CSPI Reports

Dine at Your Own Risk -- Part II


Eating Out Can Be Hazardous To Your Health

Americans are eating more of their meals in restaurants. The latest statistics available show that in 1993, consumers spent a record 46% of their food dollar on food eaten away from home, up from 39% in 1980.

The primary reason cited by consumers for eating away from home is that they do not have time to cook. As greater numbers of adults are fully employed outside the home, consumers increasingly rely upon the convenience of restaurant or delicatessen food to replace or supplement home-prepared food. But consumers may not realize that food served in a restaurant is at least as likely to carry the risk of foodborne illness and death as food prepared in the home.

Precise figures on the extent of food poisoning attributable to restaurants are not available because there is no comprehensive national system to track food poisonings. The best available data come from CDC, which collects food poisoning outbreak data from state and local health departments. CDC data covering the years 1983 through 1992, the most recent data available, show that 42% of all reported outbreaks were traced to food eaten in restaurants, delicatessens, and cafeterias, compared to 21% for food eaten at home.

Although many public health officials believe that food poisoning from food prepared at home may be a larger share of the food poisoning problem than CDC data indicate, they agree that restaurant food poisoning outbreaks are more likely to affect a larger number of people. Better food handling practices in restaurants coupled with adoption of national standards and better enforcement by state and local regulators could greatly reduce food poisonings from food prepared in restaurants.

One food safety mistake in a restaurant kitchen can sicken large numbers of people, sometimes hundreds at a time. Some reasons for large restaurant-caused outbreaks include:

Highlighted below are just some of the larger outbreaks of restaurant food poisoning in recent years:

Food Poisoning Is a Widespread and Costly Problem

Those outbreaks are just the tip of a deadly iceberg. Experts agree that foodborne illness is seriously under reported by CDC. First, CDC maintains data only for outbreaks and not for individual cases. Second, whether CDC ever hears about an outbreak depends on many factors, including whether the victims ever seek medical attention; whether patients and their doctors recognize the cause of the illness; whether doctors are motivated to contact the local health department; and whether area laboratories have the resources to identify the pathogen. One public health official estimates that only one of every 250 cases of foodborne disease is eventually reported to a local or state health department. Finally, some states do not require reporting of key foodborne diseases and may not be vigilant about reporting to CDC. In 1994, twelve states had no surveillance staff specifically assigned to monitoring foodborne illness, meaning that outbreaks are not reported routinely from those states.

Foodborne illness is a major public health risk. Particularly in children, the elderly, and those with weak immune systems, foodborne pathogens can kill or cause long-term health effects, including hemolytic-uremic syndrome and reactive arthritis. For thousands more people, foodborne illness causes personal discomfort and lost days at work.

Foodborne illness is also costly. The federal government has estimated the cost of illness in 1993 from just seven pathogens (the bacteria Campylobacter, Salmonella, E. coli O157:H7, Clostridium perfringens, Staphylococcus aureus, and Listeria, and the protozoan Toxoplasma gondii) at $5 billion to $9 billion. This estimate does not include any illnesses caused by other bacteria, viruses, or toxins commonly found in food.


Pathogens that cause food poisoning, such as bacteria and viruses, can show up in restaurant food served to customers as a result of food handling mistakes like inadequate cooking, cross-contamination in the kitchen, or improper cooling. At every stage of food preparation, from purchasing food from suppliers to serving customers, restaurants need to be aware of potential pathogens in food.