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Enhancing public trust in the food safety regulatory system
Health Policy 107 (2012) 98–103
Contents lists available at SciVerse ScienceDirect
Health Policy journal homepage: www.elsevier.com/locate/healthpol
Enhancing public trust in the food safety regulatory system Andrew Papadopoulos a,∗ , Jan M. Sargeant b , Shannon E. Majowicz a , Byron Sheldrick c , Carolyn McKeen a , Jeff Wilson d , Catherine E. Dewey a a b c d
Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada N1G 2W1 Department of Population Medicine, Centre for Public Health and Zoonoses, University of Guelph, Guelph, Ontario, Canada N1G 2W1 Department of Political Science, College of Social and Applied Human Science, University of Guelph, Guelph, Ontario, Canada N1G 2W1 Novometrix Research Inc, RR 1, Moffat, Ontario, Canada L0P 1J0
a r t i c l e
i n f o
Article history: Received 5 April 2011 Received in revised form 3 May 2012 Accepted 29 May 2012 Keywords: Food safety Trust Transparency Government regulation Public health practice
a b s t r a c t Objective: It is worth examining how public health agencies can enhance the public’s trust in the food safety regulatory system. This paper will focus on the food safety system, which can be defined as those involved in the safe manufacture, storage, handling, display, distribution, sale or offer for sale, preparation, processing or service of food. Specifically, the paper will summarize and discuss literature relating to public expectation of public health agency action regarding protecting the food supply and recent policy reforms. Methods: A meta-interpretation was conducted to identify common themes in peerreviewed publications and media sources. Literature searches retrieved 39 relevant articles published, resulting in 19 peer-reviewed articles, 8 media, 8 government reports, and 4 legislation documents. Results: The public expects a safe food system and they lack confidence in the current system. They desire increased scientifically transparent communication from a trusted source, a stronger public health presence, a coordinated food safety regulatory system, and increased access to inspection results. Conclusions: Public health agencies must communicate easily understood transparent, scientific information to the public. Inspection disclosure systems have been effective in increasing transparency. Public health agencies must have a strong presence in a coordinated food safety regulatory framework. © 2012 Elsevier Ireland Ltd. All rights reserved.
1. Introduction Awareness of food safety issues among the public has increased due to a number of significant and wellpublicized threats to public health [1–3]. Over the past
∗ Corresponding author at: Department of Population Medicine, 203A MacNabb House Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada N1G 2W1. Tel.: +1 519 824 4120x53894; fax: +1 519 766 1730. E-mail addresses: [email protected] (A. Papadopoulos), [email protected] (J.M. Sargeant), [email protected] (S.E. Majowicz), [email protected] (B. Sheldrick), [email protected] (C. McKeen), jeff [email protected] (J. Wilson), [email protected] (C.E. Dewey). 0168-8510/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.healthpol.2012.05.010
few decades, numerous public health crises have eroded consumer trust in the public health food safety regulatory system [1–6]. The population’s health depends on the availability of safe food; therefore, it is imperative that the public has trust in their food supply and in the food safety system and the agencies responsible for overseeing it. In developed nations, there is a prevailing expectation that the products we purchase, prepare, and consume are safe and will not cause illness [4]. Public health agencies are involved in food safety policy to safeguard community health for the public good [7]. The public also has a legal right to expect the food they purchase is safe based on EU legislation. Contaminated food is not easily identifiable by consumers, placing much of the onus for food safety on
A. Papadopoulos et al. / Health Policy 107 (2012) 98–103
regulatory bodies, the food industry, professional associations, and other interested parties. The economic, health, and social impact of unsafe, contaminated, or adulterated food products cannot be estimated accurately, but the effects of food-related disease outbreaks are extensive and difficult to reverse [1,3,8–10]. It may be difficult for consumers to conceptualize the regulatory role played by the various levels of government, due to the numerous public health agencies involved, and their overlapping and competing jurisdiction [11–14]. Food safety is a responsibility shared among federal, provincial, and municipal governments in Canada. The Constitution Act [14–16] outlines several powers within sections 91 and 92 that delineate responsibility between the federal and provincial governments. At the federal level, the Food and Drugs Act legislates that food sold in Canada must be fit for human consumption [16]. Section 91 of the Constitution Act allocates food safety responsibility to the federal government when food produced is traded either interprovincially or internationally [14,15]. Most inspection activities at the federal level are the responsibility of the Canadian Food Inspection Agency (CFIA). Canadian establishments must register with the CFIA in order to operate and become federally registered establishments [16]. The Public Health Agency of Canada (PHAC), formed in 2003, is involved in food safety issues as well as research, information dissemination, and outbreak investigation and support. The powers listed in section 92 enable the provincial government to enact legislation regarding retail food safety [14,15]. Provinces have the responsibility for the safety of food manufactured and sold within their borders, and have overlapping jurisdiction in federally regulated establishments [16]. Food safety is usually under the purview of the ministries of health, but with interaction and input from ministries of agriculture, natural resources and environment. In some provinces, this responsibility is delegated to the municipalities through local boards of health [16]. Furthermore, interested actors, including industry and professional associations, participate and help shape and define food safety policy in Canada. It is understood and accepted that food safety is a shared responsibility among farmers, processors, wholesalers, distributors, regulatory agencies at all levels, and consumers [16]. This approach is common and is found in EU legislation as well [16]. Some agencies have a dual role of risk regulator and risk generator [9]. This duality can erode the public’s trust in the food safety regulatory processes and agencies, which may contribute to an overall decline in public confidence in government control, cohesion, competence, and policy [9]. The food industry could suffer lost sales, and individual organizations or sectors may be threatened. If the public does not believe or trust the government, it is possible that they may be more likely to make unwise food choices [17,18]. It is acknowledged that one of the main purposes of government action is to maintain public health and safety. Although it is the manufacturers’ responsibility to produce safe food, the function of food safety regulatory agencies is to act on the public’s behalf and provide oversight to ensure
