Reflections on a Career in Public Health: Evolving Foodborne Pathogens, Environmental Health, and Food Safety Programs. (Features)

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Introduction

This paper reflects on a career in public health, revealing events that led to an understanding of foodborne diseases, their prevention, and the rationale for present policies that address them. This review is presented by decade and considers activities of the Public Health Service and the World Health Organization, national environmental health policy, emerging foodborne pathogens, the impact of foodborne-disease outbreaks, and measures to prevent and control foodborne diseases.

1940s-Impact of World War lion Public Health

The Public Health Service and Environmental Health

During the war years, the Public Health Service (PHS) broadened the Commissioned Corps, authorizing the commissioning of nurses, scientists, veterinarians, dieticians, physical therapists, and sanitarians. A Malaria Control in Wartime Areas (MCWA) program was initiated because malaria was endemic in the southern United States and posed a problem for the training of troops in the region. Massive efforts of swamp drainage and larviciding, which were done by and with the leadership of engineers, scientists, and sanitarians, eliminated the disease. This agency then took on typhus control, which revolved around rodent and flea control. MCWA was also successful in eradicating this disease from the United States. The reporting of milkborne-disease outbreaks, which had begun in 1923, and of foodborne-disease outbreaks, which had begun in 1938, continued to be done by the Division of Sanitary Engineering Services of PHS. This division published the first model ordinance and code for eating and drinking establishments. The ordinance and code was a model for state and local health departments to adopt (Division of Sanitary Engineering Services, 1943).

Following World War II, PHS formed the Communicable Disease Center (CDC) from the very successful MCWA that was headquartered in Atlanta. Divisions of the Center included Laboratory, Technology, and Training. Training centers, which emphasized training in environmental sanitation and directed it primarily at sanitarians, were established in several locations (e.g., Colorado, Georgia, Kansas, New England, New York, Pennsylvania, and Washington). The philosophy of this training was "Learn by Doing." Twelve-week field-oriented training courses on environmental sanitation (including communicable diseases, water, sewerage, waste disposal, insect and rodent control, milk, food, environmental surveys, and related topics) and specialized short courses on environmental sanitation subjects were featured. Also at this time, nationally, PHS promoted short-course training of food service workers by demonstrations, film strips, and training materials. Septic-tank research was being done at the Robert A. Taft Sanitary Engin eering Center in Cincinnati.

(Although the term "environmental health" may have been used by some during this time, the commonly used term was "environmental sanitation.")

Foodborne Diseases

In the 1940s and before, textbooks on food sanitation and microbiology were usually limited to descriptions of botulism, staphylococcal food poisoning, salmonellosis, trichinosis, and tapeworm infestations. There were a few texts specifically on food poisoning that had expanded descriptions of these hazards and covered a little more, such as chemical poisonings and plant toxicants. During this decade, accounts of Clostridium perfringens (welchii) appeared in the scientific literature (Knox & MacDonald, 1943).

(Programs dealing with foods were called "food sanitation" in the United States. They were called "food hygiene" in European countries and by international agencies.)

1950s--The Intensifying of Disease Surveillance and Continued Improvements in Sanitation

The Public Health Service and Environmental Health

At CDC, the Epidemic Intelligence Service (EIS) and an Epidemiology Division were formed. …