Controlling the Uncontrollable: Factors Influencing Retail Food Safety in Bush Alaska
Jamie L. Winchester, REHS
State of Alaska Department of Environmental Conservation
Division of Environmental Health
Food Safety & Sanitation Program
International Food Protection Training Institute
2010 Fellow in Applied Science, Law and Policy: Fellowship in Food Protection
Abstract
As the largest and least densely populated state in the United States, Alaska presents unique challenges to the Environmental Health Officers (EHOs) in the state Food Safety & Sanitation Program. This project addresses some of the factors that can impact retail food safety in rural Alaskan communities through a review of current literature and observational study of selected villages. A patchwork food transportation system can have detrimental effects on food quality, especially in warmer seasons. Food sources must be closely monitored to ensure the delivery of wholesome commercial products and acceptance of unadulterated donated fish and game meats when permitted. Water source and sewage handling have direct impacts on overall community health, which may trickle down to the retail food level through ill food handlers. Native food products and preparation methods, while not generally permitted or observed in retail establishments, can be addressed on a community level, especially considering their high contribution to foodborne illness outbreaks. Community issues, such as the extremely high cost of living, generate an unwillingness to discard even potentially dangerous foods. These factors were assigned scores based on observed effects and formatted into a community survey form to be completed by EHOs when prioritizing remote area travel.
Background
Rural “Bush” Alaska is characterized by over 280 isolated villages scattered across an area over one fifth the size of the contiguous United States. Populations in these communities are predominately Alaska Natives and range between 25 and 6,000 residents, averaging about 300 residents per village. There are 230 federally-recognized Alaska Native tribal entities, which are frequently the only governing body of smaller villages (Department of the Interior - Bureau of Indian Affairs, 2010). Nearly all villages are accessible only by air and/or water, with recurrent travel blackouts due to severe or changing weather. Most residents practice a blended subsistence lifestyle and depend heavily on moose, caribou, walrus, whale, seal, and fish for their food supply (Wolfe, 1996). Commercially-supplied food is delivered by small aircraft, hovercraft, small boat, snow machine, all-terrain vehicle and even parachute drop through the largely unregulated US Postal Service (USPS) Bypass Mail System, which exists only in Alaska. Alaska has the lowest proportion of homes with piped water and wastewater disposal service in the United States with only 93.7% for all of Alaska and 77% in rural Alaska compared to 99.4% for the United States (US Census Bureau, 2002). Many of these communities completely lack a safe source of drinking water or a safe means of sewage disposal.
The 27 Environmental Health Officers, Managers, and Technicians in the State of Alaska Department of Environmental Conservation’s (ADEC) Division of Environmental Health Food Safety & Sanitation Program are charged with ensuring the safety of the retail food supply for Alaskans, including the 138,898 residents living in rural locations (as of 2008) (State of Alaska, Department of Commerce, Community & Economic Development, Division of Community and Regional Affairs, 2009). The aforementioned factors, as well as the omnipresent issue of the lack of monetary and human resources dedicated to public health protection, combine to create a daunting environment in which to function.
Problem Statement
The geographical circumstances of rural Alaska and the low concentrations of retail food service establishments have resulted in inadequate inspection frequencies. Of permitted food establishments, including schools, senior citizen centers, and sole community general stores, 19% have gone more than 10 years without the attention of a food inspector or have not been inspected since permitting (Alaska Department of Environmental Conservation, n.d.). As a result of this regulatory silence, the potential for a serious foodborne illness outbreak is exacerbated. This paper focuses on specific community-based factors that can serve as decision-making tools when prioritizing resource allocation.
Research Question
What factors influence retail food safety in Bush Alaska? Independent variables examined include food transportation, food source, water source, sewage handling, native food preparation, and other factors observed in communities.
Methodology
The factors that influence food safety are easy to list (i.e., CDC Surveillance from 1988-1992 listing food from unsafe sources, improper holding/time and temperature, inadequate cooking, poor personal hygiene, and contaminated equipment/prevention of contamination), but assessing how these factors might occur in the Bush, or what other factors may have even more influence than those identified in the lower 48 states is more difficult. To conduct an assessment of potential concerns, field visits were conducted in 23 rural Alaskan communities, both on and off the road and Alaska Marine Highway Systems (see Table 1 for community risk factor characteristics). During routine sanitation inspections, observations regarding predetermined food safety factors, the effects of the factors on food inspections, and special community-wide issues were noted. A literature review was also completed to make use of data from previous research on community-wide factors.
