Environmental Health Food Safety

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					          Environmental Health
                  &
              Food Safety



Healthy Kansans 2010
Steering Committee Meeting
April 22, 2005
Childhood Lead Poisoning Prevention
Childhood Lead Poisoning in Kansas


•Nationally 2.2% children have EBL levels (CDC estimates)
•2004 – 3.5 % KS children tested had EBL -- >10ug/dl
    •29,879 (13% of total KS children population tested)
    •1,056 children identified with Blood Lead Levels > 10g/dl
•70% of all KS housing is pre 1978 (2000 Census)
         Prevalence of Elevated Blood Lead Values in children
        <72 months of age 1996 – 2003 by case count and Rate

                                    400                                 Mandatory reporting                1 00 0
                                                *




                                                                                                                    N um b e r E BL
                                                                        of all blood lead tests
            R a te /1 0 0 , 0 0 0


                                    350
                                                                                                           8 00
                                    300
                                    250                                                                    6 00
                                    200
                                    150                                                                    4 00
                                    100
                                                                                                           2 00
                                     50
                                      0
                                                                                                          0
                                     Y e a r '9 8   '9 9        '0 0      '0 1    '0 2       '0 3   '0 4
                                                           R a te /1 0 0 ,0 0 0          C o un t

     * Included all tests >10 g/dL, confirmed and not confirmed
      Includes only confirmed tests
      While the number of EBL in Kansas children is relatively stable under the
     current process, the rate is upward but not statistically significant.

Source: Kansas Department of Health and Environment- Reportable Diseases in Kansas Summaries
Blood Lead Tests by Ethnicity

     Number of Blood Lead Tests for Children <72 months of Age by
                           Ethnicity (2003)




                                                              Hispanic
                                                              Black
                                                              Native Hawaiian
                                                              White
                                                              Unknown
                                                              Other
              Medicaid Enrolled Children Tested

8000

7000

6000

5000
                                                  Medicaid Enrolled Children
4000
                                                  Tested
3000

2000

1000

   0
       2001        2002            2003
Addressing Childhood Lead Poisoning in Kansas

•Case management focused on primary prevention
•Increased training in primary prevention home visitors, EBL
investigators, Pre Renovation/industry and certification of licensed
supervisors and workers
•Increased partnerships with local cities and communities
•Increase the number of housing units accessed and abated for lead
hazards in the HUD Wyandotte project
Kansas Strengths and Assets for Improving

•Strong partnerships / coalitions with the Lead Advisory Council.
•The KS Childhood Lead Poisoning Prevention Program has five
programs to address lead issues
    •CDC Medical Surveillance Cooperative Agreement
    •EPA Pre Renovation and Education Cooperative Agreement
    •EPA Licensure and Certification Cooperative Agreement.
    •NIOSH Adult Blood Elevated Lead Surveillance Cooperative
    Agreement
    •HUD Lead Hazard Control Cooperative Agreement in Wy Co.
    •Passed Legislation requiring blood lead test results be submitted
    to KDHE.
Barriers Limiting Progress in Kansas
•Belief that Lead hazards are not a problem in Kansas
•Lack of mandatory testing for children as seen in other states
•Lack of mandatory environmental testing of pre 1978 houses at time of
sale
•Limited resources
    •Funding for State Lab testing likely to be eliminated in 2006
    •Funding to make housing lead free is not readily available to low
    income homeowners
•Geographic distribution of population--resources focused on 6 areas of
state
    •Wyandotte County--Sedgwick County--Saline County
    •Johnson County--Reno County--Shawnee County
Recommendations
•Legislation requiring housing units to be abated of lead hazards at the
time of a real estate transaction
•Legislation mandating blood lead testing of children entering daycare
or preschool
•Increase lead awareness message to professionals and communities
•Seek increase in resources to sustain state lab testing functions
•Increasing partnerships with cities and counties to address lead
hazards in their communities
•Increase cross cutting initiatives internally and externally to better
utilize resources. Example: Partnering with immunization to reach the
same people on immunization and lead testing.
Kansas Food Safety
 Kansas Food Safety Goals
• Reduce the burden of foodborne illness and injuries
   – Preventable illness contributing significantly to cost of health care:
      moderate, acute, some chronic illness, deaths
   – Under reported illness: CDC estimates 76 million cases/yr with
      5,000 deaths nationally
   – $75,000 estimated cost per outbreak nationally
   – Most susceptible population: very young, elderly, and
      immunocompromised persons
• Increase managerial control of food safety processes
   – KS & FDA HP2010 target is 25% improvement in risk factor
      control
   – Public health interventions
        Incidence of FBIO in Kansas

600

500

400
                                         FBI Comp
300                                      Total FBIO
                                         FBIO FSE
200

100

  0
      2000   2001   2002   2003   2004
        Incidence of FBIO in Kansas

25

20

15
                                      FBIO FSE
                                      FBIO other
10                                    Total

 5

 0
     2001   2002   2003   2004
            KS Compared to National Compliance Trend

                             % of Risk Factors IN Compliance

                  100
Percentage % In


                   80
                   60                                                            Kansas
                   40                                                            National

                   20
                    0
                                                        ne
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                                                 Risk Factors
               Healthy Kansans 2010 Goal


                                   2003 Kansas        KS Healthy People
                                   Baseline % IN      2010 Goal 25%
                                   Compliance         Improvement
                                   Observable Items
                                                      (FDA Goal 25%
                                                      Improvement)


Institutions


                  Elementary and          90%                93%
                  High Schools


Restaurants       Fast Food               84%                88%


                  Full Service            78%                84%
                        Kansas Improvement Goal
                          Healthy People 2010

                  100
Percentage "IN"
  Compliance

                  80
                                                              2003 Kansas Baseline
                  60
                                                              25% Improvement Goal
                  40                                          FDA Improvement Goal

                  20
                   0
                          Public   Fast Food   Full Service
                         Schools

                         Baseline Establishment
                                 Types
Addressing Food Safety in Kansas Now

•Monitor managerial control of processes and initiate risk reduction
interventions in food service establishments
    •HACCP based inspections of FSE – on site corrective actions
    •Initiate Risk Control Plan (980 in 2004)
    •24 hour response to FBI complaints
•Non mandatory food safety training for industry
    •80,000 food workers in KS
    •Trained approximately 8,500 (10.6%)
    •Distribution of food safety handouts at each inspection with Risk
    Factor violations

•Re-inspections in non compliance establishments (15%)
•Administrative action for repeated non compliance (2.3% in 2004)
KS Assets and Strengths for Improving

• Strong local, federal, and industry partnerships
   – Secretary’s Food Safety Advisory Committee
       • FDA Food Safety Task Force funding
       • Organization: FDA, LHD, KRHA, KPHA, KDEd, KDOA,
          KSU, Citizen representative
   – Contract with 8 local health agencies for inspection services
• Up-to-date regulations and compliance guidelines/policies
• Adopted FDA National Regulatory Program Standards
• Partnership with BEDP for FBI investigations
• Adhere to competency level and training standards for staff
• Ratio of inspector to establishment moved from 1:580 to 1:360
• Active and up-to-date web site for food safety information
Barriers Limiting Food Safety Progress

• Technology and data management system
   – Paper inspection recording system – to Topeka for processing
   – Outdated data management system
   – FBIO data not directly accessible to program
• Non mandatory training for food workers
• Minimal food safety education for consumers
   – Holiday food safety reminders
   – Special events upon request from consumers
• Limited resources – fee funded (annual license fee and 1 time
  application fee)
Recommendations
• Update data management system
   – Planned completion by summer 2005
   – Secure hand-held inspection devices
       • Increase inspection and data input efficiency
       • Generate and retrieve compliance data on site
       • Upload data directly to Topeka
   – Increase cross cutting initiatives internally and externally
       • Data sharing with BEDP for FBIO information
       • Data link local health agencies providing inspections
• Seek mandatory food safety training for managers and increase
  consumer food safety awareness activities
• Increase annual inspection to 2 times per year based on risk assessment
• Increase resources required for technology efficiency and increased
  inspections