EPID 600 - Introduction to Public Health Practice - Fall 2017

Food & Law Lecture


Food protection:

Start by looking at the diseases  Food Borne Pathogens  then at this link to  Food borne Diseases.   After this you should look at this chart. As well as the items in the next paragraph consider the elements in this notice and how simple actions can prevent food poisoning.  Take a look at the VDH website portal.  To enhance Dr. Buttery's slides (See Below) is this VDH .pdf file Regulations for Food Service. (  Most of our discussion issues can be found on pages 13 & 14 - Article 4 - Inspections and correction of Violations.  Do you think mandatory posting of food inspection scores in each restaurant, visible to the public, might help improve food hygiene within a restaurant? Think about the use of cellphones and why not to use them in a restaurant

The VDH web site has completed its food page and the related regulations, statutes and forms, as well as  the policies and philosophy.  While much of information may be found by looking at the Food Sanitation  Related web sites review the reports at the beginning of the food web sites which have been added for this evening's presentation.  I strongly recommend scanning all these pages but look at the HACCP web page in detail.  The HACCP program is the most important international standard yet developed to protect food from growth to service.  In particular look at the HACCP Principles and at least scan the elements within each principle well as the Guidelines. Then scan appendices E and F, examples of Critical Control Point decision trees. Be sure you understand how a HACCP plan is developed and the 7 guiding principles. Finally review the USDA's Food Safety Inspection Service (FSIS)Web Page.   How effective do you think the FDA's food response network will be?

Review Dr. Buttery's Power Point slides.

Scan this recent publication from the IOM (particularlythrough the first 15 pages), and look at this newspaper article on performance of the federal programs (2012).

In 2016, FoodNet identified 24,029 infections, with 5,212 hospitalizations and 98 deaths from foodborne-related illness. FoodNet tracked nine pathogens and their changes in incidences in 2016 versus 2013-2015. The following were either confirmed or CIDT positive-only infections:

Campylobacter had the highest incidence (confirmed = 11.79 per 100,000 persons; confirmed or CIDT positive-only =17.43 per 100,000), followed by Salmonella (15.40; 16.66), and Shigella (4.60; 5.94).

But almost a third of both Campylobacter and Yersinia and almost a quarter of STEC and Shigella infections were positive via culture-independent diagnostic testing, but without culture confirmation. Moreover, the increase in CIDT positive-only infections for six pathogens, including Vibrio and Salmonella, more than doubled versus 2013-2015 (114% increase, range: 85% to 1,432%).

Additional Reading:
An Important Text, available from the IOM: Scientific Criteria to Ensure Safe Food Review the Executive Summary.

Use the internet to see what you can find out about the recent outbreaks,looking at both the pathogen and the source of contamination..


Health Laws of Virginia
A Commissioner's Perspective (scan to get a sense of the breadth of the laws in Virginia)

C.M.G. Buttery MD MPH

For a very quick overview of the Health Department's and Commissioner's responsibility for law enforcement read the rest of this page [You will be taught public health law in a course by Dr. Vance. He will give you the technical details of the laws that govern public health from Federal through state and local laws.]

Click Here to obtain an overview of the process for making state health laws,

When State Health Commissioner, I could only enforce laws that came to me through the State Legislature. I had no authority to enforce health laws based on federal statutes, unless these statutes were codified into state law or adopted as part of a state law.

For example, the FDA enforces federal law regarding food safety, I could only refer violations to federal agencies unless the state had not adopted its own statutes in Title 35 of the Code of Virginia.

State Health Code, Title 32 of the state code, now has 8 chapters. There used to be 2 more for management of Medicaid, but they were removed from the health code and transferred into administration when Medicaid became a separate state agency in 1986. In addition to the Health Code there are statutes in the other titles of the state code that require action of the health department, either by direct enforcement or by cooperation. (Code Titles in Chapter 32 of the state code)

Chapter 1

Organization and administration of the department as well as the appointment of the Commissioner and members of the Board of Health, also the organization of local health departments. This chapter sets standards for the selection of the Commissioner and the structure and functions of the State Board of Health which, in Virginia, is an advisory board to the Commissioner. In Texas, this is an administrative board. It selects the commissioner, with no oversight from the Governor.

