# COLLABORATION OF STATE AND LOCAL HEALTH DEPARTMENTS IN ADOPTING THE FDA 2005 MODEL FOOD CODE

# 2007 - 2008 

# 

#  Environmental Public Health Leadership Institute Fellow:

#  Ron Marsden, BS, LEHS

*Program Manager, Utah Department of Health*

*288 North 1460 West*

*PO Box 142104*

*Salt Lake City, Utah 84114-2104*

*rmarsden@utah.gov*

# 

# Mentor:

### **Dwayne Roadcap, BS, REHS**

*Program Manager, Virginia Department of Health*

# Acknowledgements:

### **Joe Malinowski, REHS**

*Consumer Protection Coordinator*

*Boulder County Public Health*

**Jeffrey M. Brasel, REHS**

*Senior Registered Environmental Health Specialist*

*Washoe County District Health Department*

# EXECUTIVE SUMMARY:

It is estimated by FDA and CDC that 76 million people in the United
States become ill, 325,000 hospitalized and 5,000 deaths occur each year
due to food borne illnesses[^1]. An efficient, consistent and effective
public health system serves as a preventative tool to address the
national goal of reducing the food borne illness risk.

The adopted Utah food code is based on the 1999 FDA model food code. The
FDA recently adopted the 2005 code. The goal of this project was for the
Utah Dept. of Health to adopt the 2005 FDA model food code statewide to
prevent inconsistencies of interpretation arising from the different
requirements of local codes, eliminate training inefficiencies, and
prevent the reduction of effectiveness of the public health system which
can result from enforcing non uniform rules.

Using Systems Thinking, Mental Models and Logic Models, this project
describes the process used to adopt a uniform food code statewide.
Through the application of a number of the 10 Essential Services of
Public Health[^2], and Healthy People 2010[^3] food safety goal, food
inspection issues requiring attention in the state have been identified.
The next step for this project is to address these issues, and
collaborate with the Local Health Departments (LHDs) to make the changes
necessary in the food inspection system.

The application of Systems Thinking and analysis of Archetypes to
interpret system interactions resulted in collaboration between the
state and LHDs to adopt the FDA 2005 food code without modification
statewide. Additionally, industry representatives in Utah gained a new
respect for the public health system as they viewed government agencies
unite together to adopt a statewide uniform code. As a result, there is
an increased desire for government agencies in Utah to collaborate on
other issues in the future. This project demonstrates that a strong
collaboration between the state and local health departments will result
in a much more effective public health system, which will more
efficiently and consistently serve to benefit the public's health.

# INTRODUCTION/BACKGROUND:

According to the Food and Drug Administration, it is estimated that 76
million people become ill as a result of a food born illness
annually[^4]. Additionally, 325,000 persons are hospitalized, and
approximately 5,000 deaths per year associated with food borne illness
occur. An efficient, consistent and effective public health system
serves as a preventative tool to reduce the risk of food borne illness
to the public.

At the core of the reduction of risk to a food borne illness is the
existing rule or food code, which provides the outline for prevention
enforcement. In Utah, it is the responsibility of the Program Manager at
the State Department of Health to direct the rulemaking process to write
new rules, and/or update existing rules. To accomplish this task,
advisory committees comprised of representatives from the local health
departments and industry are formed as part of the rulemaking process.
The advisory committees meet and build a consensus as to the content of
a new rule, or how to update an existing one. At the end of the
committee process, the committee advises the Utah Department of Health
of their findings. This process of building a consensus among industry
and regulatory can be very time consuming, and can take months or even
years to obtain.

Due to budget cuts in 2002, the Environmental Services Program at the
Utah Department of Health was reduced from 3 Full time Equivalents (FTE)
to one. For a period of 6 months at the beginning of 2003, there was no
one in the position. As a result of this void of leadership for a time,
the local health departments took upon themselves the role the state had
historically performed. The FDA also assisted to fill the void. When the
dust settled, one person had the responsibility that three had
previously carried out. The responsibility of this one FTE included 14
environmental sanitation rules to oversee, in addition to the food code.
The consensus that had been built up over the years had been greatly
reduced, and the roles of governmental agencies had been temporarily
altered. In order to return to normalcy, a balance would need to again
be established between the state and local health departments. As the
state's role had been temporarily modified, some local health
departments saw the necessity of adopting the changes proposed by the
FDA in codes dated after 1999 in order to protect the public health.
Other LHDs did not modify their regulations. Without the state to
provide uniformity of regulation, it created an imbalance of regulations
around the state, which proved difficult for the food service industry.
This also created a feeling in the food service industry of "non
standardized enforcement", as different regulations were required in
different areas.

