Healthy People 2000: National Health Promotion and Disease Prevention Objectives is a statement of national opportunities. This prevention initiative presents a national strategy for significantly improving the health of the American people in the decade preceding the year 2000. Healthy People 2000 recognizes that lifestyle and environmental factors are major determinants in disease prevention and health promotion. It provides strategies to significantly reduce preventable death and disability, to enhance quality of life, and to reduce disparities in health status between various population groups within our society.
Healthy People 2000 defines three broad goals: to increase the span of healthy life for Americans; to reduce health disparities among Americans; and to achieve access to preventive services for all Americans. These goals are supported by 300 specific objectives that set priorities for public health during the 1990's. Subobjectives for minorities and other special populations were also established to meet the unique needs and health problems of these populations. Healthy People 2000 uses the three approaches of health promotion, health protection, and preventive services as organizing categories for 22 priority areas. For each of these priority areas, a U.S. Public Health Service agency was designated to develop an implementation plan and to coordinate activities directed toward attaining the objectives.
Work on the report began in 1987 with the establishment of a consortium that has grown to include over 300 national membership organizations and all the State health departments. The Healthy People 2000 Consortium, facilitated by the Institute of Medicine of the National Academy of Sciences, helped the U.S. Public Health Service convene eight regional hearings at which over 750 individuals and organizations presented testimony. This testimony professionals who crafted the health objectives. After further extensive public review and comment from more than 10,000 people, the objectives were refined, revised, and published as Healthy People 2000.
Food and Drug Safety is one of the 22 priority areas of Healthy People 2000. The Food Safety objectives (chapter 12) of Healthy People 2000 are listed below.
Health Status Objectives
Reduce infections caused by key foodborne pathogens to incidences of no more than:
Disease (per 100,000) 1987 Baseline 2000 Target Salmonella species 18 16 Campylobacter jejuni 50 25 Escherichia coli 0157:H7 8 4 Listeria monocytogenes 0.7 0.5
Baseline data source: Center for Infectious Diseases, CDC
Salmonella enteritidis, Campylobacter jejuni, Escherichia coli 0157:H7, and Listeria monocytogenes are four of the most important foodborne pathogens in the United States, based on the number of reported cases that occur and their severity. Because infections by Salmonella and E. coli 0157:H7 are actually increasing in incidence, decreasing their occurrence will be difficult. The growing proportion of our population that is compromised by immunologic deficiencies and age exacerbates the problem, because these subpopulations are more susceptible to infection and to dying as a result of infection.
Educational materials to increase consumer awareness of methods to prevent foodborne diseases have been developed and distributed by public and private organizations at the national, State, and local levels. However, investigations of foodborne disease have repeatedly shown that many consumers do not understand the hazards or do not take precautions to reduce their risks. Lack of effective consumer education is one reason for the concern about contamination of raw foods. Farm management strategies to reduce rates of colonization of farm animals by these four human pathogens should also be explored, including control of feed and water supplies as well as environmental controls. Sanitary shipping, slaughter, and processing operations are also vital to reducing cross-contamination.
Reduction in sporadic listeriosis cases will require altering food preparation habits through public information campaigns for foods associated with this disease. Indicators of microbial growth and/or time and temperature abuse should be used to alert food handlers at each stage of food processing when the product has been handled incorrectly. Such indicators would also increase the awareness of food handlers and the public at large about the importance of preventing time and temperature abuse. Methods that reduce the incidence of these four key pathogens may also reduce foodborne illnesses caused by certain other bacterial, viral, and parasitic pathogens.
This objective assumes that, during the coming decade, investigators in public and private sectors will be able to learn more about the natural reservoirs of these bacteria and their dissemination during food processing and will implement improvements in industry and regulatory agencies' detection of potential sources of contamination. In addition, existing surveillance efforts need to be strengthened to measure the clinical and economic impact of foodborne disease and to monitor efforts to reduce the incidence of food borne diseases.
Reduce outbreaks of infections due to Salmonella enteritidis to fewer than 25 outbreaks yearly. (Baseline: 77 outbreaks in 1989)
Baseline data source: Center for Infectious Diseases, CDC.
