Obese children and adolescents are at risk for health problems during their youth and as adults. For example, during their youth, obese children and adolescents are more likely to have risk factors associated with cardiovascular disease than are other children and adolescents.1 Childhood obesity is associated with dietary practices, environmental impacts, familial impacts and physical activity. Healthy lifestyle habits, including healthy eating and physical activity, can lower the risk of becoming obese and developing related disease. For dietary practices, the U.S. Department of Agriculture’s (USDA) National Institute of Food and Agriculture (NIFA) announced $6.3 million funding for projects to help combat childhood obesity which will benefit more than 12 million children in the United States.2 “Obesity is more likely to affect low-income children,” said NIFA Director Sonny Ramaswamy. NIFA investments help at-risk community by promoting nutrition and living condition which will meanwhile save the long-term healthcare costs.3 For environmental impacts, accumulating evidence suggests that some type of childhood obesity represents a complex metabolic disease resulting from an interaction with environmental factors, including dietary macronutrients. 4 For family impacts, within the home: parent-child interactions and the home environment can affect the behaviors of children and youth related to calorie intake and physical activity. Parents are role models for their children who are likely to develop habits similar to their parents. For physical activity, numerous health authorities have identified policy interventions as promising strategies for creating population-wide improvements in physical activity. The implementation and evaluation of school PE interventions leads to a set of lessons related to epidemiology and evidence-based policy. The U.S. Department of Health and Human Services recommends that young people aged 6-17 years participate in at least 60 minutes of physical activity daily.5 More than 80% of adolescents do not do enough aerobic physical activity to meet the guidelines for youth. Evidence show that more PE classes will not weaken the academic performance but improve it instead. Considering of sedentary behavior, children spend a considerable amount of time with media. One study found that time spent watching TV, videos, DVDs, and movies averaged slightly over 3 hours per day among children aged 8-18 years. Several studies have found a positive association between the time spent viewing television and increased prevalence of obesity in children. 1 Ogden et.al., National Center for Chronic Disease Prevention and Health Promotion, Childhood obesity Facts & Statistics, 2010 2 NewsRx Health & Science, Nutritional and Metabolic Disease and Conditions-Obesity; USDA announces $6.3 million in available funding to combat childhood obesity (Apr 23, 2017): 327 3 NewsRx Health & Science, Nutritional and Metabolic Disease and Conditions-Obesity; USDA announces $6.3 million in available funding to combat childhood obesity (Apr 23, 2017): 327 4 Garver, W.S., Newman, S.B., Gonzales-Pacheco, D.M. et al. Genes Nutr (2013) 8: 271. doi:10.1007/s12263 013-0339-5 5 U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington, DC: U.S. Department of Health and Human Services; 2008. Part 4: Solution Options: Answer the following questions about solution options for your issue. Use a matrix comparing each of 3-5 solution options on the following criteria, elaborated below: effectiveness, costs, equity, administrative burden, political feasibility. 31. What major approaches to solutions are being proposed? Are they big, small, old, new, complex, or simple? Are some solutions more incremental than others? Why is that important? How do the solution options differ? Have these changed over time: How and why? Are there state models and demonstrations? 32. How effective would each of these solution options be – compare estimates of effectiveness in solving the problem as it’s now described. 33. Who would benefit? Are the benefits concentrated or diffuse? How equitable would the solutions be in terms of serving equally the needs of various income, race, geographic, severity groups? Who made these estimates: GAO, OMB, CBO, DHHS, think tanks, interest groups, others? How do estimates differ and to what extent are they affected by political pressures and predispositions? What’s the best estimate of effectiveness that can be gleaned from the studies and analysis available? 34. How much would each solution cost – per case, total, one year, five years? How redistributive are the costs associated with each solution? Where would those costs fall – who would bear them? How equitable is the distribution of costs? That is, to what extent will costs be adjusted by ability to pay – the richer paying more, and the poorer paying less? Is means-testing proposed? Co-pays? Are the costs concentrated on powerful groups? 