In Utah, the food rule that is now in effect is based on the FDA 1999
model food code. Since this rule has been adopted, many changes have
taken place as proposed by the Conference for Food Protection, which
resulted in the need to update the current rule. This project outlines
the process taken to gain consensus among industry and the local health
departments to adopt the 2005 FDA model food code statewide to prevent
inconsistencies of interpretation arising from the different
requirements of local codes, eliminate training inefficiencies, and
prevent the reduction of effectiveness of the public health system which
can result from enforcing non uniform rules.

As indicated by the behavioral over time graph (Figure 1), as funding
and staff support at the state level decrease, technical expertise
decreases, and non-standardization of rules increases. The effect on the
risk to public health is unknown, but one might argue (as indicated by
the graph) that it could increase as the result of confusion among those
in industry who are trying to adhere to the regulations. For example,
employees working for a franchise operation with facilities in different
health districts may encounter different requirements in one LHD area as
compared to another. The differences can cause confusion as to why a
regulation is not enforced in one area, but not in another, and does not
serve the purposes of public health well. Voluntary compliance with
regulations may be reduced by this attitude.

####### ***Problem Statement:*** The State of Utah had not updated the food rule since adopting the 1999 FDA Model food code in 2000. Since that time budget cuts have occurred which shut down the program for 6 months, and has altered the available staff. In the interim, some local health departments have updated their regulations to reflect the latest updates proposed by FDA, while others have not. This has created a non-standardized food code across the state. To update the state rule and standardize regulation statewide, systems had to be redefined, relationships reestablished, and efforts to rebuild the program implemented. This project has worked to address solutions to the questions of "Why did the loss of two FTE's in the Environmental Sanitation Program affect the public health relationship between the LHDs and the State Dept. of Health , and why did this incident cause the loss of standardized food regulations in the state. 

# Variables

## Time

####### Figure 1. Behavior over Time 

####### 

####### **Accidental**

**Adversaries**

####### ***10 Essential Environmental Health Services:***

This project used several facets of the Ten Essential Environmental
Health Services[^5], and one of the three functions.

1\. An assessment of the situation was made to determine the best path
to follow to again gain consensus of industry, LHDs, and state in
regards to the direction of adoption of the 2005 FDA food code.

2\. Community partnerships were mobilized to gain a consensus with
industry in the adoption of the food code.

3\. Ancillary to this project, policies were developed and proposed to
the Executive Director of the state health department and Local Health
Officers, formally outlining the duties of the state and LHDs and put
into contractual proposal.

4\. As part of the plan to resolve the budget cut issues, the Utah Dept.
of Health formed a committee to outline what needs the local health
departments have, and what should be provided to them by the state
health department. In essence, the committee took a new look at the
state and local health department relationship and outlined a plan to
meet these needs, and provide the LHDs with more resources at the state
level to ensure a competent workforce.

![](media/image1.png){width="3.75in" height="3.8125in"}

Figure 3: Reprinted from CDC's "National Strategy to Revitalize
Environmental Public Health Services, 10 Essential Environmental Health
Services"

####### 

####### ***National Goals Supported*** 

Healthy People 2010[^6] is a comprehensive set of public health
priorities and measurable objectives for the nation. This project helps
to support focus group number 10, "Food Safety" of the 28 goals. The
project ensures a standardized rule will be adopted, which will be more
easily interpreted and enforced to reduce the risk of food borne
illness.

Ancillary activities related to this project also support the National
Strategy to Revitalize Environmental Public Health Services[^7] by
addressing the following goals:

1\. Build Capacity: Rebuild the Environmental Services Program at the
State Level.

2\. Foster Leadership. By rebuilding the program, reestablish the state
in a leadership position for the local health departments.

3\. Create Strategic Partnerships: Rebuild the relationships between the
local health departments and industry, which were affected by budget
cuts.

#######  {#section-5 .unnumbered}

# 

# PROJECT OBJECTIVES/DESCRIPTION/DELIVERABLES:

***Program Goal*** To minimize the risk of food borne illness at
restaurants through an efficient and effective public health inspection
system.

***Health Problem*** According to the Food and Drug Administration, it
is estimated that 76 million people become ill as the result of a food
borne illness. Additionally 325,000 persons are hospitalized with
approximately 5,000 deaths per year. An efficient, consistent and
effective public health system serves as a preventative tool to reduce
the risk of food borne illness to the public.

