Helping Health Agencies Adopt the FDA’s Updated Food Code

Every four years, the U.S. Food and Drug Administration (FDA) releases a new edition of its Food Code, providing an evidence-based, uniform system of best practices to reduce the risk of foodborne illnesses and establish a standardized method for conducting food safety regulatory inspections. State, local, tribal, and territorial (SLTT) government agencies nationwide are responsible for regulating retail foods and typically base their regulations on the FDA Food Code. As of December 31, 2023, only three states (Mississippi, Connecticut, and Pennsylvania) and two U.S. territories (Puerto Rico and Virgin Islands) have adopted1 the 2022 version of the FDA Food Code. The Association of State and Territorial Health Officials (ASTHO) developed a technical package to help states improve safety and reduce foodborne illnesses by helping health officials adopt the 2022 FDA Food Code. ASTHO is also working with the Retail Food Safety Regulatory Association Collaborative to deliver resources and tools that SLTTs can use to improve food safety. The Collaborative created a Food Code Adoption Toolkit2 designed to alleviate the obstacles associated with FDA Food Code adoption. They also developed the Foodborne Illness Outbreak Resource Library,3 a collection of resources that support SLTTs foodborne outbreak investigations. In this column, we outline the role that state and territorial health officials (S/THOs) and their agencies play in creating change under these strategies.Talking Points for Policy Makers on the FDA Food Code Adopting the newest FDA Food Code provides a wide range of benefits from reduction of foodborne illness to creating uniform standards that can help reduce the challenge of each jurisdiction having to develop their own food code. Even if your jurisdiction has adopted an older version of the Food Code, adopting the newest version provides important updates to food safety best practices based on the most current science and emerging technologies and ensures you remain current with federal laws. Reducing Foodborne Illness Rates: FDA Food Code adoption has been linked to lower foodborne outbreak rates; a study4 in the Journal of Food Protection found that states that had adopted specific provisions of the 2013 FDA Food Code had lower average norovirus outbreak rates than states that had not adopted those provisions. Foodborne illnesses lead to huge financial losses to the U.S. economy; USDA's Economic Research Service reports5 that the 15 most common foodborne pathogens account for nine million cases of foodborne illness and a $17.6 billion economic burden (in 2018 dollars), and with over half of all foodborne illness outbreaks being associated with restaurants,6 reducing foodborne illness through the FDA Food Code could greatly reduce illness rates and their economic impact. Regulatory and Industry Benefits: The Food Code is created through a collaborative process with stakeholders from national, state, local regulators, industry, academia, and consumers. Food Code adoption demonstrates a commitment to food safety, increasing eligibility for federal training, grants, and cooperative agreements. Standardization of retail food inspections and inspectors reduces complexity and better aids industry compliance. Regulators and industry can conserve limited resources by utilizing existing Food Code inspection tools and trainings. A Technical Package of Recommendations to Assist Health Agencies with FDA Food Code Adoption In this column, ASTHO recommends the following strategies to help health agencies adopt the 2022 FDA Food Code. Understand the food safety landscape in your jurisdiction Understanding how your jurisdiction regulates food safety, whether it has adopted a previous version of the Food Code, and what the mechanisms are to adopt the most recent Food Code can help public health leaders support food code adoption. All jurisdictions have food safety laws and as of July 2023, 49 states, three territories and Washington, D.C. have adopted a version of the FDA food code.1 While some states adopt the Food Code in statute, most jurisdictions have authorized an executive branch agency to issue food safety rules for restaurants and retail food stores, enabling these agencies to adopt the FDA Food Code through a rulemaking process. Jurisdictions vary in how they delegate the authority to regulate food safety inspections, with 39 jurisdictions granting a single regulatory agency the responsibility and 12 jurisdictions dividing that responsibility across multiple agencies.1 For example, in Virginia the Department of Health is responsible for food safety inspections for restaurants and the Department of Agriculture and Consumer Services is responsible for retail food stores, with the two agencies concurrently adopting the 2017 FDA Food Code in June 2021.7 Considerations when adopting the 2022 FDA Food Code Jurisdictions planning to adopt the 2022 FDA Food Code should first identify which agency or agencies have authority to regulate restaurants and retail food stores. Then the agency with authority to regulate should review its existing food code to identify differences between the jurisdiction's current food code and the 2022 FDA Food Code they wish to adopt. Jurisdictions can adopt the Food Code section-by-section (long-form), providing the flexibility to adopt all or part of the 2022 FDA Food Code, or they may adopt the FDA Food Code in its entirety by reference (short-form), which can be a more streamlined process. For example, Mississippi adopts the most current version of the Food Code by reference "unless otherwise noted in subsequent regulations."8 Other states grant limited authorization to the lead agency to incorporate the food code by reference, such as North Carolina's legislature which granted the Department of Health and Human Services specific authority to adopt the 2017 FDA Food Code by reference.9 After determining which entity has the authority to adopt the updated version of the Food Code – legislature, health agency, agriculture agency, and/or other – S/THOs and public health leaders can develop a plan to educate the decision makers who have authority to act about the importance of adopting the 2022 Food Code. As part of this plan, public health leaders should work with partners from nongovernmental organizations, food safety advocates, restaurant associations, and community members to support FDA Food Code adoption. Utilize ASTHO Technical Assistance Offerings to Increase Food Code Adoption Across Jurisdictions ASTHO will support jurisdictions through FDA Food Code adoption in a variety of ways. Information sharing through S/THO and regional S/THO calls provides an opportunity for health officials to learn about other jurisdictions' processes. Although jurisdictions will vary in how they adopt and implement the Food Code, there are often many common challenges and solutions. Peer support through ASTHO's Environmental Health Directors group or a Food Safety Summit will allow jurisdictions to meet with their peers and discuss food safety topics. ASTHO's Mentorship Program pairs jurisdictions looking to adopt the Food Code with a mentor who has adopted to discuss their unique challenges and learn how to work through them. ASTHO's array of capacity-building products from the daily newscast, Public Health Morning Review, to ASTHOBriefs and ASTHOBlogs features state spotlights and best practices in Food Code adoption. ASTHO will also support health agencies through technical assistance requests on specific parts of the adoption process. ASTHO's state health policy team will provide legal consultation and connect to its network of legislative liaisons to identify best practices. The Environmental Health and Infectious Disease Policy Committees can also provide insights on policy strategies to assist with adoption. Additionally, ASTHO will provide tools and toolkits to work through the media and legislative aspects of adoption. Finally, as part of the Retail Food Safety Regulatory Association Collaborative, ASTHO will connect jurisdictions with partner organizations and federal agencies for specialized technical assistance requests. Conclusion Helping states adopt the 2022 Food Code is a priority of ASTHO. Our goal is to increase adoption more rapidly than has occurred in the past. ASTHO's unique relationship with state and territorial health officials and with state environmental health directors positions ASTHO to play a leadership role in this national effort, and this technical package of strategies can be used to support their efforts towards adoption. Widespread adoption of the 2022 Food Code will ultimately lead to reduced rates of foodborne illness, more efficient use of public resources, and improved population health.