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a safe food supply [16]. Government agencies represent the common good and the public depends on and expects government to oversee where the public lacks knowledge and ability [16,20]. As the food safety system is an intertwined web of agencies and individuals, a well functioning and integrated food safety system can increase the capacity of system governance [16,20,21]. It is worth examining how public health agencies can enhance the public’s trust in the food safety regulatory system. This paper will focus on the food safety system, which can be defined as those involved in the safe manufacture, storage, handling, display, distribution, sale or offer for sale, preparation, processing or service of food [22]. Specifically, the paper will summarize and discuss literature relating to public expectation of public health agency action regarding protecting the food supply and recent policy reforms. 2. Methods A meta-interpretation synthesis methodology [23] was used to analyze the findings of other studies; the results of these studies became the primary data for this study. Initial literature searches of articles published between 1998 and 2010 revealed that, to date, little research has been conducted in the area of enhancement of public trust in regulatory food safety systems. An iterative sampling method that allowed inclusion criteria to be refined as the study and analyses progressed was an important component of the methodology used. The initial scoping process began with an online search of research databases (Medline/PubMed, CINAHL, Ovid Health and Psychosocial Instruments, CBCA and CAB Direct) using the following list of general search terms: policy sciences; public health; public opinion; risk perception; environmental health; health risk assessment; food production; food; health risk communication; information resources; consumer behavior; consumers; food safety measures; risk management; consumer education; food handling; and food service. Additional phrases and Boolean logic operators were employed using Scholars Portal in March 2007 and Scopus in July 2009 to ensure optimal capture. Search terms were added as results from preliminary searches produced new key phrases. Refer to Table 1 for a list of specific search phrases used. Only studies that analyzed retail food safety outbreaks in Canada, the United States, Great Britain, Australia, and New Zealand were included, in order to limit the information to geographic areas that had similar policy frameworks and legislative structures to those in Canada. Only studies from 1998 to 2010 were included to ensure that the most recent events and current public perceptions were captured. The peer-reviewed article search process began with one of three researchers conducting a preliminary assessment of each article by reviewing its abstract. Abstracts were reviewed to ensure that articles addressed one or more of the following themes: food safety regulation, public trust in the food supply, government action following a food safety crisis, and the public expectation of government responsibility for food safety. Selected peer-reviewed
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Table 1 Literature search terms. Specific search phrases used followed general subject area searches. Search terms Consumer/public perception AND vulnerability AND food supply Public AND expectation AND public health AND food supply Policy evolution AND public health Factors AND decision making AND public health policy Effectiveness* AND education AND campaign* AND public health Consumer/public behavi?r AND food safety Effective public AND health policy AND formation/creation Consumer/public perception AND food (supply) protection/safety Government AND safeguarding* AND food supply Government AND safeguarding AND food Government AND public perception AND food Public perception AND food protection Public perception AND food safety Policy AND food AND public perception Policy AND food safety Public expectation AND food supply Public perception AND vulnerability AND food supply Risk AND public perception AND food Public opinion AND government AND food safety Public opinion AND government AND food
articles were added to the electronic referencing tool RefWorks, and then each was reviewed in its entirety. The final inclusion criteria resulted in all of the three researchers reading and reviewing the peer-reviewed article independently, and then together verifying that it addressed the issue of public trust in the food supply within context, and its findings contributed to this research. Each researcher reviewed the relevant documents and noted mention of any public expectations with regard to food safety, and any policy reforms undertaken by public health agencies. The researchers then compared their findings with one another to ensure accurate data extraction. These findings formed the data for this study. Initially, only peer-reviewed articles were accepted; however, the literature search was expanded to include media publications using the same search process and terms as with the peer-reviewed search. During the analyses, a gap was identified in the public’s thoughts and opinions on food safety. The purpose of media reporting is to provide awareness to the public regarding significant events and the researchers felt that inclusion of media publications would contribute to the data regarding this gap, as the media both shapes and reveals public viewpoints [1,2,4]. The three researchers extracted points pertaining to the public’s opinion and/or perception of the food safety system from media articles in order to enhance information found through peer-reviewed literature. For example, interview segments with members of the public contained within media articles were considered to be reflective of public sentiment. Notwithstanding, articles from media sources tended to include multiple viewpoints which provided a balanced review of the news item. There are limitations to relying solely on media reporting as data since these reporting methods are not grounded by scientific methods and may be one-sided in their presentation.