The objectives for this project were to develop a village analysis system for cost/benefit maximization when deciding travel and inspection frequency and to assess what factors Environmental Health Officers (EHOs) could use in order to guide them to the most critical areas needing their focus, both remotely and when on site.
Special equipment needed in order to ensure inspector safety included EPIRB (Emergency Position Indicating Radio Beacon), flame-resistant arctic-weight coat, water filter, waterproof fire starters, cook stove, food (minimum 3-day supply), sleeping bag (rated to -40°F), and sleeping pad.
Results
Factor: Food Transportation
USPS Bypass Mail is utilized for the majority of food transportation in the Alaskan communities not served by the road system. A program that exists only in Alaska, Bypass Mail is a federally-subsidized system allowing mail to bypass USPS facilities, traveling directly from the supplier to rural destinations on contracted carriers, generally small airlines, at reduced freight rates. These air carriers are also required to provide passenger service to retain the contracts. While contracted carriers receive funding to compensate for the expense of providing service to remote areas, they frequently do not receive enough to feasibly provide daily or even regularly-scheduled service. Mail, including food and medical supplies, can sit in hub community hangars for days before enough has accumulated for the carrier to schedule a flight. For passengers relying on these flights, including ADEC inspectors, this scheduling can be a harrowing experience. For potentially hazardous or perishable foods, the issue is a matter of wholesomeness and adulteration.
While getting mail to the community may take longer than desirable, upon observation (and unloading) of dozens of mail planes, the communities themselves have developed their own systems of getting the food and packages to their rightful destinations. Households, vehicles, and offices are likely to have VHF radios for personal communications and for flight tracking. Upon nearing their destinations, pilots radio to the communities that they are about to land and anyone expecting a delivery (i.e., the local Postmaster, school administrator, or store manager) heads to the airstrip. Products and packages are loaded into trucks, vans, wagons, or sleds and taken on to their final destinations directly from the side of the plane, which likely pulled up beside the vehicles waiting to take delivery.
Factor: Food Source
Commercial food operations in more remote communities are often limited to Native Stores[1] and school food services. Schools are supplied with products through the USDA school food service program and are generally canned, frozen, or shelf-stable dry goods. Native stores are supplied with similar types of products as schools, with more emphasis placed on highly-processed foods and sugary beverages. Complaints are frequent regarding the quality of the food delivered to rural facilities, especially meat products. The majority of bush suppliers are located in or near cities with ADEC offices, so monitoring these complaints closely and responding quickly to any problems that arise is possible.
As subsistence practices are common, the Alaska Food Code includes provisions for acceptance of donated fish, game meat, and plants by institutions and non-profit groups. Fish may be received either whole or headed and gutted. Game animals may be received either whole or in quarters or roasts. Further processing must be conducted at a separate time from any commercially-processed foods, and storage must prevent cross-contamination of commercially processed foods (Alaska Department of Environmental Conservation, 2007). These requirements were discussed with qualifying operators, who were largely unaware of the regulations. During village visits, small quantities of fish, moose, and “Tundra tea” (brewed from the Labrador tea plant) were observed in facility freezers intermingled with commercially-processed foods.
Factor: Water Source
According to the World Health Organization, “Water Security” is defined by 13.2 gallons of potable water per person, per day and either one in-home tap or the ability to acquire water in fewer than five minutes (Howard & Bartram, 2003). In most of the United States, access to water is taken for granted. In rural Alaskan communities adequate water is frequently a significant issue. Permafrost, soil that remains frozen year-round, is present under nearly 85% of Alaska (Alaska Public Lands Information Centers, n.d.), making boring wells and laying typical underground utility lines not only extremely difficult, but not feasible for many communities. Disturbing permafrost leads to melting and ground instability. As a result, non-traditional sources of water typically have above-ground piping systems, which are highly susceptible to freezing.[2]
In communities without the resources to provide plumbing to every household, a facility called a “washeteria” is frequently maintained by the village. A washeteria building generally consists of clothes washing machines and dryers, flush toilets, sinks, coin-operated showers (costing two dollars in quarters for about seven minutes of water in the observed communities), and watering points on the exterior to fill tanks and buckets. When water must be manually hauled from the washeteria to the home, the 110.2 pounds representing water security for one person for one day can be unattainable. Lack of piped in-home plumbing has been shown to be a significant factor in higher hospitalization rates for pneumonia, influenza, and respiratory syncytial virus as well as outpatient Staphylococcus aureus infections and skin infection hospitalizations (Hennessy, et al., 2008). During community visits, a common warning given by residents was to avoid contact with washeteria toilet seats – many community members had boils infected with methicillin-resistant Staphylococcus aureus on their buttocks, widely suspected to be spread through the communal seats.
