THE ECONOMIC BURDEN OF FOODBORNE ILLNESS

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: NEW
• Funding Source: HATCH
• Reporting Frequency: Annual
• Accession No.: 1010997
• Project No.: OHO01388
• Project Start Date: Nov 28, 2016
• Project End Date: Sep 30, 2021

Project Director
Scharff, RO.

Recipient Organization
OHIO STATE UNIVERSITY
1680 MADISON AVENUE
WOOSTER,OH 44691

Performing Department
College of Human Ecology

Non Technical Summary
The Centers for Disease Control and Prevention (CDC) estimates that 48 million Americans suffer from domestically acquired foodborne illness each year from 31 identified pathogens and a broad category of unspecified agents (Scallan, Griffin, Angulo, Tauxe, & Hoekstra, 2011; Scallan et al., 2011). Annually, these illnesses are responsible for 3,000 deaths and 128,000 hospitalizations. Recent studies by Scharff (2012; 2015) suggest that the annual economic burden of foodborne illness may be as high as $93.2 billion and that the cost per case of illness varies across populations and pathogens. Though these recent estimates may be useful to regulatory economists who need estimates of illness cost for regulatory analyses, there are still significant gaps that limit the usefulness of these estimates. For this reason, there is a critical need to generate research that can be used to continue to refine and improve new estimates for the economic cost of foodborne illness. The production of this research will allow for economic evaluations that better reflect illness outcomes for given populations and lead to better policy choices.The long term objective of my research is to provide information that improves food safety policy. This includes research aimed at improving quantitative risk assessments, understanding consumer preferences for food safety, and evaluating food safety interventions. The objective of this research project is to improve economic cost of foodborne illness estimates by more inclusively and accurately accounting for costs associated with foodborne illness, providing a model that can be applied to specific populations and examining how these estimates are used and misused in program evaluations. My rationale for this study is that the results will provide a means of evaluating food safety programs tailored to national, state, and local populations. This will allow resources to be better directed towards programs that are most effective.

Animal Health Component

0%

Research Effort Categories

Basic

20%

Applied

80%

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
607	6199	3010	40%
712	6199	3010	60%

Knowledge Area
712 - Protect Food from Contamination by Pathogenic Microorganisms, Parasites, and Naturally Occurring Toxins; 607 - Consumer Economics;

Subject Of Investigation
6199 - Economy, general/other;

Field Of Science
3010 - Economics;

Keywords

cost of foodborne illness

burden of illness

cost of illness

Goals / Objectives
The primary goal of this project is to develop better and more complete estimates of the burden of foodborne illness. This will make it easier for policy makers and others to make well-informed decisions related to the control of pathogens that lead to foodborne illness.Objective 1: Examine the use of cost of illness estimates. 1.1: Use economic theory to determine when and how different components of cost of illness should be used in program evaluations. 1.2: Assess current use of cost of illness estimates and use the updated empirical model properly in economic evaluations of food safety interventionsObjective 2: Develop models to examine the heterogeneity of costs for food safety across individuals, communities, and food products. 2.1: Examine how age, sex, and other demographic variables affect consumer value for food safety. 2.2: Determine how community type affects the cost of foodborne illness. 2.3: Determine how costs differ across food categories.Objective 3: Develop new models to provide empirical estimates for economic costs not currently included in cost of foodborne illness models. 3.1: Model and estimate the cost of foodborne illness events for those not made ill by foodborne pathogens (e.g. industry, public health). 3.2: Examine the impact of including newly discovered relationships between acute foodborne illness and long term outcomes on cost of illness.