3. Results The literature searches retrieved 357 articles, of which 39 were deemed relevant. The relevant articles were categorized into peer-reviewed (19), media (8), government reports (8), and legislation (4). 3.1. Public expectation regarding food safety The public questions whether local public health agencies are continuously working to protect their food supply [4,8]. Information on food safety issues should be transparent, and from a trusted and knowledgeable source [5,8,24,25]. Physicians and the medical community are usually seen as highly trusted by the public, followed closely by local public health agencies [1,26,27]. State and provincial agencies are not as trusted, primarily due to past experiences in which the public perceived attempted cover-ups of food safety crises by these agencies [1,2,4–6,8,25,28,29]. Effective risk communication is critical in maintaining public trust after a food safety event [1,2,5,25]. Provision of transparent scientific information to inform the public may support public trust in public health agency action [5,24,25,30]. The public wants public health agencies to demonstrate leadership in food safety [8,27,30]. Constituents are not confident that public health agencies are looking after their health and well-being and, specifically their food supply [2,8,30]. Consumers are unable to assess the safety of their food personally [4], and thus need to rely on a wellfunctioning industry supported by a well-functioning and transparent regulatory system [8,28,30,31]. 3.2. Food safety policy reform In Ontario, there is a movement away from more prescriptive legislation and requirements and toward a health outcome-based and public education approach leading to a “buyer beware” phenomenon. The Mandatory Health Programs and Services Guidelines have been replaced with the Ontario Public Health Standards, which sets health outcome targets as its measure of public health activity [32,33]. A self-regulated industry does not enjoy the trust of the public, as the public’s general perception is that industry will not be forthcoming with important information that may impact its short- or long-term viability [8,19,26]. The public believes that an agency cannot effectively promote and police itself simultaneously [19,26,27,29]. Public health agencies have a responsibility to ensure consumer concerns are dealt with in a respectful manner [8]. In order to regain the public’s trust in their public health system and, more importantly, in the food that they consume, policy solutions should include transparency and public participation in the process [4,5]. Deregulating based on increasing system efficiencies, improving industry profitability [19], or to respond to public pressure while not completing a thorough risk assessment can be detrimental to public health [28]. Certain recent food safety crises have resulted in both the public and government agencies calling for food safety regulatory reform [5,25,28]. Reports published in recent
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years suggest a lack of quality and consistency in food safety services [29,34,35]. An audit of Alberta’s food safety strategy has identified systemic deficiencies that threaten the health of the public [34,35]. In many cases, reform has consisted of either a movement toward hazard analysis critical control point (HACCP) inspection systems, the exploration of the creation of centralized, arms-length agencies, or the implementation of policies and systems designed to increase public knowledge of the safety of the food premises they frequent [13,28,29]. HACCP takes a risk assessment approach to assessing the flow of food; in addition to measuring existing systems against minimum acceptable standards, it focuses on achieving the safest food product possible as the end goal [36]. An effective HACCP system is predicated on being able to adequately identify and assess food safety risks [36]. Limited research in this area may leave food safety professionals less than prepared to meet the challenges of ensuring correct HACCP implementation [28,36]. Placing the onus for food safety on the operator and consumer and off of the regulators can leave the public at risk [8]. Replacement of regulation with a quality assurance system essentially moves the regulatory function to industry and, more specifically, to its employees [19]. The public perception is that such a system cannot adequately address food safety problems because the industry is perceived as self-protective and its employees are viewed as unlikely to report food safety infractions against their employers [19,28,36]. A negative economic impact on the food industry may result from diminished public trust [19]. Furthermore, health economists have argued that a food safety system based on HACCP creates a competitive advantage to firms large enough to sustain the infrastructure required, creating an unfair advantage within the marketplace [28]. Increasing transparency, specifically by implementing a food disclosure system, is one policy option aimed at improving public trust by facilitating public access to inspection results [37]. The first such system in Canada was developed in the city of Toronto, with many other local boards of health in Ontario following suit [37,38]. Many provinces across Canada have introduced or have announced intentions to introduce legislation that will mandate public disclosure of health inspection results so that trust can be maintained or regained [38]. Many arguments have been made against the effectiveness of this system for improving public health; however, it is clear that the public desires increased access to information [37]. 4. Discussion The public has both the legal right through EU legislation and expectation that government agencies, through their public health responsibilities, will protect the food supply. The oversight of food safety systems should be arms-length from special interest groups, and information regarding food safety events should be communicated in a transparent manner through a trusted, knowledgeable scientific source [5,27]. The public is not comfortable leaving the safety of their food supply wholly in the hands of the food producers and
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would like a strong government presence, although they acknowledge that producers do play a significant role in food safety [8]. Transparency, and effective mitigation and management of threats to food safety are of key importance to ensure consumers regain confidence in their food supply [5,8,24]. Many believe that transparency will contribute to a greater degree of public trust by informing and empowering consumers [5,24]. Disclosure of food premises inspection results is becoming more widespread as public concern regarding food safety escalates. Province-wide disclosure initiatives have been launched in Alberta, Saskatchewan, and New Brunswick and are being explored in Ontario [39]. Many municipalities in Ontario and health agencies in British Columbia have enacted local by-laws requiring food premises to post inspection results at the front door [39]. It is becoming increasingly clear that the public expects public health agencies to facilitate transparency and disclosure. The public is not well-versed regarding food standards and food safety programs, and therefore, rely on regulatory agencies to act on their behalf in regard to food safety issues [16]. Mistrust will arise when there is a food safety breach and transparent and timely information is not provided by regulatory agencies [16]. The Canadian food safety system, despite performing better than most jurisdictions, is traditionally weak in risk communication [16]. Public health agencies should leverage their goodwill and provide transparent, scientific communication to the public. Reception of a health message is dependent on levels of public trust, perceived expertise on the part of the message deliverer and recipient, and demographic variables such as age, education level, race, and socioeconomic status. Variability in perception among diverse population groups needs to be acknowledged and explored in order to effectively deliver information about food safety. Any movement toward a buyer beware approach to food safety can only be successful if the public understands the message. In the various jurisdictions analyzed in this study, it was identified that multiple agencies are involved in retail food safety in Canada, with all of them having a role in direct and legislated responsibility for food safety [16]. Such configuration can erode trust, as the public receives messages from numerous sources and can be confused as to which is the most legitimate or credible [16]. Integration coupled with a proactive approach by public health agencies in the area of food safety may improve communication, thereby enhancing public safety. Many believe that the creation of a national food safety agency is essential, although this notion is most popular in European countries under the EU where it is required by legislation [28]. Canada has moved in this direction, collapsing their federal food inspection activities under the CFIA in the mid-1990s in order to provide a competent agency to protect the food supply. In some cases, deregulation is seen as a viable option, although this tends to arouse more concern with the public than a disjointed, poorly managed system [19,28].
