Modifications to Objectives and Subobjectives

The following discussion highlights the modifications, including changes, additions, and deletions, to this focus area's objectives and subobjectives as a result of the midcourse review.

As stated in Healthy People 2010: "Most developmental objectives have a potential data source with a reasonable expectation of data points by the year 2004 to facilitate setting 2010 targets in the mid-decade review. Developmental objectives with no baseline at the midcourse will be dropped." Accordingly, at the midcourse review, some developmental objectives and subobjectives were deleted due to lack of a data source. However, the U.S. Department of Health and Human Services and the agencies that serve as the leads for the Healthy People 2010 initiative will consider ways to ensure that these public health issues retain prominence, despite their current lack of data.

The objective measuring organophosphate pesticide exposure (10-7) was deleted. It was dropped because recent research has demonstrated that the absolute amounts of these substances in foods are negligible. Levels of pesticide residues in foods are monitored annually through the Total Diet Study (TDS)² conducted by the Food and Drug Administration (FDA). According to a 2002 analysis of the TDS results for organophosphates for the period 1997–99, very few detectable levels of organophosphate residues were found in foods.³ With such low levels and so few findings each year, no trend could be identified for the presence of organophosphate residues in TDS samples or for further calculation of exposure from foods.

Several subobjectives were deleted at the midcourse. Surveillance of Cyclospora cayetanensis (10-1e) was deleted because of its very low rate (0.1 cases per 100,000 population in 2002) and variable occurrence. Surveillance of congenital Toxoplasma gondii (10-1g) infections was deleted due to lack of a database and the unavailability of data. The subobjectives regarding antimicrobial drug resistance of non-Typhi Salmonella from animals at slaughter (10-3e through p) was deleted due to the unavailability of data.

For subobjectives 10-3e through p, the slaughter data available to the National Antimicrobial Resistance Monitoring System (NARMS) program are from a regulatory program of the U.S. Department of Agriculture's (USDA's) Food Safety and Inspection Service (FSIS) that is not designed to estimate total numbers nationwide.⁴ Three potential sources of data for these subobjectives are FSIS's statistically designed microbiologic baseline studies in meat and poultry products; expanded and randomized antimicrobial drug resistance data on Salmonella isolates from retail meats collected by 10 sites⁵ in the Foodborne Disease Active Surveillance Network (FoodNet); and a more comprehensive assessment of the flow of antimicrobial drug-resistant organisms throughout the farm-to-slaughter continuum, using an initiative proposed by USDA and industry—Collaboration in Animal Health and Food Safety Epidemiology.

Two objectives and one subobjective became measurable. The wording of that subobjective, reducing the number of new cases of postdiarrheal hemolytic uremic syndrome (HUS) (10-1f), was revised to reflect surveillance of children under 5 years of age. Nationally representative data from FoodNet were available to make this subobjective measurable. The 2000 baseline is 1.8 cases per 100,000 children under age 5 years. The target is a 50 percent reduction to 0.9 cases per 100,000 children under age 5 years.

The objective for reducing deaths and illness from severe food allergies (10-4) became measurable and was divided into subobjectives for deaths in the total population (10-4a) and for severe allergic reactions in adults aged 18 years and older (10-4b). Progress toward the second subobjective was measured by the proportion of doctor-diagnosed food allergic respondents in the Food Safety Survey (FSS) whose most recent allergic reaction since 2000 was severe. In the FSS, severe allergic reactions are defined as those that require the use of an epinephrine pen, treatment in a hospital or a doctor's office, or an overnight stay in a hospital. The objective is limited to adults because the FSS sample includes only adults. The 2001 baseline is 26 percent, and the target is 21 percent, a reduction of 19 percent.

The objective covering safe food preparation practices in retail establishments (10-6) became measurable. Nine measurable subobjectives were added (10-6a through i). Two additional data points are anticipated to be available for each subobjective before the end of the decade.

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