35. What administrative burden/transaction costs are associated with each solution. 36. What’s the political feasibility of each solution option? •Part 4 Page Limit: 4 page paper, FLORIDA STATE UNIVERSITY Foodborne Illness and Food Safety Policy in the United States Capstone Paper, Part 4: Possible Solutions Caitlin Murphy Cm13j@my.fsu.edu Possible Policy Solutions for Reducing Foodborne Illness & Increasing Food Safety Foodborne illness is a result of failures at several levels, including the federal, state, and person level. Policy solutions must address issues across the food safety system from food production to food consumption in restaurants and households. Three policy approaches being proposed in relation to food safety include: (1) full funding and implementation of the FDA Food Safety Modernization Act; (2) increased public awareness of and education about foodborne illness and food safety techniques; and (3) centralizing food safety through a collaborative mechanism, such as consolidating federal food safety activities under a single oversight agency. All of these solutions would provide diffuse benefits as the entirety of the American population benefits from safer food. Costs may be both narrow (fees placed on the food industry to fund the FSMA) and diffuse (taxpayer money used to increase CDC funding for education on foodborne illness). Full Funding & Implementation of the FDA Food Safety Modernization Act The FDA Food Safety Modernization Act provides new authority to the FDA and increases requirements for food inspections and other preventive practices with the goal of making the food safety system more proactive, rather than reactive. According to the Congressional Budget Office, the FSMA requires an additional $583 million for the FDA between FY 2011 to FY 2015. As of FY 2015, Congress had appropriated only $162 million of that estimate. For FY 2016, the President’s Budget requests $109.5 million for the FDA.1 To fund the FSMA, the FDA proposed user fees in the FY 2011 budget. “The Congressional Budget Office has estimated that if FSIS charged user fees, federal revenues would increase by $902 million in fiscal year 2011 and could offset inspection costs,”2 but the industry opposed user fees. Increasing Public Education on Foodborne Illness and Food Safety Techniques Many cases of foodborne illness are a result of poor food safety practices in the home, such as failure to thoroughly cook food. Public education is needed to increase awareness of the foodborne illness issue and reduce the prevalence of foodborne illness. 3 One of the goals of Healthy People 2020, a set of national goals and objectives for improving health in America, 4 is improving food safety and decreasing foodborne illness. Within that goal is the objective FS-5: “Increase the proportion of consumers who follow key food safety practices.”5 The U.S. Department of Health & Human Services recommends consumers follow four basic steps to protect themselves from foodborne illness: 1) Clean, such as washing hands for at least 20 seconds; 2) Separate, such as using different utensils for raw meat and produce; 3) Cook, such as using a food thermometer to ensure that food is cooked to the proper temperature; and 4) Chill, 1 U.S. Food and Drug Administration. (2015, March 3). President's FY 2016 Budget Request for FSMA: The Context and History of FSMA Funding. Retrieved from FDA.gov: http://www.fda.gov/Food/GuidanceRegulation/FSMA/ucm436160.htm 2 U.S. Government Accountability Office. (n.d.). Fragmented food safety system has caused inconsistent oversight, ineffective coordination, and inefficient use of resources. Retrieved from GAO.gov: http://www.gao.gov/modules/ereport/handler.php?ajax=true&1=1&path=/ereport/GAO-11318SP/data_center/Agriculture/Fragmented_food_safety_system_has_caused_inconsistent_oversight,_ineffective_coordination,_ and_inefficient_use_of_resources 3 4 Scott, E. (2003). Food safety and foodborne disease in 21st century homes. The Canadian Journal of Infectious Diseases, 277-280. U.S. Department of Health and Human Services. (2015, December 3). About Healthy People. Retrieved from Healthy People 2020: http://www.healthypeople.gov/2020/About-Healthy-People 5 U.S. Department of Health and Human Services. (2015, December 3). Food Safety. Retrieved from Healthy People 2020: http://www.healthypeople.gov/2020/topics-objectives/topic/food-safety/objectives such as refrigerating food promptly.6 In 2006, 67 percent of consumers washed their hands and surfaces often during food preparation (the Healthy People 2020 target is 74 percent), 87 percent of consumers did not cross-contaminate food products during food prep (2020 target: 92 percent), 37 percent cooked food to the proper temperature (2020 target: 76 percent), and 88 