1. Addressing Food Safety State Perspective Timothy Jones, M.D. State Epidemiologist Tennessee Department of Health

4. Produce from Farm to Table Production and harvest Initial processing Distribution Final processing Consumption Irrigation water, manure, field sanitation Wash water, handling Ice, dirty trucks Washing, handling, cross- contamination Time and temperature

5. WHO State Health Department FDA Regional HD County HD CDC USDA EPA

6. Many Pieces 3000 local health departments 50 states –Health Departments –Departments of Agriculture –Public Health Laboratories –Environmental programs

7. Public Health Law State laws –Disease reporting –Disease control –Restaurant inspections

9. State Health Department Programs Disease surveillance Communicable disease reporting Case follow-up Outbreak investigation Foodservice inspections Coordinate communication

10. Infrastructure Little state support Highly variable Supported by other programs –Bioterrorism –WNV –Pandemic influenza

11. Outbreaks EtiologyVehicle

12. Foodborne Outbreaks, TN

13. Outbreaks Per State, 1990-2003

14. 90% investigated locally

15. Human Animal Food

16. Human Animal Food Infection Terrorism Chemical

17. Human Animal Food Infection Terrorism Chemical Factory Farm Restaurant Out-of-state Multistate

18. All national data starts local

19. Ill people Medical providers Restaurant inspections Surveillance systems Ag / veterinary programs State Health Departments

20. Ill people Medical providers Restaurant inspections Surveillance systems Ag / veterinary programs State Health Departments Other states CDC FDA USDA Industry Public

21. WHO FAO PPS APHD WHA UNEP IUFOST IUPAC WMO OECD JECFA JMPR JEMRA OIE IPCS INTOX GEMS IAEA OCHA GPHIN SALMSURV IHR CDC BPRO FoodNet NARMS HACCP FDA USDA FSIS GSFS GAO RCED DOJ FBI OCI FERRET OIG ARS OEP *The Deputy Assistant to the Assistant Deputy Administrator for District Enforcement Operations agreed with this report…

22. Communication Ad hoc Difficult to coordinate Highly variable Barriers to sharing data

23. Challenges Increasing More multi-state outbreaks –Food, people move more Better laboratory technology Faster data reporting

24. There Is Hope Model programs exist FoodNet Council to Improve Foodborne Outbreak Response OutbreakNet Epi-Ready Etc., etc. …

25. Necessary Resources Personnel Communication Authority Data sharing systems Training

26. Recommendations Align resources with threats Recognize roles at all levels Improve resources at all levels Focus on prevention Update practices Establish performance standards Improve education Interagency communication

27. Tim.f.jones@state.tn.us

29. Core Public Health Functions Assessment –Monitor health –Surveillance – data for decision making –Epi studies – science behind PH IOM, The Future of Public Health, 1988

30. Core Public Health Functions Policy development –Inform & educate –Mobilize community partnerships –Develop policies Assurance –Assure competent public health work force –Provide patient care –Enforce laws

31. Public Health Approach ProblemResponse Surveillance: What is the problem? Risk Factor Identification: What is the cause? Intervention Evaluation: What works? Implementation: How do you do it?