What benefits or drawbacks do you believe might accompany either process?

Chapter 2

Focuses on disease protection and dwells on immunization standards and reporting of communicable disease. Any changes to the immunization schedule have to be approved by the Board and pass through the "Administrative Process", unless deemed an emergency, and approved as such by the Governor.

What considerations do you think the Commissioner must consider before placing a disease on the list for either immunization or reporting?

Chapter 3

Medical Care services deal not with a state medical care system, but with public health, and focuses on Maternal and Child Health (including licensing of midwives), the Virginia Voluntary formulary and the hemophilia program.

During Dr. Tweel's presentation you will hear discussions of women's health problems and child health. Most of the discussion was on programs. What oversight would the Commissioner want and how would it be exercised?

Chapter 4

Health Planning, deals with the Certificate of Need Program (COPN), health planning and resources development, a State Health Coordinating Committee and regional perinatal services.

What evidence have you seen of health planning? What is COPN supposed to accomplish? How effective has health planning been in Virginia? What is the current emphasis of health planning in the State Health Department?

Chapter 5-

Licensing of Medical Care Facilities focuses on hospitals, nursing homes, Home Health Agencies, Hospices, EMS programs and blood bank licensing. These actions are necessary for the institutions to obtain federal reimbursement.

What Federal Act prompted this oversight? Has Federal oversight improved the quality of care? How can you measure the effectiveness of this oversight?

Chapter 6

Environmental Services regulate sewage disposal, water supplies, hazardous wastes, mosquito control, migrant camps, radiation control, and toxic substances information

How is enforcement achieved for most programs? When do you resort to use of the courts?

Chapter 7

-Vital Statistics: births, deaths, adoptions, name changes, marriages.

How important is collection of these data, why is timeliness important, how can collection be improved?

Chapter 8

Postmortem examinations and medical examiner system.

In addition to responsibilities outlined in the Health Title of the state code are statutes that ensure payment to universities and colleges for training health providers and in

Title 28.1

Covers responsibility for Fish, Oysters and Shellfish managed by the environmental health division.

Title 29

Contains laws related to rabies control, responsibility of animal and game wardens, care of pigeons and laws barring fighting animals. If the local health director has responsibility for animal control the ruling codes are found here.

Title 35

Controls campgrounds, tourist establishments, and restaurants for which the Commissioner of health promulgates standards such as those for food preparation services (which you have already heard discussed tonight.)

Title 40

Labor law involves the Health Commissioner's expertise and advice about toxic chemicals

Title 54

Provides guidance the Commissioner guidance in the use of health professionals in Health Department programs.

Title 62

Defines the relationships between the health department and the departments found in the secretariat of natural resources.

In addition to the above are various commissions on which the Commissioner or delegated staff members sit to give advice such as:

The Developmental Disabilities Council
The Solid Waste Commission
The Migrant Workers Commission
The Health Services Cost Review Council
The Hazardous Waste Services Act Board
The Council on the Environment
An Agency, which provides Sewer and Water, loans to localities
Soil Conservation Districts
The Virginia Water Resources Research Center at VPI
and the Virginia Institute of Marine Sciences.

Recommended Reading: Gostin Larry O.: Public Health Law: Power, Duty, Restraint. University of California Press Ltd. 2000 Chaps: 1 & 4. [Note: This book is the required reading for Dr. Vance's Course on PH Law]

To help understand the changing field of public health law philosophy and implementation as it relates to the FDA look at this new IOM publication; For the Public's Health: Revitalizing Law and Policy to Meet New Challenges. Read the summary on pp 17-25, quick scan the remainder, Then read this Commentary from JAMA "Food and Drug Administration Regulation of Food Safety", then "Dietary Supplements—Regulatory Issues and Implications for Public Health."

Food Service URLs.