Strengthening Public Health Systems: CNMI Food Safety Program Spotlight

September 23, 2025 | Anya Groner, Taylor Francis

Public health systems are designed to protect and improve population health. These vital systems — from food safety programs to disease surveillance — help to prevent disease, respond to health threats, and ultimately improve well-being. To best benefit communities, public health agencies must remain committed to strengthening these existing systems.

The Commonwealth of the Northern Mariana Islands (CNMI), a U.S. territory in the western Pacific with a population of approximately 50,000, models this work in their exceptional efforts to improve their food safety system. Managing the risks of foodborne illness requires clear guidelines, government support, and regulatory authority. Yet, when the Environmental Health Disease Prevention Program (EHDP), part of the Commonwealth Healthcare Corporation in CNMI, conducted a voluntary review of their food regulations, the jurisdiction met only a small percentage of the FDA retail program standards, which define what constitutes a highly effective and responsive program for the regulation of retail food establishments. From there, EHDP launched an ambitious plan for the jurisdiction to adopt the FDA Food Code for the first time.

The EHDP Office spent several years analyzing the legal and technical implications of adopting the FDA Food Code and garnering leadership support. In November 2024, it was officially adopted — an extraordinary accomplishment. EHDP will now embark on a five-year implementation process which has a strong focus on training, technical assistance, and partnerships with local stakeholders — with an emphasis on education instead of enforcement. Their journey serves as an example for other jurisdictions working to strengthen their public health systems.

Getting Started

Building better systems starts with identifying opportunities to strengthen those already in place. When EHDP reviewed their existing local regulations against the 2017 FDA Food Code, they found that theirs fell short of the criteria related to risk factor interventions, good retail practices, and effective compliance and enforcement measures. This led to the realization that they needed to strengthen their food safety program and adopt their first FDA Food Code.

By moving from their old code to the FDA code, EHDP shifted from a focus on basic sanitation to foodborne illness risk factors. With limited resources and staffing challenges, it was vital that the EHDP team knew where to focus their workload and how to streamline inspections. This change will also help EHDP better protect the public’s health.

Measuring Progress

As health agencies embark on building better systems, it’s vital to have a specific measure to assess progress against. EHDP spent several years working toward adopting the 2022 FDA Food Code. Their previous regulations were outdated, vague, and inconsistent. Plus, there was a lack of clarity around critical food safety practices, like cooking temperatures, cooling procedures, and sanitization. The retail food program standards gave the team a measure to assess their food safety program compared to other programs nationally and helped them better understand gaps.

Getting Buy-In and Mobilizing Stakeholders

Two additional essential steps are garnering support and coordinating action. For EHDP, there was a lot of training to get internal support not just within the team but also from leadership. Fortunately, the adoption process to implement new regulations was fairly smooth. Their next focus is building the infrastructure, training the staff, and ensuring that the local operators have access to the necessary equipment, supplies, and sample policies. They are also looking to offer certified Food Protection Manager training to food operators. EHDP plans to focus on small behavioral changes, making sure everyone’s on the same page with employee health so retail food establishments can meet the requirements on employee health and reporting.

Every September, EHDP hosts food safety week as part of Food Safety Education Month and brings together food handlers and food operators — some of whom are familiar with the FDA Food Code due to working in the continental United States. The EDPH team always talks to them about potential changes that could come about from this new code and, so far, have received great feedback.

Collaborating with Partners

As with any effective public health initiative, collaborating with partners at all levels is crucial – as agencies can learn from others’ skills and experiences. At both the federal and local levels, EHDP worked closely with their FDA retail specialists who provided technical support and training throughout the process. The team also did a three-year mentorship with Northern Nevada Public Health, which helped them improve their field inspections and strengthen internal policies and procedures. These were the key steps in making progress towards the standards and preparing for adoption. In addition, ASTHO connected EHDP with other health departments who had gone through the food code adoption process, enabling them to hear their firsthand insights and practical guidance. The team is willing to support other Pacific Island jurisdictions, like American Samoa, as they work to adopt the FDA Food Code for the first time, too.

Celebrating Successes

It’s always important to take a step back and acknowledge wins throughout essential public health work. EHDP’s work towards the FDA Food Code strengthened the team's skills and expanded training opportunities, as they shifted from focusing on rules and regulations to risk-based inspection and partnering with food operators — emphasizing education, prevention, and collaboration, to get everyone on board. Their biggest success, however, is of course adopting their first FDA Food Code.

In Conclusion

Through EDPH’s efforts to improve their food safety program, they are reducing foodborne illness, protecting public health, and safeguarding their community. As exemplified in CNMI, improving public health systems takes time and hard work — but with that investment comes key successes that benefit communities for years to come.