Making Health Policy Consumer Friendly with Restaurant Grading

August 15, 2019 - (4 min read)

The Only Secret Should Be the Sauce

By Dr. Jonathan Fielding

Americans don’t just love to eat; we love to know about the foods we’re eating. Labels in restaurants increasingly inform the consumer about ingredients, calories, and even how animals have been raised.

But good luck trying to find out if your restaurant choice fares well in food safety inspections – it’s one of the last best kept secrets, despite the fact that these checks are supported with tax dollars. Only a few cities and states tell consumers before they walk in the door of a food establishment how well the business stores, handles, and prepares food, or whether they follow best practices to prevent you from being exposed to Salmonella, E.coli, Hepatitis A, or toxins that can lay low for days before wreaking havoc.

That shouldn’t be a secret.

Not only do consumers have a right to know, but growing evidence shows that when municipalities publicly grade restaurants, overall restaurant hygiene improves.

That’s what’s happened in cities like mine, and other leading cities that post grades, scores, and even emojis that tell how well a restaurant has done in public health inspections. A new public health group called CityHealth, a project of the de Beaumont Foundation and Kaiser Permanente, assesses which cities are putting this evidence-based policy in place. To see where your city lands, check out their list here.

Cities implement restaurant grading for two main reasons: consumers have a right to know about conditions in a food establishment open to the public, and the practice reduces the chances of getting sick from a food-borne illness. Los Angeles County prominently posted As, Bs, and Cs, or numerical grades for even lower scores, at the door of restaurants so that consumers can see how a food establishment fared before they decide to enter. When they did so, gastrointestinal illness-related hospitalization went down by 13% compared to adjacent counties without such a program. Restaurants with A’s and B’s gained more business, and overall, retailers improved their food safety records across the board.

New York City has seen the same results. Now that grades are posted on the front door, more restaurants achieve and keep top scores.  The businesses were also more likely to be pest-free when surprise inspections were held. Almost all New Yorkers approve of the program and a vast majority – 88% – consider inspection grades when making dining decisions.

It’s time for all consumers, regardless of where they live, to know inspection results. While an L.A. eater can easily find out, in another county it may be another story. New cities are adopting this consumer-friendly and health-protecting policy around the country. In 2017, Seattle-King County started using an innovative emoji-based system to help their multi-cultural population, which speaks over 300 languages, understand the signs. Boston also worked closely with their restaurant association to roll out their own system two years ago.


An example of a Public Health – Seattle-King County restaurant grade poster.

The public not only relishes this information, but it gives them a new-found understanding of how their local public health department protects them. These are the same officials who respond to health emergencies and work to report widespread illness outbreaks with little fanfare. Most of the critical health services and programs public health departments carry out every day are invisible. Restaurant grading gives these officials a new opportunity to be recognized in their community. That A on the restaurant door not only says, “Eat here!” it also assures the public that their public health workforce is on the job, protecting them. It helps to give local public health professionals an instantly recognizable value to the constituents they serve.

So, let the public know the scores. It protects their health and poses a new opportunity for those who work in health departments every day to show consumers that we are on their side in their daily quest to be healthy and well. Empowering everyone to be in the know and make good choices is, at the end of the day, a greatly appreciated public service.

Read the new CityHealth technical report on restaurant grading in cities here.

Dr. Jonathan Fielding is currently a Distinguished Professor of Health Policy and Management and of Pediatrics in the Schools of Public Health and Medicine at UCLA. Previously he served for 16 years as Public Health Director and Health Officer for Los Angeles County, and is a member of the CityHealth Policy Advisory Committee.