Editor: A PDF of the journal article is available from Robert Scharff for informational purposes only. The Journal of Food Protection holds the copyright to the article and forbids posting the article online for 12 months, and then only with permission from the International Association of Food Protection. However, Scharff’s state-by-state online appendix to the journal article is completely open to all.
COLUMBUS, Ohio — Foodborne illness costs some states more than $350 per resident every year, according to a new study in the Journal of Food Protection.
The Ohio State University study also provides an updated estimate of the total national cost of foodborne illness, up to $93.2 billion a year, an increase from $77.7 billion in 2012.
The economic analysis is the first peer-reviewed study that provides comprehensive estimates of costs borne by individual states as a result of specific foodborne illnesses. It is designed to offer public health authorities localized information to evaluate the cost-effectiveness of food safety education efforts and other interventions, said investigator Robert Scharff.
“It will give policymakers a tool to determine whether a particular intervention they’re using makes sense,” Scharff said.
“It can also be used to determine what are the biggest food safety problems in a state and how to prioritize resources accordingly.”
Scharff, an economist, is a scientist with the Ohio Agricultural Research and Development Center, the research arm of the university’s College of Food, Agricultural, and Environmental Sciences.
In 2010 and 2012, Scharff published national estimates of the cost of foodborne illness, but he realized that such costs vary widely between states.
“Take an illness from a pathogen like Vibrio,” Scharff said. “It’s associated with seafood, particularly raw seafood eaten in summer months when water gets warmer. States with higher shellfish consumption — those in coastal areas — have a higher incidence of this type of foodborne illness, and so it makes sense for them to devote more resources to battling it than other states.”
The new study, “State Estimates for the Annual Cost of Foodborne Illness,” is in the journal’s June 2015 issue. It is accompanied by an online appendix with state-by-state estimates of the incidence of illness due to specific pathogens, as well as the states’ total cost, cost per resident and cost per case for each type of illness.
Costs vary between states for a number of reasons, Scharff said, including differences in:
- The incidence of foodborne illness. States with a higher population of older people or other higher-risk groups are more likely to have higher costs related to foodborne illness. Similarly, states with a higher consumption of risky foods and those with a higher incidence of high-cost pathogens, such as Listeria, would bear higher costs.
- Medical costs and economic productivity losses due to illness. Total hospital costs for foodborne illness in New Jersey, for example, are twice those in Maryland. Hospital costs vary partly because of illnesses more commonly seen in different states and partly because of state-to-state differences in the cost of providing care. Productivity losses depend on average compensation and employment rates.
- Economic estimates of losses due to death or lost quality of life. Such estimates depend on average household income and similar factors.
In the study, Scharff includes conservative cost estimates that don’t include losses associated with quality of life due to foodborne illness, which is the model typically used by the U.S. Department of Agriculture, as well as higher, or “enhanced,” estimates that include quality of life, a model typically used by the U.S. Food and Drug Administration.
Using the conservative model, he found that the average cost per case of foodborne illness ranged from $888 in West Virginia to $1,766 in the District of Columbia. Using the enhanced model, estimates of average cost per case ranged from $1,505 in Kentucky to $2,591 in Maryland. Those costs reflect a per-resident annual cost ranging from $133 to $391.
In Ohio, the average cost per case ranged from $1,039 with the conservative model to $1,666 with the enhanced version, or $156 to $250 per resident every year.
Nationally, Scharff calculated the total cost of foodborne illness to be $55.5 billion to $93.2 billion.
Costs also vary depending on the type of foodborne illness. In the online appendix to the article (go.osu.edu/Scharff_stateestimates_2015), Scharff provides detailed information for each state and the District of Columbia on the incidence of foodborne illness, the total cost, cost per resident and cost per case for each type of foodborne illness.
“The total cost and cost per resident estimates are ideally suited for a situation where a policymaker has limited resources and has to decide which pathogens to focus on at a more macro level,” Scharff said. “On the other hand, if you’re at the point where you’re actually considering different interventions, then the cost per case estimates would be most useful."
Using those figures, policymakers can weigh the cost of a foodborne illness prevention program against the potential cost per case of the illness to determine whether the program makes economic sense.
For example, public health authorities in Ohio, which recently experienced an outbreak of botulism that resulted in at least 20 illnesses and one fatality, could use the data provided in the analysis to help determine whether additional food safety efforts should target this particular illness.
According to the Centers for Disease Control and Prevention, the annual number of foodborne botulism cases nationwide averages about 17, Scharff said.
"In Ohio, we had 20 cases just from one outbreak,” Scharff said. “That’s still a small number, but the cost per case for botulism is huge, ranging from $1.3 million to $1.6 million per case in Ohio.
“Then the question becomes, what does this mean? It could be that this outbreak was something that was completely random. But maybe it reflects something that’s going on in Ohio that makes botulism more likely to occur here. It’s still a low probability, but if it’s something that’s more likely to happen here, then we might want to put more resources toward preventing something like this from happening in the future.”
Using the figures in the new study, the Fairfield County botulism outbreak will cost an estimated $26 million to $33 million.
Given those numbers, and the fact that it was the second documented outbreak of botulism in Ohio in the last seven years associated with home-canned vegetables, policymakers may determine that putting more resources toward home canning food-safety education would make sense, Scharff said.
The analysis does not include costs associated with foodborne illness pathogens identified in foods that are recalled or otherwise do not cause foodborne illness, Scharff said.
For example, the recent recall by Jeni’s Splendid Ice Creams after Listeria was found in a pint during a routine test cost the company $2.5 million, but it would not be reflected in these numbers because no illnesses were linked with the episode.
The analysis does reflect the severity of different types of foodborne illness, Scharff said.
For example, although Campylobacter is commonly found on raw chicken — some estimates indicate it is on nearly half of all chicken in the U.S. — it is killed easily during the cooking process, and when it does cause illness, just 1 in 10,000 die. On the other hand, although Listeria is less common, it is often associated with foods such as ice cream, lunchmeat and fresh produce that are not cooked, and when it does cause illness, the chance of dying is high — 1 in 6.
“That’s a big difference,” Scharff said. “And that’s reflected in the cost per case figures — it’s why both Listeria and botulism are so high.”
In Ohio and in most states across the nation, Salmonella would be a good pathogen to target, he said.
“If you look at the numbers, the biggest problem is Salmonella,” Scharff said. “Norovirus is more common, but Salmonella has a very high incidence of illness and also has a relatively high cost associated with it.”
Scharff hopes the analysis brings more attention to the seriousness of foodborne illness not only among policymakers but consumers as well.
“These numbers reflect the fact that 1 out of every 6 people becomes ill every year from foodborne illness,” Scharff said. “That’s a pretty big number.”
Scharff is an associate professor of human sciences in Ohio State’s College of Education and Human Ecology.