Outbreaks of Salmonella enteritidis infections increased dramatically over the decade of the 1980s, especially in the New england and mid-Atlantic States. this food borne disease is often traced to contaminated eggs. It produces severe diarrhea, fever, vomiting, and cramps and can cause death. The 77 outbreaks reported in 1989 involved 2,394 cases and 14 deaths. This disease can be particularly dangerous for infants, older adults, and immunocompromised people. With the projected increase in the number of older people and people with AIDS, death and illness caused by Salmonella infections are expected to continue to increase.
Thorough cooking kills Salmonella, but heavily contaminated eggs used in some standard cooking methods (as in preparation of sauces, meringue, scrambled or soft-boiled eggs) may still not be safe. Risk increases significantly if raw or undercooked eggs are left at room temperature more than 2 hours. Outbreaks of salmonellosis often result from eating contaminated foods at picnics and parties for which food was prepared privately, rather than commercially. For this reason, public education about proper food preparation is crucial to efforts to reduce the number of outbreaks as well as individual cases. The U.S. Department of Agriculture provides information on safe cooking and handling of eggs, as well as other potentially hazardous foods, through both a central hotline and county extension home economists.
Increase to at least 75 percent the proportion of households in which principal food preparers routinely refrain from leaving perishable food out of the refrigerator for over 2 hours and wash cutting boards and utensils with soap after contact with raw meat and poultry. (Baseline: For refrigeration of perishable foods, 70 percent; for washing cutting boards with soap, 66 percent; and for washing utensils with soap, 55 percent, in 1988)
Baseline data source: Food Safety Survey, FDA; Diet-Health Knowledge Survey, USDA.
Government inspection and strict standards within the food industry assist in the job of keeping the American food supply safe and wholesome. The law requires that inspectors check and recheck the safety and quality of meat and poultry from the time the animals arrive at the packing plant until the final product is ready for sale. The individual consumer also plays an important role in keeping food safe. Preventing food poisoning must begin when food is purchased at the supermarket and must continue through storing, preparing, cooking, and serving the food at home. The U.S. Department of Agriculture has developed 7 commandments of food safety:
1. Wash hands before handling foods.
2. Keep it safe, refrigerate.
3. Don't thaw food on the kitchen counter.
4. Wash hands, utensils and surfaces again after contact
with raw meat and poultry.
5. Never leave perishable food out over 2 hours.
6. Thoroughly cook raw meat, poultry, and fish.
7. Freeze or refrigerate leftovers promptly.
Extend to at least 70 percent the proportion of States and territories that have implemented model food codes for institutional food operations and to at least 7- percent the proportion that have adopted the new uniform food protection code (FDA Food Code) that sets recommended standards for regulation of all food operations. (Baseline: For institutional food operations currently using FDA's recommended model codes, 20 percent; for the new Unicode to be released in 1991, 0 percent, in 1990)
Baseline data source: Center for Food Safety and Applied Nutrition, FDA.
A primary concern of this objective is to extend protective standards and regular monitoring to food services that may tend to be missed. Such food services include health care facilities, congregate feeding programs for older adults, day care and Head Start programs, meal programs for the homeless, and other food services that are not usually covered by programs on retail or commercial enterprises.
Health and sanitation inspections directed to restaurants, cafeterias, congregate feeding programs, and food stores are a basic part of the public health protection system in this country. They are authorized by codes adopted at the State level. In all 56 States and territories and the District of Columbia have authority to set standards and monitor adherence on the part of food service providers. In the past, separate codes have generally been promulgated for restaurants and cafeteria operations and for food stores principally marketing packaged foods and fresh produce. The variety of possible settings for food services that involve food handling and preparation for immediate consumption and the expansion of food preparation services in settings that previously offered only packaged foods and fresh produce have blurred the distinctions between the separate inspection code systems. From the perspective of protecting the health of the public, the requirements for ensuring safe food are not essentially different, regardless of the nature of the retailer or food service. Neither does it appear appropriate to hold one type of food service provider to a set of standards that are more or less demanding than those applied to another provider of the same kind of food. The new FDA Food Code (published in January 1994) will hold all food operations to the same standard.
Healthy People 2000: 1991, 1992