1. AAAS Annual Meeting Seattle, Washington February 14, 2004
Food Safety Priority Setting Constructing the Decision Tools for a More Science- and Risk-Based Approach
AAAS Annual Meeting
Seattle, Washington
February 14, 2004
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

2. Presentation Overview
FSRC background
FSRC research agenda
Risk ranking models
Prioritizing opportunities to reduce risk
Establishing a conceptual framework for priority setting models and tools
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

3. FSRC Background
Formed in 2002 as a multidisciplinary collaboration to improve public health
Responding to calls by NAS and others for a more science- and risk-based food safety system
Objective is to foster progress toward such a system by developing the analytical and decision tools required to implement it
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

4. FSRC Background (con’t)
Member institutions and steering committee
U. California at Davis (Jerry Gillespie)
U. Georgia (Mike Doyle)
Iowa State (Cathie Woteki)
U. Maryland (Glenn Morris)
U. Massachusetts (Julie Caswell)
Michigan State (Ewen Todd)
Resources for the Future (Mike Taylor)
Key to success is collaboration with all food safety stakeholders: government, industry, consumer and academic
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

5. The Public Health Issue
Significant burden of illness, including --
5,000 deaths
325,000 hospitalizations
76 million cases
Illness is caused by complex interaction of factors from production to consumption
Most illness is preventable with the right combination of interventions
The Issue: How best to target interventions and allocate resources to reduce illness?
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

6. The FSRC Research Agenda
Developing models and decision tools required for risk-based priority setting and resource allocation
Requires tools for --
Ranking risks (prototype developed; work in progress)
Prioritizing opportunities to reduce risk (project launched)
Allocating resources to maximize risk reduction (long range goal)
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

7. Risk Ranking Model and Decision Tool
FSRC has developed a prototype computer model for ranking public health impact of specific pathogen-food combinations
“Top-down” model that integrates data from multiple sources, including data on --
Incidence of illness associated with specific pathogens
Attribution of illnesses to specific foods
Valuation of health outcomes
Model produces rankings of the public health impact of specific pathogen-food combinations
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

8. Risk Ranking Model Interface
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

9. Risk Ranking Model Outcomes
Number of cases
Number of hospitalizations
Number of deaths
Economic cost
Monetary valuation
Cost of illness (COI)
Willingness to pay (WTP)
Quality Adjusted Life Years (QALY)
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

10. Risk Ranking Model Attributes
First step in priority setting
Provides a tool, not an answer
Designed to be --
Transparent
Flexible
Adaptable
Accessible
Highlights data needs
It’s a work in progress
Video demonstration at
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

11. Prioritizing Opportunities to Reduce Risk
This is the BIG CHALLENGE
It’s what policymakers need in a science- and risk-based system to allocate resources and efforts in ways that maximize risk reduction
Requires consideration of the magnitude of the risk AND the feasibility, effectiveness, and cost of risk reduction interventions and strategies
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

12. Prioritizing Opportunities to Reduce Risk
Building the models and decision tools to do this is the central theme of the FSRC research agenda
Requires multiple models and decision tools to deal with all the factors relevant to priority setting
Begins with an integrated, systems approach to food safety
FSRC has just launched a project to develop the conceptual framework for this approach and the needed tools
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

13. An Integrated, Systems Approach to Food Safety
Foodborne illness results from the interaction of multiple factors, arising from farm to table, that affect both causation and prevention of illness
Opportunities to reduce risk thus arise across the food system
Prioritizing opportunities to reduce risk requires --
an integrated understanding of both causation and prevention, and
tools for identifying the most cost effective interventions and strategies to reduce risk
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

14. Analytical Needs Tools must meet these analytical needs --
Risk-based assessment of foodborne hazards
Ranking of public health impacts
Measurement and valuation of the benefits of reducing risk
Evaluation of the effectiveness and cost of risk reduction intervention options
Integration of these analyses to prioritize risk reduction opportunities
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

15. Constructing the Models and Decision Tools

16. What Do We Mean By “Model”?
Models are representations of important functional relationships in parts of the food safety system, coupled with data that permit these relationships to be understood and analyzed
The risk ranking model is the algorithm that integrates incidence, attribution and valuation data PLUS the data on these risk ranking factors
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

17. What Do We Mean By “Decision Tool”?
Decision Tools are computer- and web-based, interactive programs that organize and aggregate information needed for decision making
The risk ranking decision tool is the interface with the model that allows analysts to alter assumptions, choose among relevant data sets, and evaluate a range of “what if” scenarios
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

