, had no clue about the contents of the Material Safety Data Sheet (MSDS) handbook known as "The Yellow Book." The Occupational Safety and Health Administration (OSHA) requires that all restaurant workers sign this book, acknowledging that they are aware of the chemicals used in the establishment and have read the pertinent information in case of an incident.

Today, chain restaurants, especially fast-food establishments, are slowly realizing how important it is to check food safety on a daily basis. Some fast-food corporations have shown more vigilance by establishing quality assurance departments to oversee the food safety and quality of service in their establishments. They have also provided preliminary grounds for the further education of restaurant management teams and a job requirement of passing a food safety course to receive certification. In this regard, credit should be given to NSF International and other associations that provide Certified Professional Food Manager courses nationwide. These developments, as well as the perseverance of health departments around the country, have kept us on track in ensuring the health and safety of the public. There are circumstances, however, that have led to insufficient care and shortcomings on both sides--that of the health agencies and that of the private sector--in managing eating establishments in this advanced society.

One of the significant advances in food safety in this country is the evolution of the Hazard Analysis Critical Control Point (HACCP) system. Fortunately, since 1990, many scientific articles and a great deal of technical information have introduced the HACCP system to our profession, making it unnecessary to give full details in this column. The HACCP program is widely accepted in food manufacturing as a significant tool for eliminating or reducing foodborne hazards. Using the HACCP system, manufacturing companies can control time, temperature, pH, and the water activity of food. Unfortunately, many eating establishments are not quite familiar with this concept yet, and, sad to say, we may not see familiarity developing any time soon, for several reasons: One reason is the lack of attention on the part of many restaurant managers natiomvide and their lack of interest in advancing their knowledge of food safety and certification. Also, many health departments, although they are responsible for making the effo rt to universalize the HACCP method, have not yet done so. Staffing and budget issues are the biggest hurdle here. The manpower shortage in environmental health is a national issue because not enough high school graduates have been encouraged to pursue a degree in environmental health. Budget is a traditional problem of health departments that depend on citizens' tax money These issues should be taken into account when we think about the gap between what we know and what we do to protect the public from existing hazards.

Major food-processing plants in the United States have started to recognize the importance of the HACCP approach in their industries. This development in safety precautions will help make consumers confident about the transfer of raw materials from industry to markets. Simultaneously, the major fast-food conglomerations need to come up with an appropriate blueprint for how to use the HACCP method and how to mobilize themselves with proper tools and enough experts in a timely manner.

Future Expectations and Our Share of the Commitment

The United States has the greatest number of fast-food establishments in the world. In no other country do people go out to eat as we do in the United States. We live in a modern society, an advanced industrial country, that has highly respected scientific organizations with exuberant researchers and highly developed educational institutions. People around the globe seek our advice in many areas. Hence, we have an important duty to fill the gap between what we know and what we do, first at home, and then in countries that are facing catastrophic situations in food safety and human health.

The following are obstacles to progress in food safety:

* inadequate and limited inspections,

* inadequate numbers of food safety professionals in local health departments,

* lack of undivided attention and devotion on the part of some public-health sanitarians,

* lack of interest among restaurant managers in obtaining more education on food safety and food quality,

* unacceptable personal hygiene of restaurant workers,

* language barriers among immigrant workers,

* lack of good cleanliness habits,

* delay in putting the HACCP system to work,

* lack of encouragement in public education for pursuit of food safety education, and

* the low priority given to food safety research (the number of grants available is limited).

We can't afford to continue to experience tragedies caused by foodborne illnesses such as the one that occurred in 1993 when a fastfood chain sold undercooked hamburgers contaminated with E. coli bacteria that killed several and made hundreds of children ill. Local health agencies should keep a closer watch and provide more surveillance of chain fast-food restaurants, where more violations have been observed than in fine-dining restaurants.

Regulatory organizations such as the Centers for Disease Control and Prevention (CDC), the U.S. Department of Agriculture (USDA), the Food and Drug Administration (FDA), and state health departments are the keys to action. These agencies are expected to do more and better based on the ample knowledge and understanding we have of food safety in this country. Only by expediting our actions can we narrow the gap between what we know and what we do. Reemergence of disease, even in rich and powerful countries, and the threat of bioterrorism should make us more alert than ever to keep up our knowledge and roll up our sleeves simultaneously.

RELATED ARTICLE: Did you know...

Up to 30% of people in industrialized countries suffer from suffer from foodborne diseases each year.

source: World Health Organization.

Dr. Leo F. Parvis researched environmental health science as a graduate student in the Mediterranean region for three years in the late 1980s. In 1998, he received a Ph.D. in public health from Walden University in Minneapolis, Minnesota. Dr. Parvis has spent many years working in both the public and the private sectors on issues related to environmental health and education research. Currently, he is writing a book for parents--and professionals who work with parents--about protecting children from environmental health problems. He will be contributing material for the "Learning from Experience" column in every other issue of the Journal. Questions and/or comments for Dr. Parvis can be sent to <[e-mail]>.