percent refrigerated food promptly (2020 target: 91 percent).7 Increased Collaboration Among Agencies & Consolidation of Food Safety Activities Though the FDA and USDA are the primary authorities in U.S. food safety, fifteen different agencies carry out federal food safety activities through at least thirty laws, which results in a fragmented system with “inconsistent oversight, ineffective coordination, and inefficient use of resources.”8 The U.S. Government Accountability Office (GAO) has been reporting on and calling for changes within the federal food safety system for decades. At the start of each new Congress, the GAO produces a report, titled the High Risk List, identifying areas in the federal government that are “high risk” or in need of reform due to waste, fraud, abuse, and poor management.9 In 2007, the GAO added food safety oversight to the High Risk List “because of risks to the economy, to public health, and to safety.” Food safety oversight remains on the list in 2015. 10 Since the GAO added food safety oversight to the High Risk List, the FDA and USDA have increased their collaborative efforts. The agencies work together on specific projects related to food safety but they still do not have a broader mechanism for fostering regular collaboration. Additionally, the FDA Food Safety Modernization Act provides much needed changes in the system, but it focuses mostly on one agency – the FDA – and fails to provide the broad collaborative mechanism needed. Narrowly focusing collaborative efforts on specific programs fails to get the FDA, USDA, and other agencies to see the bigger picture of how the system works to create safer food for the American people. Many food safety experts say “a centralized collaborative mechanism on food safety is important to foster effective interagency collaboration and could enhance food safety oversight.” 11 Two ways to centralize food safety activities include the creation of a government-wide food safety performance plan that includes all fifteen food safety agencies 12 or the consolidation of food safety activities under a single oversight agency. 6 U.S. Department of Health and Human Services. (n.d.). Check Your Steps. Retrieved from Foodsafety.gov: http://www.foodsafety.gov/keep/basics/ 7 U.S. Department of Health and Human Services. (2015, December 3). 8 U.S. Government Accountability Office. (2015, February). Report to Congressional Committees: High-Risk Series, An Update. Retrieved from http://gao.gov/assets/670/668415.pdf 9 U.S. Government Accountability Office. (n.d.). High Risk List. Retrieved from GAO.gov: http://www.gao.gov/highrisk/overview#t=0 10 U.S. Government Accountability Office. (2015, February). 11 U.S. Government Accountability Office. (2015, February). 12 U.S. Government Accountability Office. (2015, February). Foodborne Illness, Solution Options Evaluative Criteria Effectiveness Cost Equity 13 Full Funding & Implementation of the FDA Food Safety Modernization Act The FSMA focuses on expanding FDA authority and increasing FDA food safety activities.13 Despite the passage of the FSMA, the food safety system is still fragmented. CBO estimated the FSMA necessitates an additional $583 million for the FDA between FY 2011 to FY 2015. For FY 2016, the President’s Budget requests $109.5 million for the FDA.18 The FDA proposed user fees as an FSMA funding method in the FY 2011 budget, which were estimated to increase federal revenues by $902 million.19 Fully funding the FSMA would provide equal benefits for all Americans. Anyone who consumes food in the U.S. benefits from increased regulation and preventive actions Increased Public Education on Foodborne Illness and Food Safety Techniques Increased Collaboration Among Agencies and Consolidation of Food Safety Activities Many cases of foodborne illness are a result of improper food handling practices in the home, and public education is key to preventing foodborne illness.14 Foodborne illness costs an estimated $17-23 billion per year due to medical expenses and lost productivity. 20 Some Democrats feel the FSMA alone is inadequate and more changes should be made,15 such as consolidating all food safety regulation under a single agency.16 17 Both costs and benefits would be fairly equally distributed if food safety education programs were increased. Everyone benefits from Both costs and benefits would be fairly equally distributed if food safety activities were consolidated under a single agency. Everyone benefits from In the short-term, costs for reorganizing the food safety system would likely be high. In the long-term, duplication would likely be reduced and it would be more cost effective to consolidate food safety activities under a single agency. Johnson, R. (2012, November 26). Scott, E. (2003). Food safety and foodborne disease in 21st century homes. The Canadian Journal of Infectious Diseases, 277-280. 