18. Risk Assessment and Causation Model
First critical step in risk ranking and priority setting
Grounded in standard risk assessment approaches from toxicology and epidemiology
Causation component focuses on the exposure event that causes illness, which is the interaction of an agent’s inherent toxicity, level and duration of exposure, and sensitivity of the consumer
And considers the transmission pathway, which includes all the factors that lead to the presence of an agent in food at a level capable of causing illness
An understanding of causation provides a guide to prevention
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

19. Public Health Outcomes
Understanding public health outcomes is --
The starting point for priority setting at the risk ranking stage
The benchmark for evaluating the effectiveness and the benefits derived from alternative risk reduction interventions and strategies
Public health outcomes follow from the risk assessment and drive the overall system
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

20. Risk Ranking Model and Decision Tool
Current prototype addresses illnesses associated with 28 known pathogens and attributes them to specific food groups
As data on food attributable risk and valuation of health outcomes are refined, it will permit comparisons and rankings based on several measures of public health impact
Risk rankings are the starting point for priority setting
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

21. Benefits Measures
Benefit measures are derived from the risk ranking model
Values placed on illnesses associated with a pathogen-food combination for ranking purposes become benefit measure when illness is reduced
As incidence rates and patterns change over time, the risk ranking model reveals public health benefits of risk reduction and provides basis for up-dating risk-based priorities
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

22. Intervention Options Model and Decision Tool
Like causation, prevention of foodborne illness is affected by behaviors and events throughout the chain from farm to table
Cost effective strategies to reduce illness require knowing which intervention options at what point in the system will make the greatest contribution to reducing risk
This requires predictive modeling of intervention options based on feasibility, effectiveness, and cost
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

23. Intervention Options Model and Decision Tool: Current Practices
Modeling of intervention options to address a foodborne hazard must begin with the base case of current practices, and ask:
What current practices and interventions are addressing the hazard?
How effective are current practices and interventions?
What are the costs to government? Private sector? Consumers?
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

24. Intervention Options Model and Decision Tool: Identifying Options
Next step is identifying intervention options, which means asking
Are there alternative practices or technologies that could prevent or mitigate hazards at particular points in the chain?
What are the obstacles to their adoption?
How might adoption be induced through government regulation? Market-based incentives? Research and education?
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

25. Intervention Options Model and Decision Tool: Effectiveness & Cost
Once plausible intervention options are identified, their potential effectiveness and cost in reducing illness must be modeled predictively, taking into account
Likely effectiveness of the intervention itself in reducing the targeted risk factor
Interaction of the intervention with other factors affecting illness outcome throughout the food chain
Measures of costs and cost effectiveness
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

26. Priority Setting Decision Tool
Integrates results from the risk ranking and intervention options models
Permits linking of interventions with health outcomes and
Analysis of the potential public health benefits of alternative interventions
Ranking of risk reduction opportunities and strategies, based on public health impact, cost effectiveness, and benefit/cost ratios
Becomes a tool for planning, priority setting, and risk management
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

27. Priority Setting Decision Tool: Data Realities
Models and decision tools need data to be useful
Enormous amount of the needed data has already been generated by government, industry, and academia
Models and tools can provide an incentive and vehicle for sharing existing data
Models and tools can help identify the most critical needs for future data collection
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

28. Policy Choice & Resource Allocation
Goal is to increase the role of risk analysis and public health-oriented priority setting in the food safety system
Policymakers also must consider
Legislative mandates (e.g. pre-market approval systems and mandated inspection activity)
Other public health and public confidence priorities (e.g. bioterrorism and BSE)
We need frameworks that can guide policy choice and resource allocation with all relevant factors in mind
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

29. Feedback Loops
The systems approach to food safety is a continuous loop that incorporates constant feedback
The effectiveness of interventions and resulting changes in public health outcomes are measured and the results used to adjust risk rankings and priority setting
The focus throughout is on making the best use of available resources to achieve better public health outcomes
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH

30. Conclusion
Goal is to make targeted data collection, risk analysis, and program evaluation “built in” features of how society addresses foodborne illness
The test of the FSRC’s models and decision tools is whether they are useful for this purpose
FSRC is building on the work of many
Success requires creativity and effort of scientists, policymakers, and food safety practitioners throughout the system
Food Safety Research Consortium
A MULTI-DISCIPLINARY COLLABORATION TO IMPROVE PUBLIC HEALTH