Project Methods
Methods for Objective 1: Examine the use of cost of illness estimates.For the first task in this objective I will examine the economic literature to determine which costs are relevant for different types of market failures and interventions. I will create a taxonomy that can be used by applied economists and others to ensure that they are accurately characterizing the costs associated with a given problem. While not all of the relevant costs currently have monetary estimates associated with them (see objective 3), the taxonomy will make it easier to address these costs from a qualitative perspective.For the second task in objective 1, I will examine the food safety intervention evaluation literature and review a sample of regulatory impact analyses to determine what rationales are typically given for the interventions in question, which costs are included, and assess the weaknesses in the approaches taken (if any). This will be an ongoing review that I will use recursively to inform and improve my efforts on objectives 1-3 and any economic evaluations of food safety interventions that I may perform over the period of this project.Methods for Objective 2: Develop models to examine the heterogeneity of costs for food safety across individuals, communities, and food products.Food safety programs are employed by all levels of government and targeted towards many distinct population groups. Given that there are significant differences in costs for different populations, it is important to have cost of illness estimates that can be tailored for use with a specific group. Specifically, I will explore in greater depth the state cost differences found by Scharff (2015). For 2.1, I will create models that look at the relationship between illness, demographics, and cost. The data need for this task is available from CDC's FoodNet and in the economics literature. For 2.2, I will look at differences in costs across difference types of communities (e.g. urban/rural). I will likely need to conduct a survey to collect this data and am planning to apply for funding to do so. For 2.3, I will assess costs across different food groups to provide an alternative way of demonstrating burden of illness of potentially greater use in a policy context. I will rely on data from currently available food/illness attribution studies and outbreak data available from CDC. For each of these tasks I will build on and update the model developed for Scharff (2015) to generate costs, provide measures for uncertainty and provide sensitivity analyses. .Methods for Objective 3: Develop new models to provide empirical estimates for economic costs not currently included in cost of foodborne illness models.For objective 3.1, I will continue efforts to construct generalizable estimates of the cost of foodborne illness for industry participants and the public health sector. The lack of availability of these measures means that current estimates limited to health-related costs likely underestimate the true cost of foodborne illness.Assessing these costs is difficult. For industry, there are costs associated with recalling tainted product, cleaning up contaminated facilities, litigation, and perhaps most importantly, lost sales due to the effect of bad publicity on company reputation. For the public health sector, there is the cost of following up on reported illnesses, testing food and stool samples, litigating enforcement actions, and managing recalls. I will use event analyses, similar to the one used by Seo et. al. (2013) to assess industry reputation costs. I will use data from the foodsafety.gov recall database, coupled with industry estimates of recall costs to assess the cost of recalls. My goal for assessing public health costs is much more limited. By the completion of this project I only expect to have an outline of expected costs and a preliminary plan for assessing these costs.For objective 3.2, I will start with a literature review of long-term health outcomes associated with foodborne illness. I will work with other food safety experts to assess the level of confidence in causation between foodborne illness and the sequela. Where confidence is high, I will assess the costs of the sequelae and include them in the cost model.

Progress 10/01/19 to 09/30/20

Outputs
Target Audience:My target audiences primarily include students, academics and government officials who use my research to supplement their own research efforts or as a tool in making policy decisions. During this reporting period I was limited in my efforts to reach these audiences due to Covid-19, but was able to accomplish the following: 1. Participation in the design of a Food Safety class (Summer 2020). 2. Three day workshop on "Disease Burden and Health Economics." Presented virtually to 136 researchers, policymakers, and students from 14 countries at the Global One Health Institute in (July 2020). Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?I will continue to work on the ongoing projects described above. I will submit 2-4 related papers for publication, participate in 2-3 conferences, and develop new research projects.

Impacts
What was accomplished under these goals? Objective 1: I have begun work on a solicited review piece for Journal of Food Protection. The review will examine efforts to assess the economic burden of foodborne illness in the United States and abroad. It will also identify gaps in research. Objective 2: I published a paper examining how costs vary across food categories. Objective 3: I have begun an effort to estimate the cost to industry from foodborne illness recalls and outbreaks. I have begun work on a project designed to use medical records to estimate the coasts of long term health outcomes from foodborne illness.

Publications

• Type: Journal Articles Status: Published Year Published: 2020 Citation: Robert Scharff. 2020. Food Attribution and Economic Cost Estimates for Meat and Poultry Related Illnesses. Journal of Food Protection, 83 (6): 959-967.
• Type: Book Chapters Status: Published Year Published: 2020 Citation: 2. Brecht Devleesschauwer, Sara M. Pires, Barbara B. Kowalcyk, Robert L. Scharff, Arie H. Havelaar, and Niko Speybroeck. 2020. Risk Metrics: Quantifying the Impact of Adverse Health Effects. In Risk Assessment Methods for Biological and Chemical Hazards in Food. Edited by Fernando Rodriguez. Springer Nature.