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Governments need to ensure consistency and quality of food safety programs and transparency in their communication to enhance public trust. They face pressure to overhaul retail food safety systems under their control and have responded in most cases by moving toward a system of less prescriptive regulation while attempting to supplement the current regulatory framework with one that focuses on outputs and quality assurance. 5. Conclusion To enhance public trust in the food safety regulatory system, public health agencies must communicate easily understood transparent, scientific information to the public. This information must be delivered by a trusted source. Inspection disclosure systems have been effective in increasing transparency, thereby improving public trust. The public expects public health agencies to take action to protect the food supply. Public health agencies must have a strong presence in a coordinated food safety regulatory framework. 6. Future research The research process identified a number of research gaps. The following areas require continued research if a full understanding of this subject is to be gained: the effects of deregulation on retail food safety; evaluation of prescriptive versus outcome-based measures in retail food safety inspection; the public’s expectations of government agencies with regard to retail food safety regulation; the role of the media in retail food safety; the role of researchers and public health leaders in retail food safety; the risk associated with various food processing and food handling activities; and, replacement of retail food safety regulation with public education. It is necessary for government to explore how to best meet the expectation of the public with regard to retail food safety. Conflict of interest None identified. References [1] Tucker M, Whaley SR, Sharp JS. Consumer perception of foodrelated risks. International Journal of Food Science & Technology 2006;41:135–46. [2] Murphy-Lawless J. The impact of BSE and FMD on ethics and democratic process. Journal of Agricultural and Environmental Ethics 2004;17(4–5):385. [3] de Jonge J, van Trijp H, Goddard E, Frewer L. Consumer confidence in the safety of food in Canada and the Netherlands: the validation of a generic framework. Food Quality and Preference 2008;19: 439–51. [4] Verbeke W, Frewer LJ, Scholderer J, De Brabander HF. Why consumers behave as they do with respect to food safety and risk information. Analytica Chimica Acta 2007;586:2–7. [5] Jensen KK, Sandøe P. Food safety and ethics: the interplay between science and values. Journal of Agricultural and Environmental Ethics 2002;15(3):245. [6] Disney H. Food policy proves hard to digest. Sweden: Stockholm; 2007.
[7] Jochelson K. Nanny or steward? The role of government in public health. Public Health 2006;120(12):1149–55. [8] Kriflik LS, Yeatman H. Food scares and sustainability: a consumer perspective. Health, Risk & Society 2005;7(1):11–24. [9] Lobb AE. Consumer trust, risk and food safety: a review. Food Economics 2005;2(1):3–12. [10] Public Health Agency of Canada. Lessons learned: Public Health Agency of Canada’s response to the 2008 listeriosis outbreak [Internet]; c2008 [cited 2009 October 5]. Available from: http://www. phac-aspc.gc.ca/fs-sa/listeria/2008-lessons-lecons-eng.php. [11] Ontario Ministry of Agriculture Food and Rural Affairs. Government roles and responsibilities for food safety in Ontario [Internet]; c2008 [cited 2009 September 9]. Available from: http://www.omafra. gov.on.ca/english/infores/foodsafe/govt roles food safety.htm. [12] Schlosser E. Has politics contaminated the food supply? New York Times 11 December 2006:A27. [13] Anonymous. Stop playing chicken with food safety. Consumer Reports 2007;72(1):57. [14] 95. Ontario Ministry of Agriculture, Food and Rural Affairs. The Ontario food safety system, the Haines report: follow up audit report, Haines report [Internet]; c2005 [cited 2009 May 2009]. Available from: http://www.omafra.gov.on.ca/english/ infores/foodsafe/progresssince2005.htm. [15] Constitution Act, 1867; 1996. [16] Miller L. Beyond the listeriosis crisis: strengthening the food safety system. Report of the standing committee on agriculture and agrifood; June 2009. [17] Mazzocchi M, Lobb A, Traill B, Cavicchi A. Food scares and trust: a European study. Journal of Agricultural Economics 2008;59(1):2–24. [18] Hansen J, Holm L, Frewer L, Robinson P, Sandøe P. Beyond the knowledge deficit: recent research into lay and expert attitudes to food risks. Appetite 2003;41:111–21. [19] Law C. America’s looming food safety crisis. USA Today Magazine 1992;121:22. [20] Government of Canada. Listeriosis investigative review [Internet]; c2009 [cited 2012 April 30]. Available from: http://www. listeriosis-listeriose.investigation-enquete.gc.ca/index e.php?s1= rpt&page=chap10. [21] Gostin LO, Stewart KF. Food and drug administration regulation of food safety. Journal of the American Medical Association 2011;June. Available from: http://jama.ama-assn.org/content/early/ 2011/06/13/jama.2011.885.full.pdf. [22] Ontario