摘要：Objectives. We evaluated the relationship between local food protection capacity and service provision in Maryland's 24 local food protection programs (FPPs) and incidence of foodborne illness at the county level. Methods. We conducted regression analyses to determine the relationship between foodborne illness and local FPP characteristics. We used the Centers for Disease Control and Prevention's FoodNet and Maryland Department of Health and Mental Hygiene outbreak data set, along with data on Maryland's local FPP capacity (workforce size and experience levels, budget) and service provision (food service facility inspections, public notification programs). Results. Counties with higher capacity, such as larger workforce, higher budget, and greater employee experience, had fewer foodborne illnesses. Counties with better performance and county-level regulations, such as high food service facility inspection rates and requiring certified food manager programs, respectively, had lower rates of illness. Conclusions. Counties with strong local food protection capacity and services can protect the public from foodborne illness. Research on public health services can enhance our understanding of the food protection infrastructure, and the effectiveness of food protection programs in preventing foodborne illness. Protecting the food supply requires diligence from farm to fork—from ensuring that our produce is grown in sanitary conditions to inspecting restaurants to ensure that food service workers are using proper hand-washing techniques. However, foodborne outbreaks continue to dominate the media headlines. Approximately 48 million cases of foodborne illness (FBI) occur annually, 1 with 66% of foodborne outbreaks associated with restaurants and 9% with catered events. 2 Numerous studies demonstrate that a large percentage of outbreaks are related to poor food-handling procedures. 2 , 3 , 4 Shigella, hepatitis A, and norovirus, among many other infections, can all be readily transmitted to restaurant patrons through improper hand washing by infected food handlers. 5 In Maryland, where restaurant sales were projected to reach $8.7 billion in 2010 6 and nearly 55% of residents eat in sit-down restaurants on a weekly basis, 7 63% of foodborne outbreaks reported to the Maryland Department of Health and Mental Hygiene (DHMH) occurred in restaurants. 8 To prevent these outbreaks from occurring, a strong public health infrastructure is essential. In Maryland, ensuring that restaurants provide safe meals to consumers is the primary role of the state's 24 county-level food protection programs (FPPs). 9 Housed in the environmental health division of the county-level health department, these programs conduct routine inspections of restaurants (hereafter referred to as food service facilities [FSFs]), public notification programs (such as posting FSF closures in local media outlets), educational programs for both FSF workers and county residents, and collaboration with county-level legislators to develop and enforce food protection regulations, such as certified food manager programs. The ability of local FPPs to conduct these tasks and provide services is contingent on a robust infrastructure and strong internal capacity—that is, structural inputs, such as workforce size and internal budgets, that allow the FPP to deliver services such as FSF inspections. In light of new data indicating that FBI costs $156 billion a year, 10 health departments are even more accountable to the public to reduce illnesses and their significant human and financial costs. With the resurgence of performance measurement at all levels of government, the need to measure local FPP capacity to protect the food supply and demonstrate the effectiveness of food protection programs, through measuring the impact of food protection programs on key public health outcomes, is more essential than ever to ensure sustained financial and political support for local programs. However, despite the longstanding importance of these food protection activities, in Maryland the relationship between county-level food protection capacity and services and FBI cases and outbreaks has not been evaluated. Using public health services and systems research methods, we sought to evaluate this relationship.
