Report Documents Foodborne Illness “Poverty Penalty”

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A new report released by CFA earlier this month, Foodborne Illness: Another Way the Poor Pay More, shines a light on the disparate impact wrought by lax food safety policy. The report explores research showing that being in poverty puts consumers, particularly those under five years of age, at higher risk of infection from foodborne pathogens such as Campylobacter, Salmonella, and Shigella.

Each year, Salmonella alone causes an estimated 1.35 million illnesses, 26,500 hospitalizations, and 420 deaths in the United States, at an estimated cost of $3.7 billion in medical bills. Despite this high cost, progress on reducing foodborne illness has largely stalled in recent years, with the last four years of CDC data showing an upward trend in reported foodborne illnesses.

As noted in the report, research on foodborne illness and poverty has been beset by measurement challenges, in particular because so many foodborne illnesses are not reported. Reports of foodborne illness provide a key feedback mechanism to curb foodborne pathogens. However, consumers may not provide specimen samples for testing, may receive an incorrect diagnosis, or may simply not seek medical care. As a result, CDC researchers estimate that, for every reported case of Salmonella infection, another 29 go unreported.

Compounding the uncertainty, the best dataset available in the United States, the Centers for Disease Control and Prevention’s (CDC) Foodborne Diseases Active Surveillance Network, or FoodNet, does not include key data on foodborne illness victims. The state and local public health partners that contribute to FoodNet do not track income or other indicators of socioeconomic status in their reporting. In addition to not tracking these economic markers, the FoodNet “catchment area was not chosen to equally represent all racial and ethnic groups, and even in the expanded FoodNet population, Hispanics and those living below the poverty level are underrepresented when compared to the general American population (6% vs. 12%, and 11 vs. 14%, respectively).”

Despite this uncertainty, recent research provides a clear indication that living in poverty is an important risk factor for acquiring a foodborne illness. By using location data for reported cases, researchers have analyzed whether living in zip codes with higher rates of poverty makes a person more likely to report a foodborne illness. Their studies strongly suggest that poverty puts consumers, particularly those under five years of age, at higher risk of infection from certain foodborne pathogens, including Campylobacter, Salmonella, and Shigella. However, due in part to the measurement challenges, determining why poverty increases one’s risk for foodborne illness is difficult.

While some cultural practices, such as the consumption of chitterlings or fresh Mexican style cheeses, may contribute to more foodborne illness among poor consumers, the harsh reality is that living in poverty itself represents a risk factor for a wide range of health problems, including foodborne illness. “Over 23 million U.S. consumers, about half of whom are ‘low-income,’ live in a food desert. While this may translate into fewer foodborne illness cases attributable to fresh produce, it likely increases the burden of foodborne illness overall, because poor nutrition makes individuals more vulnerable to foodborne illness,” according to the report.

The dynamics behind this increased vulnerability are straightforward. Researchers have noted that poor nutrition is “well understood to impair immune function,” in part because it tends to “impair the production and activity of immune cells and antibodies.” A weakened or compromised immune system can, in turn, increase one’s risk for infection, including from foodborne illness. Studies have shown, for example, that poor nutrition leads to reduced gut health, which in turn stymies the body’s ability to fight off Salmonella infections. As a result of these factors, consumers struggling with the stresses of scarcity tend to be the least equipped to fend off foodborne pathogens that pose a threat to all consumers.

CFA’s report provides five action steps to help protect the poor from foodborne illness:

1. Protect consumers from meat and poultry adulterated with virulent Salmonella

Through the use of vaccines, close monitoring, and data transparency, regulators could make significant progress in reducing the toll of salmonellosis.

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2. Make fresh produce safer

To avoid future outbreaks, federal regulators should follow through on rules requiring sanitization of agricultural water and should consider incentives for cattle producers to vaccinate cattle against E.coli.

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3. Slow the rise of superbugs

Widespread use of antibiotics creates antibiotic resistant bugs. While a comprehensive response from Congress is needed, a good start would be to create a system to collect data on how antibiotics are used on-farm, including information on quantities of antibiotics used and the specific indications for use.

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4. Promote a culture of food safety in the workplace

Food workers are on the front lines of the fight to prevent foodborne illness. Yet workers that lack basic workplace safety protections, including paid sick leave, cannot be expected to contribute to the attitudes, values and beliefs that make a successful culture of food safety possible.

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5. Create a single, independent food safety agency

15 different federal agencies currently divvy up responsibility for ensuring the safety of the food supply. The Safe Food Act would consolidate federal food safety activities into one independent food safety agency, with broad jurisdiction to address food safety hazards wherever they may emerge.

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“Too often foodborne illness is characterized as a minor nuisance, and food safety a luxury that we can afford to cut back on,” said Thomas Gremillion, Director of Food Policy at CFA. “This report shows that investing in food safety isn’t just good for public health, it’s a matter of social justice.

“The burden of foodborne illness on our most vulnerable communities is alarming,” said Nick Roper, CFA Administrative and Advocacy Associate. “Policymakers should take steps to better understand this problem and direct the resources necessary to eliminate this additional poverty penalty.”

Consumer Federation of America (CFA) is a non-profit organization advancing the consumer interest through research, advocacy, and education.

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