Factor: Sewage Handling
Hand-in-hand with water source is the sewage handling issue. In communities where individual sewage disposal systems or community wastewater systems are not or cannot be built, sewage is disposed of using a “honeybucket” system or a “flush-haul” system.
[1] Generally small pre-packaged and frozen goods grocery stores operated by the area Native Corporation.
[2] “Traditional” water sources, including collecting rain and snow and hauling ice from tundra ponds, may be utilized by community members regardless of the presence of a centralized water system due to factors such as cultural influence and distaste for chemical treatment of drinking water (Marino, White, Schweitzer, Chambers, & Wisniewski, 2009).
Honeybuckets are typically 5-gallon plastic buckets lined with a plastic bag and topped with a toilet seat. When full, the bag is tied off and taken to the community sewage lagoon or placed outside if community pickup is provided. “Flush-haul” systems have a pump and holding tank for sewage which must be hauled to the sewage lagoon or pumped out and hauled if the service is available. These systems frequently have freezing problems, and local stories abound of exploding holding tanks. Fecal bacteria have been found on water dippers, kitchen counters, and in handwashing basins in homes without piped water or sewage (Chambers, Ford, White, Barnes, & Schiewer, 2008). Due to this demonstrated presence of indicator organisms on high-touch surfaces in communities without sewage disposal systems, there may be a higher potential for fecal bacteria transfer to retail food establishments.
In smaller communities without full plumbing, retail food establishments operating beyond the public school and dry-goods store are uncommon, as most facilities are unable to comply with water supply and plumbing fixture requirements. However, surveying these communities during field visits to ensure that no un-permitted establishments are in operation in such high-hazard circumstances is important.
Factor: Native Food Preparation
It tasted good the moment I got it into my mouth. But I had to be taught how to eat this remarkable dish. As long as it is frozen, you just chew away. You get feathers and bones in your mouth, of course, but you just spit them out. Frozen meat always has an enticing taste, and as it dissolves in the mouth, you get the full aroma of the raw fermented bird. It is incredible how much you can get down, unbelievable how hard it is to stop. If you happen to come across a fully developed egg inside a bird, it tastes like a dream. Or the liver, which is like green cheese. Breast and drumsticks are cooling and refreshing. It was late before we were full, and there was about half the giviak left. This was put up on one of the bunks to thaw for later use (Freuchen & Freuchen, 1961, p.104-105).
While giviak, auk aged in a seal poke, is not likely to be served for a school lunch, traditional food preparation methods are useful to consider when discussing food safety with food workers and community members. Imposition of current food safety ideals onto traditional food preparations, such as the use of plastic or glass vessels for fermentation rather than grass-lined holes in the ground, has led to foodborne illness outbreaks due to botulism (Horn, Stamper, Dahlberg, McCabe, Beller, & Middaugh, 2001). From 2004-2008, over half of the foodborne illness outbreaks investigated in Alaska were caused by the ingestion of pre-formed toxin from Clostridium botulinum (Provo & Castrodale, 2010). All of these recognized outbreaks were caused by food products specifically prohibited by the Alaska Food Code, such as seal oil and fermented fish. During routine facility inspections conducted for this project, no prohibited foods were offered to the public, however, small quantities of foods such as “stinkheads” (fermented fish heads) were observed stored in facility coolers as staff snacks.
Other Community Factors
Figure 4: Western AK grocery ad, week of 03/07/11 (AC Value Center).
The cost of living in many rural Alaskan communities is extremely high. In June 2010, the average price for one gallon of gas in 97 Alaskan communities ranged from $3.95 to $5.67, with a statewide average of $5.10; one gallon of #1 diesel, used for power generation and heating oil, ranged from $1.62 (in a subsidized borough) to $5.84, with a statewide average of $4.83 (excluding the subsidized borough) (Alaska Division of Community and Regional Affairs, 2010). The average weekly cost for a family of four on the USDA “Thrifty” food plan in June 2010 was $134.50 in the contiguous United States compared to $160.10 in Anchorage, Alaska (USDA Center for Nutrition Policy and Promotion, 2010). When the food cost based in Anchorage is indexed at 100%, 16 surveyed Alaskan communities ranged up to 229% in King Salmon/Naknek, Alaska, equivalent to a weekly food cost of $366.63 for a family of four (University of Alaska Fairbanks Cooperative Extension Service, 2010). As one gallon of milk can cost over nine dollars, if liquid milk is available at all, facilities and families alike can become creative in their preparation of foods that would likely be discarded by residents of the contiguous United States. Every postal rate increase and fuel surcharge adds stress to an already fragile system, creating further incentive for the use of all products that are shipped to the community, regardless of condition. During facility inspections, acceptability versus danger of dented cans was a frequent topic of discussion; even school food service personnel were unwilling to discard the most severely dented and bulging cans.
One trip completed in part for this project included 13 village visits over 11 days; the final cost of this trip, including several non-commercial lodging discounts and the use of a school district charter plane, excluding labor or supply costs, was $4,068.04. Considering the 280+ Bush villages, budgeting for adequate inspectional frequencies is nearly impossible. Many facilities cannot be inspected annually without extreme increases in staffing and funding. Barring this unlikely event, gauging where the greatest impact can be made with current inspection resources is necessary. A “catch-up” phase is necessary, allowing villages and facilities that have not been inspected in the previous 10 or more years to become a high program priority, before moving into a “maintenance” phase with the highest feasible inspection frequency.
Conclusions
Specific factors that can have a large impact in rural Alaska retail food safety include food transportation, food source, water source, sewage handling, and the high cost of living. Native food preparation has a smaller impact on retail food, but is extremely important for overall community health.
When prioritizing inspections, several factors need to be considered which include plumbing, due to the high potential for cross-contamination in washeteria-dependent villages; date of last ADEC Food Safety & Sanitation inspections; and number of higher-risk category permitted food facilities. To a lesser extent, population should be considered to maximize impact, and ease of access to the community must be accounted for when considering travel cost. See Table 2 for a proposed prioritization scale, with examples of implementation shown on Table 1.
Factors that can be addressed “from a distance” – and therefore avoid high travel expense – include food transportation, especially during summer months when a frozen state of food cannot be presupposed, and food source, to ensure that Bush suppliers are not sending outdated or unsafe foods to rural communities that are unable and unwilling to return defective products.
The limitations of this study include the inability to survey a larger number of communities due to travel and time constraints, the observation-only approach to risk-factor analysis, and the lack of summer observations in communities, specifically those supplied by seasonal barge service.
Recommendations
The proposed community prioritization scale should be utilized by ADEC for rural travel planning. Future work must be done to reassess the effectiveness of the “catch-up” provision which raises the priority of villages that have not been inspected in more than ten years, and optimistically to transition into a maintenance phase at the highest inspectional frequency feasible based on staffing and funding levels. Continuous observations must be made during routine inspections to reassess any current factors that are no longer high-risk or new factors that may arise, potentially to include the effect of climate change on Arctic community utilities and food storage.
Acknowledgments
This project has been generously supported by the International Food Protection Training Institute’s 2010 Fellowship in Food Protection and the State of Alaska Department of Environmental Conservation. The project was completed under the direction of my mentor James Sevchik, Ron Klein, and Robert Pressley. Additional thanks go to Mike Gentry, Tandi Fox, Jim Moore, Jason Wiard, and Bob Carlson with ADEC for travel advice, logistical assistance, and psychological support.
Corresponding Author:
Jamie L. Winchester, State of Alaska Department of Environmental Conservation Division of Environmental Health Food Safety & Sanitation Program. Email: jamie.winchester@alaska.gov
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