76 MILLION ILLNESSES

David Merrefield

Not long ago, the Centers for Disease Control and Prevention, Atlanta, issued a new estimate for the number of people in this nation who are sickened, or killed, each year by foodborne maladies. The grim statistics were reported far and wide, including in the pages of SN.

Estimates worked up by the CDC tell us that, each year, 76 million people fall ill from their food, 325,000 are hospitalized and 5,000 die. The newer estimates replace an older estimate that was so broad as to be nearly worthless, namely that from 6 million to 81 million foodborne illnesses occur each year and that up to 9,000 deaths occur.

But, no matter how finely drawn the new numbers may be, the estimate that 76 million Americans fall ill on account of their food is a ghastly business indeed. At that illness rate -- equivalent to about every third person in the country -- each of us must know scores of people, or maybe a hundred or more, who are felled by food each year. Viewed another way, each of us must be stricken with a foodborne illness once every third year, on the average, or one member of a three-person household annually. It also follows from the CDC numbers that each of us must know at least several people who have been hospitalized on account of food-related illness, and maybe even someone who has died; the mortality number suggests that about one person in 50,000 contracts a fatal illness.

Does this dour analysis ring true? It may be that the CDC's outlook on this is right on the money, and that foodborne illnesses are as common a plague as the numbers suggest. But, somehow, it seems as though the numbers -- especially the 76 million -- are high.

How did CDC arrive at its estimates, and how plausible are they? Here, very briefly, is how it works: The first fact to keep in mind is that the number of illnesses cited is the product of an elaborate estimating process. The original CDC report itself acknowledges how difficult it is to approximate such things: "Foodborne illness can be severe [but] milder cases are often not detected [and] many pathogens transmitted through food are also spread through water or from person to person, thus obscuring [food's role]. Finally, some ... illness ... is caused by pathogens or agents that have not yet been identified." And, the CDC's study acknowledges, "well-documented estimates of underreporting [of illness] are not available for most pathogens." This means that no one is actually counting the incidence of illness. Moreover, the CDC study specifies that just 14 million cases, of the 76 million, are caused by "known pathogens."

This means that the vast majority of illnesses have no known cause. In the end, the CDC extrapolated known or suspected cases to develop a national outlook on total disease counts, sometimes applying heavy multipliers against no more than a handful of cases. (Incidentally, I'm indebted to Food Distributors International's director of communications David A. Coia for pointing out to me how these estimates work, based on the CDC's own monograph on the topic.)

The point here isn't that foodborne illness is unimportant, or that the industry doesn't have room for improvement. It is that simply no one knows what the provable incidence of foodborne illness is.