ASSESSING STATE FOOD SAFETY PERFORMANCE AND FDA CONTRACTS: THE PUBLIC HEALTH IMPLICATIONS OF STATE VARIATIONS IN A NEW REGULATORY REGIME

Foodborne disease is considered to be a major public health problem globally, with rapidly rising rates of foodborne illness around the world taxing already strained public health systems. While the U.S. is considered to have a comparatively safe food supply, the Centers for Disease Control and Prevention (CDC) estimates that each year roughly 1 in 6 Americans (or 48 million people) gets sick from, 128,000 are hospitalized for, and 3,000 die of foodborne diseases that are considered largely preventable, with economic impacts estimated at billions of dollars. Several recent studies report that the percentage of solved outbreaks—defined as a laboratory-confirmed strain of illness across all cases in a single outbreak—has declined across the country, owing in large part to loss of capacity at the state and local levels. Responsibility for food safety inspections is diffusing from the U.S. Food and Drug Administration (FDA) to states via contracts in a phenomenon that has been referred to in other policy arenas as “contractual devolution.” The reliance on contracts with states to carry out a core FDA regulatory duty appears to be unique, and therefore offers fresh insights into what Wright (1990) referred to as the “complex configuration” of intergovernmental relations and federalism. This leads to the two main research questions for this dissertation: Which factors explain variation in states’ identification of the causes of foodborne illness outbreaks? Does FDA’s contracting policy influence states’ capacity and performance in solving outbreaks, and if so, how?Little prior research has documented variation across states’ food safety program capacity and outcomes, especially as related to FDA’s contracting policy. This multi-methodological analysis, which draws on a combination of primary and secondary data, including quantitative data from the Centers for Disease Control and Prevention (CDC) on foodborne illness outbreaks, 53 semi-structured interviews with food safety actors including federal and state managers, and document analysis. Lacking a clear mechanism by which to measure the quality of states’ regulatory inspections or the rigor of their enforcement, analysis of their outbreak solve rate provides some sense of state capacity and performance as affected by a variety of theoretically derived state-level factors, including states’ regulatory contract work for FDA. As states turn their attention to meeting federal standards for inspections, and if they do not or cannot expand capacity to perform contract inspections, they may experience reduced capacity to respond effectively to outbreaks. Multivariate tests reveal that state solve rates are affected by political factors, the choice of lead state agency responsible for food safety, and the strain created by multiple outbreaks. Perhaps most importantly, there appears to be no relationship between state performance in solving outbreaks and FDA contract decisions, suggesting that the agency’s devolution of regulatory responsibility has not been tied to individual states’ records on this key food safety function. As a greater proportion of federal food safety regulatory inspections are devolved to states through contracts, the consequences of FDA’s relationship with states take on significance for public management, public health, and regulatory policymaking. This study offers important insights to policymakers, as well as to scholars interested in government contracting, regulation, federalism, and the performance and accountability challenges of managing contracting and intergovernmental relationships.