On Friday March 14, 2008, Healthinspections.com published their ranking of the most dangerous states for eating out. The ranking was based on an analysis of 2006 foodborne outbreak surveillance data compiled by the Centers for Disease Control and Prevention (CDC). The five most dangerous states for eating out, according to this analysis, were Florida, California, Minnesota, Ohio, and New York. Florida and California were cited as having the most dangerous restaurants for the third year in a row. This is wrong, wrong, wrong.
Florida, California, and New York are three of the four largest states in the nation. Ohio ranks 7th. More people mean more restaurants. More restaurants mean more outbreaks in restaurants. It really is that simple.
If you turn the number of outbreaks into a rate that compares outbreaks per million population, or outbreaks per 1,000 eating and drinking establishments (see table below) the rankings change.
As you can plainly see from this table, Minnesota is twice as dangerous for eating out as any of the other states, right? Wrong again.
Minnesota has the highest rate of reported outbreaks because it has the most aggressive and effective public health surveillance system for foodborne illnesses. This is an example of the tree falling in the woods problem. Falling trees generate sound waves, but if no one is there to hear them, they don’t generate any sound. In Minnesota, we may not actually have more falling trees, but we’re out there listening for them.
One important source for hearing about outbreaks in restaurants is from the restaurants themselves. Because many environmental health specialists in Minnesota view themselves as teachers rather than enforcers, they take the time to get to know the restaurant operators and listen to their problems. This, in turn, fosters a relationship of trust where restaurant operators actually report illness complaints to the local health department. Outbreaks are identified, problems are corrected, and we all learn a little bit more about the constantly changing challenges of making food safe.
In this ranking, being at the top of the list is a good thing.
Craig Hedberg is a foodborne disease epidemiologist and Associate Professor in the Division of Environmental Health Sciences at the University of Minnesota School of Public Health.