TRANSPARENCY POLICIES

8. Disclosing Restaurant Hygiene to Protect Public Health

Example: Restaurant Grades

On November 16, 1997, the CBS affiliate in Los Angeles, KCBS, broadcast the first of a three-part series regarding restaurant hygiene. Using the increasingly popular “hidden camera” technique, the local news exposé took viewers behind the scenes into a number of restaurant kitchens.82 The series revealed a smorgasbord of unsanitary practices that—according to the series—were common in restaurants throughout Los Angeles County, despite the presence of an aggressive restaurant hygiene monitoring system maintained by the county. The anecdotal evidence in Los Angeles, however, was indicative of amore widespread problem. Food-borne diseases cause an estimated 325,000 hospitalizations and 5,000 deaths each year in the United States. The Centers for Disease Control (CDC) estimates that nearly 50 percent of food-borne disease outbreaks are connected to restaurants or other commercial food outlets.83

The public outcry arising from the investigative series led the Los Angeles County Board of Supervisors to legislate transparency to informthe public about hygiene conditions in all restaurants in the region.They unanimously adopted a disclosure requirement on December 16, 1997 (one month after the series was aired), which went into effect on January 16, 1998. The county ordinance requires public posting of restaurant hygiene grades (A, B, or C) based on Los Angeles County Department of Health Services (DHS) inspections. By making these grades public, the Board of Supervisors sought to reduce the effects of food-borne diseases by putting competitive pressure on public eating establishments with poor hygiene practices.84 Not surprisingly, the requirement was opposed by the California Restaurant Association (a statewide trade group), as well as by many local restaurant associations. Although the transparency requirement was adopted at the county level, individual citieswithin the countywere not required to adopt the ordinance (all but ten had chosen to do so by the end of 2005).85

The system builds directly on the health inspections conducted regularly by the DHS. Health inspections cover a range of very specific practices, including food temperatures, kitchen and serving area handling and preparation practices, equipment cleaning and employee sanitary practices, and surveillance of vermin.86 Each violation receives one or more points. Cumulative points are then deducted from a starting score of 100. A score from 90 to 100 points receives an A, 80 to 89 a B, and 70 to 79 a C.87 Cumulative scores below 70 require immediate remediation by the restaurant owner, which may include suspension of the owner’s public health permit and closing of the restaurant.88

The transparency system requires restaurants to post the letter grade arising from the most recent inspection on the front window.89 A searchable Web-based system includes inspection grades, numeric scores onwhich the gradeswere based, and a listing of specific violations found on the last inspection. Restaurants receive two or three unannounced inspections and one reinspection, upon request, per year. Thus, although the posting of grade cards entails relatively small costs, the systemrelieson a large number of inspections (about seventy-five thousand in 2003) and therefore means a sizable enforcement budget for the DHS.

The introduction of the new transparency system led to fairly rapid and significant changes in the overall grade distribution in county restaurants (as noted, the grading system existed before the disclosure requirement).When the programbegan, 58 percent of restaurants received an A grade, a number that grew to 83 percent by 2003. The incentives to improve are significant. Jin and Leslie report that after grade posting became required, restaurants receiving an A grade experienced revenue increases of 5.7 percent (other factors held constant); B-grade restaurants had increases of 0.7 percent; and those with a C grade had declines in revenue of 1 percent.90 The introduction of grades also improved hygiene at franchised units in chain restaurants, whereas franchised units tended to have lower hygiene than company-owned restaurants.91

More important, studies found significant decreases in food-borne-illness hospitalizations, ranging from13 percent (Simon et al., 2005) to 20 percent (Jin and Leslie, 2003). The system is not without its problems. There is some evidence that inspectors have becomemore lenient over time.92 There is no systemic evidence of corruption in grading, although the economic incentives for it are significant, given the high stakes involved in restaurant grades.93 Some critics of the system have argued that it is incompatible with the standard food preparation practices of certain ethnic groups who therefore face an unfair disadvantage from the grading system.94

Several other cities in the United States have similar restaurant hygiene disclosure systems.95 While eight states had introduced legislation requiring posting grade cards, as of 2005 only Tennessee and North Carolina had statewide systems.96

