Screen shot 2011-01-19 at 5.06.41 PM.pngThe Center for Science in the Public Interest (CSPI), released today a nationwide report card grading the 50 states and the District of Columbia on how well they detect, investigate, and report outbreaks of foodborne illness. The report shows that there is some room for improvement. CSPI assigned a letter grade and created an outbreak profile for each state.

A’s: Oregon, Minnesota, Florida, Hawaii, Maryland, Washington, and Wyoming.

B’s: Colorado, Illinois, Kansas, Maine, Michigan, Ohio, and Vermont.

C’s: Alabama, Alaska, California, Connecticut, Iowa, New Hampshire, North Dakota, and Wisconsin.

D’s: Delaware, the District of Columbia, Georgia, Idaho, Massachusetts, Montana, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, South Dakota, Tennessee, Utah and Virginia.

F’s: Arizona, Arkansas, Indiana, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, Nevada, New Mexico, Oklahoma, South Carolina, Texas, and West Virginia.

Now, let’s look at resources to get every State and D.C. to an A. (See Report)

Perhaps the answer to the low grades may lie in Sec. 205 in the recently passed Food Safety Act signed by President Obama. The Section would:

– coordinate Federal, State and local systems, including complaint systems and networks of public health, food regulatory agencies and labs;

– facilitate sharing of findings between FDA, USDA, State and local agencies, and the public;

– develop improved epidemiological tools;

– improve systems that attribute an outbreak to a specific food;

– expand fingerprinting and other detection strategies for food-borne agents;

– allow public access to aggregated, de-identified surveillance data;

– publish findings at least yearly;

– rapidly initiate scientific research by academic institutions;

– integrate surveillance systems and data with other biosurveillance and public health entities.

Also, is the creation of “PARTNERSHIPS,” which appears to actually be a “working group of experts and stakeholders from Federal, State and local food safety and health agencies, the food industry, consumer organizations and academia.” In addition, Sec. 205 (c) adds “strengthen[ing] the capacity of State and local agencies to carry out inspections and enforce safety standards” and, “the Secretary to (within a year) complete a review of State and local capacities, including staffing levels, laboratory capacity, outbreak response, inspection and enforcement functions.”

  • Gabrielle Meunier

    Perhaps Vermont has improved considerably since my experience over two years ago, but I would have given them a D based upon my experience. I wonder if any outbreaks were followed or if the judging criteria was just what protocol they say they follow and not true performance. If the Outbreak I was part of was given a B for performance, then I’d hate to see what their D is!

  • I think they have created a benchmark my assigning a letter grade showing the outbreak profile of each state. This will motivate other states to follow the guidelines and bring changes in their system.

  • Art Davis

    It’s hard to take the “Statistics” as reported very seriously, see Bill Keene’s comment for example. That said how about correlating the results as given with some other metric, perhaps “$/capita spent on the state health department”, “Number of state employees involved in tracking illness”, or “Number of trained epidemiologists on state health department staff”. It might be interesting to see if there are correlations with potential to provide guidance to those trying to improve individual states abilities. I’ll venture a guess that a staff of a few well trained epidemiologists backed by the funding and commitment that established and runs “Team diarrhea” in Minnesota will provide an “A” grade under any measuring system.

  • Dog Doctor

    Art, you are correct there is no agreed measure of health departments or response capability but most people who are involved in the food borne outbreaks know some states do a better job than others. Especially with budget cuts recently (see; or ) where the country has lost over 25,200 state and local public health officials. This mirrors what happened with the last economic downturn in 1991-92 ( The difference between response is as varied as states i) it can be from lack of personal ii) lack of budget, iii) lack of training, iv) food illness isn’t priority related to other public health issues, childhood vaccines (see page 22 and 22 of the report listed below to look at some of those priorities. If you want to see per captia spending in Health department go to
    People may not agree with CSPI report but it re emphasizes the need for the Federal government to help the states develop a minimal standard of ability. Hopefully this will help the new congress see the need to fund the FDA modernization act which has a section for improving state capabilities but it was not funding. Basically this report highlights the vital need for the United States to look at our health infrastructure and determine what our national priorities are. We need to develop a strategy for funding preventive medicine activities from food protection, to preventive care, to healthy living education and programs which will reduce the nation’s cost of health care because preventable chronic diseases are linked to the rapid escalation of costs.
    A PS note for Bill Anderson, Mark McAfee, if you want to sell raw milk move to the “F” states since it is the states and locals that detect these outbreaks and if they have the resources, you can skate under the radar. Just make sure none of your customers live in the “A” states next store.

  • I’m looking at the states in each category and am having difficulty seeing a pattern. It looks like many states in the D and F range are smaller and likely have smaller economies. Then again, New York got a D, and California got a C — so size of economy is not likely a factor.
    I like that you focused on steps that the lower ranked states can take to improve their status. But, going back to the financial point, would implementing these suggestions take a significant investment? Obviously it would be worth it. But I’m curious whether improvements can be made cost efficiently.
    Thanks for the post!

  • Caitlin Catella

    CSPI really appreciates this feedback. We hoped that this report would open dialogue between food safety experts, and we’re gratified for the positive responses and constructive criticisms from our public health partners.

    It is correct that the state rankings were based on the median number of reported foodborne outbreaks per million population. We decided to use the number of outbreaks reported to the CDC because it is the only credible measurement available for every state and D.C. that allows for comparison between states.

    It is important to note that when determining the grades for each state, we used all reported outbreaks– solved, unsolved, single-state and multi-state– when calculating the median number of outbreaks reported per million population. When discussing single-state outbreaks, we were introducing a new element in outbreak reporting– foodborne outbreaks that are ‘solved,’ meaning that both a pathogen and food source are identified. (Note- these are the outbreaks we include in our Outbreak Alert! database).

    We agree wholeheartedly that funding and staffing data would add texture and detail to the existing outbreak data. In fact, we initiated the study as an analysis of state budget data. But, even after repeated attempts to survey states to determine their food safety budgets, the states we contacted were unable to provide that information in a way that could be compared or analyzed. Each state budget differs significantly in how they allocate dollars and define programs. We hope that this information will become available for future analysis.

    Similarly, health department employees are often categorized under a variety of titles: preventable disease, environmental health, infectious disease, epidemiology & surveillance, etc. Each of these programs could potentially work on food safety and outbreak investigation, but the staff cannot easily be compared between states in terms of their time spent on food safety. In addition, during consultations with state and local health department epidemiologists, we learned that it is rare, especially now, with the high number of cuts to public health programs, to have a staffer who solely works on food safety issues. More often, a “food safety” staffer may also promote H1N1 vaccinations, inspect swimming pools, work with the community to control pests, and perform other public health duties.

    As the first report of its kind on the states, we recognize that there is more to be done, and we look forward to continued dialogue and research collaboration moving forward. If a state has information on better predictors of the strength in foodborne illness investigation, CSPI would be eager to explore those variables.

    Caitlin Catella, MPH
    Sarah Klein, JD, MA