Progress 10/01/18 to 09/30/19

Outputs
Target Audience:My target audiences primarily include students, academics and government officials who use my research to supplement their own research efforts or as a tool in making policy decisions. During this reporting period I reached each of these audiences. Specific efforts included: 1. Integration of a module on foodborne illness into a consumer policy class I teach (January 2019). 2. Food safety economics presentation to students and faculty at the Ohio State University Human Nutrition department seminar (March 2019) and the University of Minnesota School of Public Health (June 2019). 3. Food safety economics presentations to researchers and policymakers at the Society for Risk Analysis World Congress (May 2019) and the International Association for Food Protection Annual Meeting (July 2019), and the Minnesota Department of Health (June 2019). 4. Three day workshop on "Disease Burden and Health Economics." Presented to researchers, policymakers, and students at the Global One Health Institute in (July 2019). Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?My efforts led to a number of opportunities for training and development. At Ohio State University, I added material focused on the economics of foodborne illness to a class I teach and I am working with several graduate students on food safety research. I also taught a course on the economics of infectious diseases to a group of policymakers, academics, and students at the One Health Summer Institute in Addis Ababa, Ethiopia. Finally, I presented food safety research at 2 conferences, 2 departmental seminars, and 1 health department. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?I will continue to work on the ongoing projects described above. I will submit 2-4 related papers for publication, participate in 2-3 conferences, and develop new research projects. Specifically, I expect my work on illness/cost attribution to specific foods and restaurants will be published. I have begun to collect data for a new project that will examine the contribution of factors (such as public health investment) associated with foodborne illness burden. I am also currently in the planning stages of a project that would supply questions to a large, publically available, national dataset with the intent of examining the relationship between household food safety behaviors and diarrheal illness.

Impacts
What was accomplished under these goals? In this reporting period, the impact of my efforts associated with this project have been significant. I have derived and published updated estimates for the cost of foodborne illness, broadened my research to examine foodborne illness costs associated with specific food product categories, conducted research on the role that restaurants play as a source of foodborne illness, and continued efforts to look at economic burdens across distinct populations and population subgroups. I have also worked on improving our understanding of the burden imposed by long term health outcomes such as irratable bowel syndrome and hemolytic uremic syndrome. I have also developed and delivered educational materials for students, researchers, and policymakers. Objective-specific accomplishments are as follows. 1. I have continued to examine models used to estimate the burden of foodborne illness and applications of those models. This has contributed to both my educational applications and my modeling choices moving forward. 2. I have continued to develop models that can be flexibly applied across individuals, communities and food products. Specifically, I have begun working on an alternative means of estimating cost of illness based on a panel of person-level insurance data. This should lead to an improved understanding of lifecycle costs of illnesses from food. This will allow for an assessment of cost by demographics (2.1) and communities (2.2). I have also continued to examine burden of illness by food source (2.3). I submitted a paper for publication that assesses costs associated with meat and poultry products and am working on another study that will assess burden of illness for all major food products. I have also drafted a paper on the role that restaurants play as a source of foodborne illness, which I submit (2.3). Finally, I have developed a modeling approach for assessing costs in a less developed country (Ethiopia) where information is scarce. 3. My efforts to develop more complete cost estimates has also moved forward. The new empirical approach based on insurance data (see above) is designed to more comprehensively capture medical costs associated with specific pathogens (3.1). It also should yield better estimates of the incidence and cost of long term health outcomes associated with foodborne illness (3.2). Additionally, I am working on a project designed to evaluate the burden of PTSD on parents of children afflicted with hemolytic uremic syndrome caused by e coli (3.2). As part of my work in Ethiopia, I will also assess both costs and benefits to industry from food safety interventions (3.1). Finally, I am part of two proposed multi-state NIFA projects that, if funded, will assess industry costs associated with recalls/outbreaks and costs from implementation of food safety interventions (3.1).

