The Economic and Emotional Burden of Foodborne Disease

Comments by Barbara Kowalcyk
Presented to the U.S. House of Representatives’ Food Safety Caucus
Rayburn Foyer, Rayburn House Building, Washington, DC
September 22, 2025

Good afternoon, my name is Barbara Kowalcyk. I am a biostatistician from Mount Horeb, Wisconsin and a Board Member of Safe Tables Our Priority. I would like to thank the U.S. House of Representatives’ Food Safety Caucus for sponsoring this important event and taking the time to really listen to consumers about the costs that they face from contamination in America’s food.

Three years ago, my oldest child, Megan started Kindergarten. One night, as I was putting our 2 ½ year old son, Kevin, to bed, we talked about how Megan - his best friend - would be going to Kindergarten in just a few weeks. As I kissed him goodnight, Kevin said, proudly, “When I grow up, Mommy, I’m going to Kindergarten too.” This month Kevin should have started Kindergarten, but foodborne illness robbed him of that chance.

Kevin’s Story

On Tuesday, July 31, 2001, Kevin awoke with diarrhea and a mild fever. By Thursday morning, Kevin was much sicker and was hospitalized for dehydration and bloody stools. Later that afternoon, we were given the diagnosis: E. coli O157:H7. My husband, Mike and I were distraught - we had heard of E. coli and knew that it could kill. The doctors, however, reassured us that Kevin would be ok…as long as he didn’t develop Hemolytic Uremic Syndrome (HUS), a condition we had never even heard of.

The following day Kevin’s kidneys started failing and he was transferred to the Pediatric Intensive Care Unit at the University of Wisconsin’s Children’s Hospital. Kevin had developed HUS. My husband and I will never forget sitting in this tiny waiting room while grim-faced doctors informed us that this was one of the worst things that could have happened to our child. The best they could do was keep Kevin alive while the disease ran its course and hope they could fix everything when it was over.

Our family spent the next eight days living in that hospital - watching our beautiful child slip away from us. Kevin spent the first three days crawling around a crib in agony. He threw up black bile. He became drawn and his eyes were sunken. He looked like a malnourished third world child. And he smelled - a horrible and overwhelming smell - a smell that you could never forget. During those three long days, Kevin begged us to give him water or juice, but the doctors said it would only make him worse. Kevin finally convinced us to give him a sponge bath and, as soon as the washcloth came near his mouth, he grabbed it, bit down on it and sucked the water right out of it. It broke our hearts.

On Tuesday, August 7th, Kevin was placed on a ventilator and continuous dialysis. In hopes of preventing Kevin from remembering this horrible ordeal, doctors heavily sedated him. As the medication would wear off, Kevin would try to pull the tubes out so braces were put on his arms. His body began to swell. Doctors inserted tubes to drain fluid off both of his lungs. By the end of the week, he was receiving more medications than we could count to stabilize his blood pressure and heart rate. He had received eight units of blood. Then, on the evening of August 11th, those same grim-faced doctors ushered us back into that tiny waiting room. Kevin’s heart had stopped but they were able to resuscitate him. Kevin had a 10% chance of survival - if they could get him on a heart and lung machine. Did we want them to proceed? Yes, we said. Those same grim-faced doctors came back to the waiting room a second time. Kevin’s heart had stopped again and they had been able to resuscitate him. Did we still want them to proceed? Yes, we said. Those same grim-faced doctors came back to the waiting room a third time. Our beloved Kevin had died. He was only 2 years, 8 months and 1 day old.

The Cost of Foodborne Illness

I find it difficult to come before you to tell you about the death of my son, Kevin. He was a wonderful little boy who died a horrific death. But as tragic as Kevin’s story is, he is not alone. According to CDC estimates, 325,000 Americans are hospitalized and 5,000 die each year in the United States from foodborne disease and the majority of these are children. It is for this very reason that I began with my family’s story - so that you understand that this is not just about dollars and cents but about American families whose lives have been drastically changed by foodborne disease.

Many argue that demanding stronger food safety policies is cost-prohibitive. In January 2003, the USDA attempted to shut down Nebraska Beef due to an inadequate food safety system. Nebraska Beef immediately took USDA to court arguing that the company would lose $2.7 million a day in revenue and 1,100 employees would be out of work. The judge in the case ruled in favor of Nebraska Beef stating that the harm to Nebraska Beef would be “far greater than any injury” to the federal agency. I find it appalling that no consideration seems to have been given to the health and economic costs for American consumers.

In reality, the cost of foodborne illness to American society is very high. There are approximately 1.5 million cases of Salmonella in this country every year. According to USDA’s Economic Research Service (ERS), each of those cases costs an average of $2,126 in lost wages and medical costs ( Economic Research Service, USDA. Foodborne Illness Cost Calculator, www.ers.usda.gov). In fact, the ERS estimates that, each year in the United States, five foodborne illnesses - Camploybacter, Salmonella, E. coli O157:H7, Listeria monocytogenes and Toxoplasma gondii - cause $6.9 billion in medical costs, lost productivity and premature deaths( Buzby. Food and Rural Economics Division, Economic Research Service, USDA. Children and Microbial Foodborne Illness. Food Review, Vol 24, Issue 2). That is a pretty steep figure, but it is just for 5 diseases. It leaves out so many others, such as, Norwalk virus - the leading cause of foodborne disease, botulism, shigella, foodborne staph, and parasites. And it still does not reflect any of the hidden costs that victims and their families suffer: the cost of traveling to receive medical care, time lost from work caring for sick children, lost leisure time, and pain and suffering.