15 Wheeler, L. (2015, January 28). Democrats call for new food safety agency. The Hill. Retrieved from http://thehill.com/regulation/231000-democrats-call-for-an-independent-food-safety-agency 16 Johnson, R., Lister, S. A., Williams, E. D., Burrows, V. K., Upton, H. F., & Monke, J. (2010, December 1). Food Safety in the 111th Congress: H.R. 2749 and S. 510. Congressional Research Service. Retrieved from https://www.fas.org/sgp/crs/misc/R40443.pdf 17 Haberman, C. (2015, May 10). Action and Dysfunction in the U.S. Food-Safety Effort. The New York Times. Retrieved from http://www.nytimes.com/2015/05/11/us/action-and-dysfunction-in-the-us-food-safety-effort.html 18 U.S. Food and Drug Administration. (2015, March 3). President's FY 2016 Budget Request for FSMA: The Context and History of FSMA Funding. Retrieved from FDA.gov: http://www.fda.gov/Food/GuidanceRegulation/FSMA/ucm436160.htm 19 U.S. Government Accountability Office. (n.d.). Fragmented food safety system has caused inconsistent oversight, ineffective coordination, and inefficient use of resources. Retrieved from GAO.gov: http://www.gao.gov/modules/ereport/handler.php?ajax=true&1=1&path=/ereport/GAO-11318SP/data_center/Agriculture/Fragmented_food_safety_system_has_caused_inconsistent_oversight,_ineffective_coordination,_and_ine fficient_use_of_resources 20 Harman, J. W. (1994, May 25). A Unified, Risk-Based Food Safety System Needed. Testimony Before the Human Resources & Intergovernmental Relations Subcomittee, House of Representatives. U.S. Government Accounting Office. Retrieved from http://www.gao.gov/products/T-RCED-94-223 14 Administrative Burden Political Feasibility 21 within the food safety system. Costs, however, are not equally distributed. To meet increased standards, the food industry must increase costs. If industry fees were passed, food companies would bear a large portion of the cost of the FSMA (though passage of industry fees is not likely). The FDA had a large burden to bear in creating and implementing regulations after the passage of the FDA. Inadequate funding due to small appropriations from Congress made the implementation process more difficult. • House Republicans in the 112th Congress opposed increases to the FDA’s food programs budget and actually made budget cuts in FY 2012.21 • Much of the food industry opposes user fees. • 66% of likely voters support increased funding for implementation of the FSMA, 74% believe a small increase (1-3%) in the price of food is acceptable to pay for new safety measures, and 70% are in favor of fees on food companies to fund the FSMA.22 increased food safety knowledge, and taxpayers would likely bear the cost of new or increased educational programs. increased food safety, and taxpayers would likely bear the cost of reorganization. The CDC would likely bear most of the administrative burden for implementing new food safety education programs, along with partners such as local health departments. While there is public support for increased food safety activities by the federal government, 23 there has been opposition to increased funding for the FDA by House Republicans.24 The CDC would likely encounter the same opposition if they asked for an increased budget to address food safety education deficits. Whatever agency (whether pre-existing or new) takes full responsibility for food safety would bear an extremely high administrative burden. • Polls show 90% of likely voters support increased food safety measures by the federal government.25 • The Obama administration and some members of Congress support the idea of a single oversight agency. 26 27 Layton, L. (2011, June 16). Pew Charitable Trusts. (2011, May 19). Poll Finds Most Americans Favor Increased Funding for Stronger Food Safety Oversight. Retrieved from http://www.pewtrusts.org/en/about/news-room/press-releases/0001/01/01/poll-finds-most-americans-favor-increasedfunding-for-stronger-food-safety-oversight 23 Pew Charitable Trusts. (2009, September 8). Pew-Commissioned Poll Finds Large Majority of Americans Want Stronger Food Safety Rules. Retrieved from http://www.pewtrusts.org/en/about/news-room/press-releases/0001/01/01/pewcommissioned-poll-finds-largemajority-of-americans-want-stronger-food-safety-rules 24 Layton, L. (2011, June 16). 25 Pew Charitable Trusts. (2009, September 8). 26 Johnson, R., Lister, S. A., Williams, E. D., Burrows, V. K., Upton, H. F., & Monke, J. (2010, December 1). Food Safety in the 111th Congress: H.R. 2749 and S. 510. Congressional Research Service. Retrieved from https://www.fas.org/sgp/crs/misc/R40443.pdf 27 Haberman, C. (2015, May 10). Action and Dysfunction in the U.S. Food-Safety Effort. The New York Times. Retrieved from http://www.nytimes.com/2015/05/11/us/action-and-dysfunction-in-the-us-food-safety-effort.html 22 
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