Publications

• Type: Book Chapters Status: Published Year Published: 2018 Citation: Robert L. Scharff and Craig Hedberg. 2018. The Role of Surveillance in Promoting Food Safety. In Food Safety Economics. Edited by Tanya Roberts. Springer Nature. 251-266.
• Type: Book Chapters Status: Published Year Published: 2018 Citation: Tanya Roberts and Robert L. Scharff. 2018. Pathogen Information is the Basic Problem for Economic Incentives. In Food Safety Economics. Edited by Tanya Roberts. Springer Nature. 13-28.
• Type: Book Chapters Status: Published Year Published: 2018 Citation: Brecht Devleesschauwer, Robert L. Scharff, Barbara Kowalcyk, and Arie Havelaar. 2018. Burden and Risk Assessment of Foodborne Disease. In Food Safety Economics. Edited by Tanya Roberts. Springer Nature. 83-106.
• Type: Journal Articles Status: Under Review Year Published: 2019 Citation: Robert Scharff. 2019. Food Attribution and Economic Cost Estimates for Meat and Poultry Related Illnesses. Journal of Food Protection, Under Review.
• Type: Book Chapters Status: Published Year Published: 2018 Citation: Robert L. Scharff. 2018. The Economic Burden of Foodborne Illness in the United States. In Food Safety Economics. Edited by Tanya Roberts. Springer Nature. 123-142.

Progress 10/01/17 to 09/30/18

Outputs
Target Audience:I presented research from this project at a departmental seminar that was attended by faculty and graduate students. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?I am working to develop a short summer course that will be used to provide researchers in East Africa with training focused on how to evaluate food safety interventions.This has been submitted to the OSU Global One Health Initiative for approval. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?I am planning to submit two papers related to food attribution to peer reviewed journals. I will also present updates of my research at one or more conferences. I plan to teach the short course I am developing in Ethiopia. I will further develop, and hopefully submit, a paper related to illnesses costs associated with restaurant meals.

Impacts
What was accomplished under these goals? My work towards the major goals of the project has focused on objectives 2 and 3 this year. For 2.1 and 2.2 I have improved the cost of foodborne illness model I use to include more population-specific variables. For example, I can now more estimate productivity losses based on the age profile of the group targeted by an intervention. This allows for more precise estimates of benefits from interventions across different populations. For 2.3 I have improved and updated the food attribution model I use to look at cost differences across food categories. Specifically, I have increased the number of food categories examined and have added outbreak data through 2016. For 3.2, my work on assessing the cost of long-term health consequences continues through a collaboration with an epidemiologist. Specifically, we have worked on a model to evaluate the burden of illness-related irritable bowel syndrome. The addition of this and other important sequelae to burden estimates will yield a more complete accounting of costs associated with foodborne illness.

Publications

Progress 11/28/16 to 09/30/17

Outputs
Target Audience:Two undergraduate classes focusing on consumer issues were updated to include recent examples of the use of economics as a metric for determining intervention efficacy. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? I have continued my work to develop better estimates of the economic cost of foodborne illness. By doing so, I am providing information that can be used to evaluate interventions more accurately and precisely. For objective 1, I have continued to improve the cost of illness model I use (1.1), have applied it to a program evaluation of an EFNEP program (1.2), and am in the initial stages of intergrating the model into a more general risk assessment framework (1.1). For objective 2, I have completed an initial draft of a paper examining costs associated specifically with meat and poultry products (2.3). For objective 3, I am in the early stages of working with another scientist to assess costs associated with long term health consequences from foodborne illness (3.2).

Publications

• Type: Journal Articles Status: Published Year Published: 2017 Citation: Zan, H., Lambea, M., McDowell, J., & Scharff, R. L. (2017). An Economic Evaluation of Food Safety Education Interventions: Estimates and Critical Data Gaps. Journal of Food Protection, 80(8), 1355-1363.
• Type: Journal Articles Status: Published Year Published: 2017 Citation: Kendall, P., Scharff, R., Baker, S., LeJeune, J., Sofos, J., & Medeiros, L. (2017). Food Safety Instruction Improves Knowledge and Behavior Risk and Protection Factors for Foodborne Illnesses in Pregnant Populations. Maternal and Child Health Journal, 1-13.
• Type: Conference Papers and Presentations Status: Other Year Published: 2017 Citation: Robert L. Scharff. 2017. The Health-related Economic Burden of Foodborne Illness from Meat and Poultry. International Association for Food Protection Annual Meeting. Tampa, FL. (July 10. 2017).