Medical Costs

My son, Kevin went from being perfectly healthy to being dead in just 12 days. The cost of his medical treatment exceeded $100,000. For those who survive foodborne illness, the cost can be much higher.

According to an ERS report, ( Buzby, Frezen, and Rasco. Food and Rural Economics Division, Economic Research Service, USDA. Agricultural Economic Report No. 799: Product Liability and Microbial Foodborne Illness.) “Foodborne illnesses account for about 1 of every 100 U.S. hospitalizations and 1 of every 500 U.S. deaths.” But the acute stage of foodborne disease can be only the start of the problem. The Food and Drug Administration (FDA) estimates 2 to 3 percent of foodborne illness victims develop secondary long-term medical problems ( Frezen. Economic Research Service, USDA. The Economics of Food, Farming, National Resources and Rural America, www.ers.usda.gov) - that’s over 1.5 million lingering health problems per year. Salmonella is one of the leading predictors for reactive arthritis, a painful, chronic and potentially debilitating condition that causes joint inflammation. Camplyobacter is believed to be a leading cause of Guillian-Barre Syndrome, an autoimmune reaction that causes paralysis and kills between five and ten percent of its victims. E. coli O157:H7 and other foodborne diseases are almost the exclusive cause of HUS, the relentless condition characterized by cascading organ failure that injured Sarah’s sister, Lizzy and Ann’s daughter, Katelyn and killed my son, Kevin. HUS can cause its victims, most of them young children, to have seizures, strokes and heart attacks and many HUS patients require splenectomies, chemotherapy, repeated blood transfusions, and even intestinal reconstruction. One-third of HUS survivors will suffer life-long medical problems such as high blood pressure, diabetes, kidney failure and brain damage. In fact, HUS caused by E. coli O157:H7 is the leading cause of acute kidney failure in children in the United States.

Emotional Costs

What about the hidden financial costs of foodborne illness? My husband and I were lucky because we have good health insurance and a life insurance policy on our children. Even so, Kevin’s life insurance did not cover the entire cost of his funeral, and despite our good medical insurance, neither myself, my husband or my daughter, Megan, were entitled to grief counseling which we all desperately needed. Because of Kevin’s death, my marriage is statistically more likely to end in divorce and my surviving children are at risk of developing eating disorders. It is now three years since Kevin died and we continue to spend money every month on grief counseling to help ensure that our family doe not incur yet another loss. The price of foodborne illness is too high.

And what about the losses you can’t put a price on? The parents of a four year old are informed that their child will likely need a kidney transplant before she is fifteen. A perfectly healthy six year old loses her pancreas, becomes a diabetic and has to take 40 pills a day in order to eat. A nine year old is terrified to go to sleep for fear she will never wake up again. An active twelve year old girl is easily winded. A college freshman loses her hair and is told that her kidneys would never survive a pregnancy. A two year old child dies. The price of foodborne illness is too high.

The Economics of Foodborne Illness

USDA’s Economic Research Service’s report on Product Liability and Microbial Foodborne Illness identifies three economic incentives most likely to result in the production of safe food: market forces, food safety laws and regulations and product liability.

Market Forces

Ideally, companies that produce contaminated food would lose market share and sales revenue. In a basic economic model, markets are most efficient when both producers and consumers have complete information. In the real world - and especially when it comes to foodborne pathogens, this is rarely the case. You cannot see, smell or taste them. In other words, you - the consumer - do not have complete information. American consumers need our government to fill in this information gap by providing assurance, through enforceable microbial performance standards, that food products are wholesome and safe.

Food Safety Laws and Regulations

Ideally, companies that violate food safety laws or regulations would be subject to various government-mandated penalties such as fines, product recalls and plant closures. That, however, is not the case. No agency has the power to levy civil fines on producers for repeatedly selling tainted food. No agency has the power to recall contaminated food products even when scientific testing conclusively establishes the presence of deadly bacteria. No agency has the power to effectively close plants that repeatedly fail to meet HACCP performance standards as demonstrated in the Supreme Beef case.

Product Liability

Ideally, companies that produce contaminated food would be held liable for the injuries and deaths caused by their defective products. However, it is documented by USDA, and well known among food processors, that foodborne illnesses are rarely traced to their source. Therefore, the likelihood of a company being held financially responsible for damages caused by their defective product is slim. As a result, there is little incentive to produce safer food. An effective traceback system would make food producers accountable for the safety of their products rather than shifting the burden of foodborne illness onto their consumers.

Market forces, food safety laws and regulations, product liability. The food industry is almost uniquely insulated from these three economic incentives to produce safer food. Meanwhile American families, hospitals, health insurance companies and strained federal health programs are picking up the costs.

Conclusion

Americans want their dollar menu, or so they say. But, a dollar menu really costs more than dollar. No American wants a $2,126 Salmonella-infested hamburger. No American wants what the families here today have gone through - not at any price. Some would have you believe that our experience is rare. But we are not alone. We are here to give a voice to the thousands of families who live through serious foodborne illness every year. So, as you - our country’s leaders - think about food safety policies, ask yourself this: How much more per pound would you be willing to pay to make sure your family’s food is safe? Three cents? Fifty cents? A dollar? What price do you put on your health? On your life? On your loved one’s life?

On August 16, 2001, we didn’t just bury our son. We also buried part of ourselves. We will never be the same people we were before. No parent should have to watch their child die the type of death that Kevin suffered. Our daughter will never be the same. No one should have to grow up at the age of five. Our community will never be the same. No preschooler should have to go to a cemetery to visit their friend.

The price of foodborne illness is too high.

Thank you.