Association Between Food Establishment Compliance and Foodborne Illnesses and Means to Improve Effectiveness of Food Control

Foodborne pathogens are a severe public health concern estimated to annually cause 5,000 foodborne outbreaks and 24 million foodborne illnesses in Europe. The majority of foodborne outbreaks originate from food business operators (FBOs). Consumers rely on official food control to protect them from foodborne illnesses; thus, food control must be effective. To achieve this, food control must be risk based, meaning, for example, that inspections should specifically target FBOs with high food-safety risks, while more seldom inspections of FBOs with low food-safety risks could be adequate. Determining the risk level of FBOs can include, for example, the type and volume of their operations and inspection history. Food control research has largely focused on the effect of food control on compliance with food safety legislation; the relationship between compliance and foodborne illnesses is a less-studied subject. This dissertation used food control inspection reports, foodborne outbreak investigation reports, and the Finnish Infectious Disease Register to study the associations between compliance and foodborne outbreaks and illnesses. It also examined some possible means to increase effectiveness of food control. The results indicate that food control recognizes non-compliances that may lead to foodborne illnesses. “Monitoring employees’ health status” and “Verification of hygiene proficiency” were inspection items that had inferior compliance in outbreak FBOs compared to non-outbreak FBOs. Outbreak FBOs also more often had cleanliness problems when verbal descriptions of inspection findings were examined. When regional compliance of food establishments and incidence of foodborne illnesses were analyzed, an association between them were found in overall compliance, as well as in “Cleanliness of facilities, surfaces, and equipment,” “Storage of foodstuffs,” and “Verification of hygiene proficiency.” Increasing the effectiveness of food control could lead to increased compliance which, in turn, could decrease the risk for foodborne illnesses. It was demonstrated, when examining how changes in compliance level would affect incidences of foodborne illnesses, that if all food control units in Finland were to have compliance levels matching the top 50% of the units, domestically acquired Campylobacter and Salmonella infections would decrease by 12%. This is a significant result, because such a decrease in the number of foodborne illnesses would have notable effects not only on the disease burden but also on the economic burden caused by these pathogens. The results also indicate that prolonged inspection intervals are associated with increased risks for non-compliances and that these non-compliances may lead to foodborne outbreaks. Additionally, the inspection history is associated with future compliance. Based on these results, the effectiveness of food control could be increased by a more dynamic approach in determining an FBO’s risk level, i.e., the frequency that an FBO is inspected. Moreover, certain inspection items, mainly those related to temperature management and actions of personnel, should receive more frequent attention at inspections. Food control units were noted to have large differences in how well non-compliances are corrected within their regions. This study identified that shorter verbal descriptions of inspection findings made by inspectors associate with better correction of non-compliances. This finding should be further investigated to better understand how communication of observed non-compliances influence correction of non-compliances.