Influence of Public Health Spending and Staffing on Variation in Process and Outcome of Local Health Department Food Safety Inspections

Purpose: Describe how Local Health Department (LHD) spending and staffing influence variation in process and outcome of food safety inspections. Background: Public health financing research has typically focused on structure and outcomes with little emphasis on process. Investigation of food safety inspections has identified important variations in outcome based on differences in LHD and Sanitarian characteristics.  This investigation examines the influence of public health spending and staffing on process and outcome. Methods: Original data gathered through direct observation of food service establishment (FSE) inspections in 20 LHDs by 77 Registered Sanitarians (RS) conducting 551 inspections. Ohio Annual Financial Report (AFR) provides public health spending and staffing data. This comparative case study utilizes mixed methods, including direct observation, survey, interview, and AFR. Analysis includes multivariable data integration between original data and AFR. Results: Citations were issued in 67% of inspections (2.19/FSE inspection); and verbal corrections given in 80% of inspections (1.93/inspection). Sanitarians frequently discussed improvement plans (87%) and offered food safety education (69%). Low budget LHDs produced more citations; greater thoroughness; greater job strain; more negative attitudes toward FSE; yet showed higher professionalism and fewer encounters with negative interactions. High budget LHDs offered more verbal corrections; more food safety education; and more effective checkouts. Lower staffing levels were related to more citations; greater thoroughness; less effective checkouts; more job strain; more negative attitudes toward FSEs; yet more positive attitudes about their jobs; and greater expression of gratitude from FSEs. Conclusion: Variations related to public health spending/staffing were common and often paradoxical. Low budget/staff demonstrate better performance on some food safety inspection characteristics; while high budget/staff perform better on others. Food safety inspection process and outcomes demonstrate important variation based on public health spending and staffing. Opportunities for cross jurisdictional communication and training may enhance performance in all LHDs.