Ministry of Health and Long-Term Care. Regulation 562: food premises, 562, (R.R.O. 1990). Queen’s Printer for Ontario; 1999. [23] Weed M. Meta interpretation: a method for the interpretive synthesis of qualitative research. Forum: Qualitative Social Research 2005;6(1). [24] Worsfold D. Eating out: consumer perceptions of food safety. International Journal of Environmental Health Research 2006;16(June (3)):219–29. [25] Masood E. UK panel formed to rebuild trust in government science advice. Nature 1999;397:458. [26] Frewer LJ, Miles S. Temporal stability of the psychological determinants of trust: implications for communication about food risks. Health, Risk & Society 2003;5(3):259–71. [27] Agricultural Union. Canadians place food safety trust in government – Nanos poll [Internet]; c2009 [cited 2009 May 20]. Available from: http://www.newswire.ca/fr/story/552869/canadians-place-foodsafety-trust-in-government-nanos-poll. [28] Caduff L, Bernauer T. Managing risk and regulation in European food safety governance. Review of Policy Research 2006;23(1):153–68. [29] Butler D. UK seeks to appease food safety critics. Nature 1997;385:474. [30] Brom FWA. Food, consumer concerns and trust: food ethics for a globalizing market. Journal of Agricultural and Environmental Ethics 2000;12(2):127–39. [31] Lupton DA. Lay discourses and beliefs related to food risks: an Australian perspective. Sociology of Health & Illness 2005;27(4):448–67. [32] Ontario Ministry of Health and Long-Term Care. Mandatory health programs and services guidelines. Toronto, ON: Queen’s Printer for Ontario; 1997. [33] Ontario Ministry of Health Long-Term Care. Ontario public health standards. Queen’s Printer for Ontario; 2008. [34] Bennett D. Alberta government watchdog finds lax inspections on food, drinking water. Red Deer Advocate (AB) 2006:A3. Available from: Canadian Reference Centre, Ipswich, MA. [35] Klein vague on how Alberta will respond to auditor’s food safety concerns. Canadian Press News Wire 2006. Available from: Canadian Reference Centre, Ipswich, MA.
A. Papadopoulos et al. / Health Policy 107 (2012) 98–103 [36] Becker GS. HACCP: prescription for safer food or smokescreen for deregulation? Choices: The Magazine of Food, Farm & Resource Issues 1992;7(2):28. Available from: Academic Search Premier, Ipswich, MA. [37] Toronto Public Health. Food premises inspection and disclosure system evaluation report; December 17, 2002.
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[38] Canadian Press News Wire. N.S. government moves to make restaurant inspections available. Halifax Chronicle-Herald 2007. Available from: Canadian Reference Centre, Ipswich, MA. [39] Bienfeld M. Food premise inspection disclosure activities in Canada; 2010.
Contents lists available at SciVerse ScienceDirect
Health Policy journal homepage: www.elsevier.com/locate/healthpol
Enhancing public trust in the food safety regulatory system Andrew Papadopoulos a,∗ , Jan M. Sargeant b , Shannon E. Majowicz a , Byron Sheldrick c , Carolyn McKeen a , Jeff Wilson d , Catherine E. Dewey a a b c d
Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada N1G 2W1 Department of Population Medicine, Centre for Public Health and Zoonoses, University of Guelph, Guelph, Ontario, Canada N1G 2W1 Department of Political Science, College of Social and Applied Human Science, University of Guelph, Guelph, Ontario, Canada N1G 2W1 Novometrix Research Inc, RR 1, Moffat, Ontario, Canada L0P 1J0
a r t i c l e
i n f o
Article history: Received 5 April 2011 Received in revised form 3 May 2012 Accepted 29 May 2012 Keywords: Food safety Trust Transparency Government regulation Public health practice
a b s t r a c t Objective: It is worth examining how public health agencies can enhance the public’s trust in the food safety regulatory system. This paper will focus on the food safety system, which can be defined as those involved in the safe manufacture, storage, handling, display, distribution, sale or offer for sale, preparation, processing or service of food. Specifically, the paper will summarize and discuss literature relating to public expectation of public health agency action regarding protecting the food supply and recent policy reforms. Methods: A meta-interpretation was conducted to identify common themes in peerreviewed publications and media sources. Literature searches retrieved 39 relevant articles published, resulting in 19 peer-reviewed articles, 8 media, 8 government reports, and 4 legislation documents. Results: The public expects a safe food system and they lack confidence in the current system. They desire increased scientifically transparent communication from a trusted source, a stronger public health presence, a coordinated food safety regulatory system, and increased access to inspection results. Conclusions: Public health agencies must communicate easily understood transparent, scientific information to the public. Inspection disclosure systems have been effective in increasing transparency. Public health agencies must have a strong presence in a coordinated food safety regulatory framework. © 2012 Elsevier Ireland Ltd. All rights reserved.
