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Public health interventions help to ensure food safety
EV IDE NCE-B ASED PU BL I C HE AL TH
Public health interventions help to ensure food safety Campbell ME, Gardner CE, Dwyer JJ, Isaacs SM, Krueger PD, Ying JY. Effectiveness of public health interventions in food safety: a systematic review. Canad Public Health 1998; 89:197d202.
OBJECTIVE To summarise evidence on public health food safety interventions. METHOD Descriptive systematic review. LITERATURE REVIEW The authors searched for English language, published and unpublished literature. They searched nine databases from 1975 to 1997, hand-searched key publications and interviewed experts. Included studies needed to: (a) describe food safety interventions or programs; (b) be relevant to public health in Ontario; (c) use predetermined outcome measures, and (d) meet epidemiological quality criteria. The authors abstracted data with a pretested form and tabulated characteristics, quality and results.
Commentary This review is timely, as in the UK, health workers have been urged to undertake a more evidence-based approach to public health interventions.1,2 Its findings emphasize the problems clinicians face when practising in the face of uncertainity and against a culture of professional expertise. For many years, I have argued for local authorities not to reduce funding of environmental health officers and sought expansion of training for food handlers. I have always supported community education programs on food hygiene. This review shows how little evidence there is for such views. Fortunately, it prioritized the interventions in the order that I had summarized. For several reasons, many local authorities have periodically reduced funding for environmental health department activities on food safety. Pollution and noise abatement have become greater political priorities. It has been difficult to recruit adequately trained staff. The first casualty is usually education of food handlers, with greater priority given to inspection. A few community programs focus on schools and local advertising. It is interesting to note that, even with rising concerns about food poisoning outbreaks, food safety has not been given higher political priority.
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Evidence-based Healthcare (1999) 3, 96
RESULTS The search revealed 34 from 168 potentially relevant studies addressing three types of interventions: inspections, food handler training and community-based education. The studies found that (a) routine inspection (at least once per year) of food service premises reduces the risk of food-borne illness; (b) food handler training improves knowledge and practice of food handlers, and (c) selected community-based education programs increase public knowledge of food safety.
AUTHORS’ CONCLUSIONS There is evidence that several public health interventions ensure food safety.
Changing practice is difficult and insufficiently researched; 3 this attempt to include environmental health colleagues in public health reform is welcome. Do we need a systematic review on getting research evidence into environmental health practice? Philip Milner Wiltshire Health Authority Devizes, UK
Literature cited 1. Gray JAM. Evidence-based Health Care. Edinburgh: Churchill Livingstone, 1997. 2. Fahey T, Hyde C, Milne R, Thorogood M. The type and quality of randomized controlled trials (RCTs) published in UK health journals. J Public Health Med 1995; 17: 469d474. 3. Haynes B, Haines A. Getting research fundings into practice: barriers and bridges to evidence-based clinical practice. BMJ 1998; 317: 273d276.
^ 1999 Harcourt Publishers Ltd
Public health interventions help to ensure food safety Campbell ME, Gardner CE, Dwyer JJ, Isaacs SM, Krueger PD, Ying JY. Effectiveness of public health interventions in food safety: a systematic review. Canad Public Health 1998; 89:197d202.
OBJECTIVE To summarise evidence on public health food safety interventions. METHOD Descriptive systematic review. LITERATURE REVIEW The authors searched for English language, published and unpublished literature. They searched nine databases from 1975 to 1997, hand-searched key publications and interviewed experts. Included studies needed to: (a) describe food safety interventions or programs; (b) be relevant to public health in Ontario; (c) use predetermined outcome measures, and (d) meet epidemiological quality criteria. The authors abstracted data with a pretested form and tabulated characteristics, quality and results.
Commentary This review is timely, as in the UK, health workers have been urged to undertake a more evidence-based approach to public health interventions.1,2 Its findings emphasize the problems clinicians face when practising in the face of uncertainity and against a culture of professional expertise. For many years, I have argued for local authorities not to reduce funding of environmental health officers and sought expansion of training for food handlers. I have always supported community education programs on food hygiene. This review shows how little evidence there is for such views. Fortunately, it prioritized the interventions in the order that I had summarized. For several reasons, many local authorities have periodically reduced funding for environmental health department activities on food safety. Pollution and noise abatement have become greater political priorities. It has been difficult to recruit adequately trained staff. The first casualty is usually education of food handlers, with greater priority given to inspection. A few community programs focus on schools and local advertising. It is interesting to note that, even with rising concerns about food poisoning outbreaks, food safety has not been given higher political priority.
96
Evidence-based Healthcare (1999) 3, 96
RESULTS The search revealed 34 from 168 potentially relevant studies addressing three types of interventions: inspections, food handler training and community-based education. The studies found that (a) routine inspection (at least once per year) of food service premises reduces the risk of food-borne illness; (b) food handler training improves knowledge and practice of food handlers, and (c) selected community-based education programs increase public knowledge of food safety.
AUTHORS’ CONCLUSIONS There is evidence that several public health interventions ensure food safety.
Changing practice is difficult and insufficiently researched; 3 this attempt to include environmental health colleagues in public health reform is welcome. Do we need a systematic review on getting research evidence into environmental health practice? Philip Milner Wiltshire Health Authority Devizes, UK
Literature cited 1. Gray JAM. Evidence-based Health Care. Edinburgh: Churchill Livingstone, 1997. 2. Fahey T, Hyde C, Milne R, Thorogood M. The type and quality of randomized controlled trials (RCTs) published in UK health journals. J Public Health Med 1995; 17: 469d474. 3. Haynes B, Haines A. Getting research fundings into practice: barriers and bridges to evidence-based clinical practice. BMJ 1998; 317: 273d276.
^ 1999 Harcourt Publishers Ltd