####### ***Outcome Objective*** Adopt a uniform code statewide, and assure that all stakeholders use the adopted 2005 FDA Food code and consistently interpret and enforce it.

####### ***Determinant*** (1) Adopt statewide FDA 2005 Food code, (2) standardize local health inspectors to increase effectiveness, and reduce inconsistencies., and (3) Hold routine meeting between local health departments and industry to address interpretation issues.

####### ***Impact Objective*** By June 2008, adopt the FDA 2005 food code to give stakeholders one guideline for accepted food safety practice.

####### ***Contributing Factors*** 

1\. No uniform inspection sheet among local health districts.

> 2\. No consistent communication between industry and regulatory
> personnel to discuss differences of opinions and provide a mechanism
> for guidance on interpretation of the food code.

4\. Inadequate amount of training for local health department
inspectors.

####### *Process Objective 1:* By January 2008, develop plan to adequately train and standardize stakeholders**.**

*Event:* Hold quarterly meetings with Environmental Health Directors.
Convene committee meetings with industry representatives and regulatory
representatives. Participate in quarterly meetings with joint
industry/regulatory Food Safety Coalition

*Activities:* Discuss proposed food code changes with industry in
committees. Discuss model food code with all Environmental Health
Directors. Develop consensus opinion on a statewide rule for model food
code.

*Process Objective 2:* By June 2008, 50% of the local health departments
will be using the same inspection sheet.

*Event:* Quarterly meetings with Environmental Health Directors, and
standardization training meetings with inspectors.

***Activities**:* Draft uniform inspection sheet for consensus
development with stakeholders.

*Process Objective 3:* By June 2008, convene a committee consisting of
both industry and regulatory representatives to give guidance regarding
questions on interpretation of the food code.

*Event:* Identify pertinent stakeholders and contact them. Determine
their willingness to serve. Designate committee and set-up first
meeting.

*Activities:* The committee will provide input on uniform inspection
sheet, differences in interpretation of the food code, and issue
guidance to implement the 2005 FDA Model Food Code.

*Process Objective 4*: By June 2008, train six local health department
inspectors as statewide standardization offers in the FDA format

# *Event:* FDA standardization by certified state official

*Activities:* Standardization exercises will be first conducted in areas
of the state, which have not been standardized recently. After that is
accomplished, the balance of the LHD's in the state will be
standardized.

# METHODOLOGY:

####### *Events and Activities*

*Event:* Quarterly Meetings with Environmental Health Directors

*Activities:* Collaborate with directors from the local health
departments regarding adoption of the 2005 FDA food code as the state
rule for enforcement in Utah. Get input on the direction desired for the
inspection program. Propose uniform state inspection form to the
directors, and form consensus. Develop a schedule of standardization
activities for the next year to ensure standardization of inspectors to
the new rule.

*Event:* Food code meetings with Utah Dept. of Agriculture and Food,
Industry and LHD representative.

*Activities:* Collaborate with industry representatives, other state
agencies, local health departments to gain consensus on the adoption of
the food code. Form a consensus on how to address interpretation
inconsistencies statewide.

*Event:* Meetings with the Utah Food Safety Coalition

*Activities:* Collaborate with industry and regulatory representatives
to promote food safety in the state of Utah. Seek funding from FDA to
hold meeting to promote and educate attendees on food safety. Write a
grant to obtain the necessary funding.

*Event:* Meetings held with the Utah Environmental Services Workgroup
Committee, and Presentation of Committee Findings to Health Officers and
Executive Director of State Health Department

*Activities:* Collaborate with state and local representatives on
defining the role and relationship of the state and local health
departments in Utah. Develop a joint plan to rebuild the Environmental
Services Program in Utah to fulfill the needs of the LHDs, and provide
state leadership. Seek new ways of providing funding for the program,
including actively seeking grant opportunities and/or developing new
fees to provide a funding base increase. Present the committee findings
to the Health Officers and Executive Director of State Health for
approvals.

# RESULTS/CONCLUSIONS:

Through the tedious and patience building task of meeting with the
leaders of the local health departments and industry, a consensus has
been reached. Both the Local Health Department Directors and industry
have agreed that Utah should adopt the FDA 2005 Food code chapters 1
through 7 by reference without any modifications. In the beginning, the
LHDs desired some modifications to the FDA food code, but industry and
the LHDs were not in agreement in regards to this. A consensus to adopt
the 2005 FDA food code by reference was reached as this food code had
been approved at the Conference for Food Protection by both industry and
regulatory representatives. The proposed code will need to go through
administrative review at the Utah Department of Health, and go out to
public comment before the rule will go into effect.