1. Introduction Awareness of food safety issues among the public has increased due to a number of significant and wellpublicized threats to public health [1–3]. Over the past
∗ Corresponding author at: Department of Population Medicine, 203A MacNabb House Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada N1G 2W1. Tel.: +1 519 824 4120x53894; fax: +1 519 766 1730. E-mail addresses: [email protected] (A. Papadopoulos), [email protected] (J.M. Sargeant), [email protected] (S.E. Majowicz), [email protected] (B. Sheldrick), [email protected] (C. McKeen), jeff [email protected] (J. Wilson), [email protected] (C.E. Dewey). 0168-8510/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.healthpol.2012.05.010
few decades, numerous public health crises have eroded consumer trust in the public health food safety regulatory system [1–6]. The population’s health depends on the availability of safe food; therefore, it is imperative that the public has trust in their food supply and in the food safety system and the agencies responsible for overseeing it. In developed nations, there is a prevailing expectation that the products we purchase, prepare, and consume are safe and will not cause illness [4]. Public health agencies are involved in food safety policy to safeguard community health for the public good [7]. The public also has a legal right to expect the food they purchase is safe based on EU legislation. Contaminated food is not easily identifiable by consumers, placing much of the onus for food safety on
A. Papadopoulos et al. / Health Policy 107 (2012) 98–103
regulatory bodies, the food industry, professional associations, and other interested parties. The economic, health, and social impact of unsafe, contaminated, or adulterated food products cannot be estimated accurately, but the effects of food-related disease outbreaks are extensive and difficult to reverse [1,3,8–10]. It may be difficult for consumers to conceptualize the regulatory role played by the various levels of government, due to the numerous public health agencies involved, and their overlapping and competing jurisdiction [11–14]. Food safety is a responsibility shared among federal, provincial, and municipal governments in Canada. The Constitution Act [14–16] outlines several powers within sections 91 and 92 that delineate responsibility between the federal and provincial governments. At the federal level, the Food and Drugs Act legislates that food sold in Canada must be fit for human consumption [16]. Section 91 of the Constitution Act allocates food safety responsibility to the federal government when food produced is traded either interprovincially or internationally [14,15]. Most inspection activities at the federal level are the responsibility of the Canadian Food Inspection Agency (CFIA). Canadian establishments must register with the CFIA in order to operate and become federally registered establishments [16]. The Public Health Agency of Canada (PHAC), formed in 2003, is involved in food safety issues as well as research, information dissemination, and outbreak investigation and support. The powers listed in section 92 enable the provincial government to enact legislation regarding retail food safety [14,15]. Provinces have the responsibility for the safety of food manufactured and sold within their borders, and have overlapping jurisdiction in federally regulated establishments [16]. Food safety is usually under the purview of the ministries of health, but with interaction and input from ministries of agriculture, natural resources and environment. In some provinces, this responsibility is delegated to the municipalities through local boards of health [16]. Furthermore, interested actors, including industry and professional associations, participate and help shape and define food safety policy in Canada. It is understood and accepted that food safety is a shared responsibility among farmers, processors, wholesalers, distributors, regulatory agencies at all levels, and consumers [16]. This approach is common and is found in EU legislation as well [16]. Some agencies have a dual role of risk regulator and risk generator [9]. This duality can erode the public’s trust in the food safety regulatory processes and agencies, which may contribute to an overall decline in public confidence in government control, cohesion, competence, and policy [9]. The food industry could suffer lost sales, and individual organizations or sectors may be threatened. If the public does not believe or trust the government, it is possible that they may be more likely to make unwise food choices [17,18]. It is acknowledged that one of the main purposes of government action is to maintain public health and safety. Although it is the manufacturers’ responsibility to produce safe food, the function of food safety regulatory agencies is to act on the public’s behalf and provide oversight to ensure
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a safe food supply [16]. Government agencies represent the common good and the public depends on and expects government to oversee where the public lacks knowledge and ability [16,20]. As the food safety system is an intertwined web of agencies and individuals, a well functioning and integrated food safety system can increase the capacity of system governance [16,20,21]. It is worth examining how public health agencies can enhance the public’s trust in the food safety regulatory system. This paper will focus on the food safety system, which can be defined as those involved in the safe manufacture, storage, handling, display, distribution, sale or offer for sale, preparation, processing or service of food [22]. Specifically, the paper will summarize and discuss literature relating to public expectation of public health agency action regarding protecting the food supply and recent policy reforms. 2. Methods A meta-interpretation synthesis methodology [23] was used to analyze the findings of other studies; the results of these studies became the primary data for this study. Initial literature searches of articles published between 1998 and 2010 revealed that, to date, little research has been conducted in the area of enhancement of public trust in regulatory food safety systems. An iterative sampling method that allowed inclusion criteria to be refined as the study and analyses progressed was an important component of the methodology used. The initial scoping process began with an online search of research databases (Medline/PubMed, CINAHL, Ovid Health and Psychosocial Instruments, CBCA and CAB Direct) using the following list of general search terms: policy sciences; public health; public opinion; risk perception; environmental health; health risk assessment; food production; food; health risk communication; information resources; consumer behavior; consumers; food safety measures; risk management; consumer education; food handling; and food service. Additional phrases and Boolean logic operators were employed using Scholars Portal in March 2007 and Scopus in July 2009 to ensure optimal capture. Search terms were added as results from preliminary searches produced new key phrases. Refer to Table 1 for a list of specific search phrases used. Only studies that analyzed retail food safety outbreaks in Canada, the United States, Great Britain, Australia, and New Zealand were included, in order to limit the information to geographic areas that had similar policy frameworks and legislative structures to those in Canada. Only studies from 1998 to 2010 were included to ensure that the most recent events and current public perceptions were captured. The peer-reviewed article search process began with one of three researchers conducting a preliminary assessment of each article by reviewing its abstract. Abstracts were reviewed to ensure that articles addressed one or more of the following themes: food safety regulation, public trust in the food supply, government action following a food safety crisis, and the public expectation of government responsibility for food safety. Selected peer-reviewed
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Table 1 Literature search terms. Specific search phrases used followed general subject area searches. Search terms Consumer/public perception AND vulnerability AND food supply Public AND expectation AND public health AND food supply Policy evolution AND public health Factors AND decision making AND public health policy Effectiveness* AND education AND campaign* AND public health Consumer/public behavi?r AND food safety Effective public AND health policy AND formation/creation Consumer/public perception AND food (supply) protection/safety Government AND safeguarding* AND food supply Government AND safeguarding AND food Government AND public perception AND food Public perception AND food protection Public perception AND food safety Policy AND food AND public perception Policy AND food safety Public expectation AND food supply Public perception AND vulnerability AND food supply Risk AND public perception AND food Public opinion AND government AND food safety Public opinion AND government AND food
articles were added to the electronic referencing tool RefWorks, and then each was reviewed in its entirety. The final inclusion criteria resulted in all of the three researchers reading and reviewing the peer-reviewed article independently, and then together verifying that it addressed the issue of public trust in the food supply within context, and its findings contributed to this research. Each researcher reviewed the relevant documents and noted mention of any public expectations with regard to food safety, and any policy reforms undertaken by public health agencies. The researchers then compared their findings with one another to ensure accurate data extraction. These findings formed the data for this study. Initially, only peer-reviewed articles were accepted; however, the literature search was expanded to include media publications using the same search process and terms as with the peer-reviewed search. During the analyses, a gap was identified in the public’s thoughts and opinions on food safety. The purpose of media reporting is to provide awareness to the public regarding significant events and the researchers felt that inclusion of media publications would contribute to the data regarding this gap, as the media both shapes and reveals public viewpoints [1,2,4]. The three researchers extracted points pertaining to the public’s opinion and/or perception of the food safety system from media articles in order to enhance information found through peer-reviewed literature. For example, interview segments with members of the public contained within media articles were considered to be reflective of public sentiment. Notwithstanding, articles from media sources tended to include multiple viewpoints which provided a balanced review of the news item. There are limitations to relying solely on media reporting as data since these reporting methods are not grounded by scientific methods and may be one-sided in their presentation.
3. Results The literature searches retrieved 357 articles, of which 39 were deemed relevant. The relevant articles were categorized into peer-reviewed (19), media (8), government reports (8), and legislation (4). 3.1. Public expectation regarding food safety The public questions whether local public health agencies are continuously working to protect their food supply [4,8]. Information on food safety issues should be transparent, and from a trusted and knowledgeable source [5,8,24,25]. Physicians and the medical community are usually seen as highly trusted by the public, followed closely by local public health agencies [1,26,27]. State and provincial agencies are not as trusted, primarily due to past experiences in which the public perceived attempted cover-ups of food safety crises by these agencies [1,2,4–6,8,25,28,29]. Effective risk communication is critical in maintaining public trust after a food safety event [1,2,5,25]. Provision of transparent scientific information to inform the public may support public trust in public health agency action [5,24,25,30]. The public wants public health agencies to demonstrate leadership in food safety [8,27,30]. Constituents are not confident that public health agencies are looking after their health and well-being and, specifically their food supply [2,8,30]. Consumers are unable to assess the safety of their food personally [4], and thus need to rely on a wellfunctioning industry supported by a well-functioning and transparent regulatory system [8,28,30,31]. 3.2. Food safety policy reform In Ontario, there is a movement away from more prescriptive legislation and requirements and toward a health outcome-based and public education approach leading to a “buyer beware” phenomenon. The Mandatory Health Programs and Services Guidelines have been replaced with the Ontario Public Health Standards, which sets health outcome targets as its measure of public health activity [32,33]. A self-regulated industry does not enjoy the trust of the public, as the public’s general perception is that industry will not be forthcoming with important information that may impact its short- or long-term viability [8,19,26]. The public believes that an agency cannot effectively promote and police itself simultaneously [19,26,27,29]. Public health agencies have a responsibility to ensure consumer concerns are dealt with in a respectful manner [8]. In order to regain the public’s trust in their public health system and, more importantly, in the food that they consume, policy solutions should include transparency and public participation in the process [4,5]. Deregulating based on increasing system efficiencies, improving industry profitability [19], or to respond to public pressure while not completing a thorough risk assessment can be detrimental to public health [28]. Certain recent food safety crises have resulted in both the public and government agencies calling for food safety regulatory reform [5,25,28]. Reports published in recent
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years suggest a lack of quality and consistency in food safety services [29,34,35]. An audit of Alberta’s food safety strategy has identified systemic deficiencies that threaten the health of the public [34,35]. In many cases, reform has consisted of either a movement toward hazard analysis critical control point (HACCP) inspection systems, the exploration of the creation of centralized, arms-length agencies, or the implementation of policies and systems designed to increase public knowledge of the safety of the food premises they frequent [13,28,29]. HACCP takes a risk assessment approach to assessing the flow of food; in addition to measuring existing systems against minimum acceptable standards, it focuses on achieving the safest food product possible as the end goal [36]. An effective HACCP system is predicated on being able to adequately identify and assess food safety risks [36]. Limited research in this area may leave food safety professionals less than prepared to meet the challenges of ensuring correct HACCP implementation [28,36]. Placing the onus for food safety on the operator and consumer and off of the regulators can leave the public at risk [8]. Replacement of regulation with a quality assurance system essentially moves the regulatory function to industry and, more specifically, to its employees [19]. The public perception is that such a system cannot adequately address food safety problems because the industry is perceived as self-protective and its employees are viewed as unlikely to report food safety infractions against their employers [19,28,36]. A negative economic impact on the food industry may result from diminished public trust [19]. Furthermore, health economists have argued that a food safety system based on HACCP creates a competitive advantage to firms large enough to sustain the infrastructure required, creating an unfair advantage within the marketplace [28]. Increasing transparency, specifically by implementing a food disclosure system, is one policy option aimed at improving public trust by facilitating public access to inspection results [37]. The first such system in Canada was developed in the city of Toronto, with many other local boards of health in Ontario following suit [37,38]. Many provinces across Canada have introduced or have announced intentions to introduce legislation that will mandate public disclosure of health inspection results so that trust can be maintained or regained [38]. Many arguments have been made against the effectiveness of this system for improving public health; however, it is clear that the public desires increased access to information [37]. 4. Discussion The public has both the legal right through EU legislation and expectation that government agencies, through their public health responsibilities, will protect the food supply. The oversight of food safety systems should be arms-length from special interest groups, and information regarding food safety events should be communicated in a transparent manner through a trusted, knowledgeable scientific source [5,27]. The public is not comfortable leaving the safety of their food supply wholly in the hands of the food producers and
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would like a strong government presence, although they acknowledge that producers do play a significant role in food safety [8]. Transparency, and effective mitigation and management of threats to food safety are of key importance to ensure consumers regain confidence in their food supply [5,8,24]. Many believe that transparency will contribute to a greater degree of public trust by informing and empowering consumers [5,24]. Disclosure of food premises inspection results is becoming more widespread as public concern regarding food safety escalates. Province-wide disclosure initiatives have been launched in Alberta, Saskatchewan, and New Brunswick and are being explored in Ontario [39]. Many municipalities in Ontario and health agencies in British Columbia have enacted local by-laws requiring food premises to post inspection results at the front door [39]. It is becoming increasingly clear that the public expects public health agencies to facilitate transparency and disclosure. The public is not well-versed regarding food standards and food safety programs, and therefore, rely on regulatory agencies to act on their behalf in regard to food safety issues [16]. Mistrust will arise when there is a food safety breach and transparent and timely information is not provided by regulatory agencies [16]. The Canadian food safety system, despite performing better than most jurisdictions, is traditionally weak in risk communication [16]. Public health agencies should leverage their goodwill and provide transparent, scientific communication to the public. Reception of a health message is dependent on levels of public trust, perceived expertise on the part of the message deliverer and recipient, and demographic variables such as age, education level, race, and socioeconomic status. Variability in perception among diverse population groups needs to be acknowledged and explored in order to effectively deliver information about food safety. Any movement toward a buyer beware approach to food safety can only be successful if the public understands the message. In the various jurisdictions analyzed in this study, it was identified that multiple agencies are involved in retail food safety in Canada, with all of them having a role in direct and legislated responsibility for food safety [16]. Such configuration can erode trust, as the public receives messages from numerous sources and can be confused as to which is the most legitimate or credible [16]. Integration coupled with a proactive approach by public health agencies in the area of food safety may improve communication, thereby enhancing public safety. Many believe that the creation of a national food safety agency is essential, although this notion is most popular in European countries under the EU where it is required by legislation [28]. Canada has moved in this direction, collapsing their federal food inspection activities under the CFIA in the mid-1990s in order to provide a competent agency to protect the food supply. In some cases, deregulation is seen as a viable option, although this tends to arouse more concern with the public than a disjointed, poorly managed system [19,28].
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Governments need to ensure consistency and quality of food safety programs and transparency in their communication to enhance public trust. They face pressure to overhaul retail food safety systems under their control and have responded in most cases by moving toward a system of less prescriptive regulation while attempting to supplement the current regulatory framework with one that focuses on outputs and quality assurance. 5. Conclusion To enhance public trust in the food safety regulatory system, public health agencies must communicate easily understood transparent, scientific information to the public. This information must be delivered by a trusted source. Inspection disclosure systems have been effective in increasing transparency, thereby improving public trust. The public expects public health agencies to take action to protect the food supply. Public health agencies must have a strong presence in a coordinated food safety regulatory framework. 6. Future research The research process identified a number of research gaps. The following areas require continued research if a full understanding of this subject is to be gained: the effects of deregulation on retail food safety; evaluation of prescriptive versus outcome-based measures in retail food safety inspection; the public’s expectations of government agencies with regard to retail food safety regulation; the role of the media in retail food safety; the role of researchers and public health leaders in retail food safety; the risk associated with various food processing and food handling activities; and, replacement of retail food safety regulation with public education. It is necessary for government to explore how to best meet the expectation of the public with regard to retail food safety. Conflict of interest None identified. References [1] Tucker M, Whaley SR, Sharp JS. Consumer perception of foodrelated risks. International Journal of Food Science & Technology 2006;41:135–46. [2] Murphy-Lawless J. The impact of BSE and FMD on ethics and democratic process. Journal of Agricultural and Environmental Ethics 2004;17(4–5):385. [3] de Jonge J, van Trijp H, Goddard E, Frewer L. Consumer confidence in the safety of food in Canada and the Netherlands: the validation of a generic framework. Food Quality and Preference 2008;19: 439–51. [4] Verbeke W, Frewer LJ, Scholderer J, De Brabander HF. Why consumers behave as they do with respect to food safety and risk information. Analytica Chimica Acta 2007;586:2–7. [5] Jensen KK, Sandøe P. Food safety and ethics: the interplay between science and values. Journal of Agricultural and Environmental Ethics 2002;15(3):245. [6] Disney H. Food policy proves hard to digest. Sweden: Stockholm; 2007.
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