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FOOTNOTES
82. The series, by KCBS-TV newsman Joel Grover, aired November 16, 17, and 18, 1997, on the Channel 2 News in Los Angeles.
83. Hospitalizations and fatality estimates from Mead et al., 1999. CDC estimates, based on surveillance data from 1993 to 1997, reported in Centers for Disease Control and Prevention, Surveillance for Foodborne Disease Outbreaks–United States, 1993–1997, Morbidity and Mortality Weekly Report, vol. 49 (SS-1) 2000, pp. 22–26.
84. For a general description, see Simon et al., 2005, pp. 32–36. Los Angeles County Ordinance 97–0071 §2 (part), 1997. http://municipalcodes.lexisnexis.com/codes/lacounty/DATA/TITLE08/Chapter 8 04 PUBLIC HEALTH LICENSE/804225Gradingandlettergr.html (site accessed June 3, 2006); see also County of Los Angeles Department of Health Services, Public Health Programs and Services, Environmental Health, Posting Requirements Advisory Bulletin: Retail Food Establishments, http://search.ladhs.org/images/nrfood.htm (site accessed April 29, 2006).
85. The cities that had not adopted grade cards in Los Angeles County as of 2005 were Avalon, Azusa, City of Industry, Hidden Hills, La Habra Heights, Montebello, Redondo Beach, SanMarino, SierraMadre, and Signal Hill. Restaurants in those cities were inspected and received grades from the county, but were not required to post them.
86. The DHS provides inspectors a detailed retail food inspection guide, broken into five sections. See County of Los Angeles, Department of Health Services, Retail Food Inspection Guide, H-3046 (May 2000). A subjective element (based on the inspectors’ overall assessment of hygiene status) was eliminated from the survey in July 1997 to improve the objectivity of the guidelines.
87. The guidelines define an A as “[g]enerally superior in food handling practices and overall food facility maintenance”; a B as “[g]enerally good in food handling practices and overall food facility maintenance”; and a C as “[g]enerally acceptable in food handling practices and overall general food facility maintenance.” A score below 69 is associated with “[p]oor food handling practices and overall general food facility maintenance.” See County of Los Angeles, Department of Health Services, Retail Food Inspection Guide, “Understanding Your Grade,” http://www.lapublichealth.org.
88. A total of 989 restaurants out of 24,000 received closure orders in Los Angeles County in 2002. Most were temporary. See Martin Miller, “Five Years into L.A. County’s Grade-Posting Project, Most Restaurants Are Getting TopMarks,” Los Angeles Times, July 28, 2003.
89. The ordinance specifically requires that the grade card be posted within five feet of the point of entry. If the numeric grade is below a C, the restaurant is required to post the numeric grade in its window.
90. See Jin and Leslie, 2005, for a summary of these results. Jin and Leslie find that these changes arise froma combination of “sorting” (customers switching from restaurants with low grades to those with higher grades) and improvement in the hygiene practices of restaurants with lower ratings. See Jin and Leslie, 2003 and 2005.
91. See Jin and Leslie, 2006.
92. Along with anecdotal evidence, Jin and Leslie, 2005, p. 100, report that the distribution of grades around the critical scores of 89 (the line between an A and B) and 79 (between a B and C) show a dramatic upward spike around the higher number, implying that inspectors may choose to bump up scores. If such activity occurs only at break points, this may imply only a mild form of grade inflation.
93. Miller, “Five Years into L.A. County’s Grade-Posting Project, Most Restaurants Are Getting Top Marks.”
94. David Pierson, “Where ‘A’ is Not on the Menu: Chinese Eateries in an L.A. County Enclave Struggle with Hygiene Ratings,” Los Angeles Times, September 28, 2005.
95. An effort to replicate the Los Angeles County system in San Francisco faced fierce opposition when it was proposed in 2004. After a six-month battle, the San Francisco Board of Supervisors adopted a compromise measure requiring restaurants to post health inspection reports (but not summary grades), as well as merit symbols for those receiving high marks. See Suzanne Herel, “Health Ratings Win Approval,” San Francisco Chronicle, May 12, 2004, p. B4. Efforts to adopt a similar system in San Bernardino County have also faced opposition from restaurant owners and restaurant associations. See Martin Hugo, “San Bernardino County Considers Grading Restaurants,” Los Angeles Times, April 20, 2004, p. B5; see also Martin Hugo, “S.B. County Restaurants May Soon Get Health Ratings,” Los Angeles Times, April 28, 2004, p. B3.
96. Based on a survey by the National Conference of State Legislators in 2005. North Carolina’s system is called the “Know the Score” program and uses a grading system similar to the one employed in Los Angeles. See N.C. Gen. Stat. §130A-249 (2005). Tennessee’s system also uses grade cards. See Tenn. Code Ann. §68–14–317 (2001). See also Pytka, 2005.

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