A proposed draft of the inspection form to be used statewide has been
developed, and was given to the local health departments for input. This
form is still under consideration, and a final approval has not yet been
obtained. The most rural health departments have no objection, but the
most populated health departments desire more time to consider the
proposal. Standardization exercise dates will be finalized in January
2008 for the coming year.

The Environmental Services Workgroup has concluded their task of
defining the roles of the local health departments and the state. And
the task of proposing how to rebuild the Environmental Services Program
has been completed. This was proposed for approval at a meeting in
November 2007 to the Health Officers and Executive Director of the State
Health Dept. The committee's findings were approved.

A grant has been written and will be sent to FDA to obtain funding to
promote food safety in Utah at a meeting which will be held in 2008.
Food Safety representatives from both industry and regulatory will be
invited to attend.

# 

# LEADERSHIP DEVELOPMENT OPPORTUNITIES:

####### *Ron Marsden*

The opportunity to attend the Environmental Public Health Leadership
Institute has been an opportunity of a lifetime for me. Where else could
you meet "leaders" from all over the United States and have the
opportunity to discuss issues, and learn leadership concepts to apply in
your position. The MBTI, Skillscope 360, and Change Style indicator were
of great benefit to my understanding of others and myself. I feel the
applications of the knowledge learned through these activities will
enable me to become a more effective leader in the years to come. Also,
to gain an understanding of Systems Thinking to more effectively tackle
complex problems, will enable me to become a more effective problem
solver and collaborator. I thoroughly enjoyed the presentation on Verbal
Judo, which will be of great benefit in both my personal and
professional life. Additionally, I am most grateful to have had the
opportunity to learn skills necessary to apply in a public health crisis
BEFORE one occurs. I plan on keeping the material discussed at EPHLI
readily available for reference and guide in the event I am involved as
a responder in a public health crisis in the future.

I am sincerely grateful for this opportunity and I would recommend
others who might be extended this opportunity to attend.

# ABOUT THE EPHLI FELLOW

Ron Marsden is the Program Manager of the Environmental Services Program
at the Utah Department of Health, located in Salt Lake City, Utah. Ron
has a BS in Environmental Health from Brigham Young University, and is a
licensed Environmental Health Scientist. He has also attended some
graduate classes for a MPH at the University of Utah. He has been the
manager of this program since 2003. The program manager has the
responsibility of oversight of all environmental sanitation rules;
serves as a liaison with federal, state, local agencies, as well as
industry representatives; and standardize food inspectors statewide. In
the capacity of holding this position, Ron has had the opportunity to be
a state delegate to the Conference for Food Protection, serve as the FDA
State Standardization Officer for Utah, and is a Certified Pool
Operator. Training coursework has included FDA courses in the Food Code,
Plan Review, Legal Aspects of Enforcement, Retail Food Service, HACCP,
Milk Pasteurization Controls and Test, Milk Plant and Farm Sanitation
and Temporary Food Establishments. He serves on the Utah Environmental
Health Association Board and Education Committee.

Previous to holding this position, Ron worked in the Environmental
Epidemiology Program at the Utah Dept. of Health. Training courses he
has had the opportunity to attend include: Epi in Action, Epi Ready Food
borne Illness Training, Hazwopper 40 hour course, Lead Inspector and
Risk Assessor, and Epidemiology and Biostatistics Summer Institute at
Johns Hopkins.

Ron has worked in the Environmental field for his whole career. Previous
to the Utah Dept. of Health Ron worked at the Utah Department of
Agriculture and Food as a Food and Dairy Compliance Officer, Coca Cola
of Salt Lake as the Sanitation Supervisor, and DataChem Laboratories as
the Quality Control Manager.

# REFERENCES

1\. FDA Center for Food Safety and Applied Nutrition (CFSAN):
<http://www.cfsan.fda.gov/~dms/a2z-f.html>

2\. Carl Osaki, RS, MSPH, Northwest Center for Public Health Practice,
10 Essential Environmental Health Services.

3\. CDC Healthy People 2010 Objectives
<http://www.cdc.gov/nchs/about/otheract/hpdata2010/abouthp.htm> .

4\. CDC National Strategy to Revitalize Environmental Public Health
Services <http://www.cdc.gov/nceh/ehs/Docs/nationalstrategy2003.pdf>

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[^6]: ^3^

[^7]: