MPH 599 Week 7 Short Scholarly Paper Example

Would Posting Inspection Grades at Restaurant Entrances Reduce Foodborne Illness in Larkin County? A Short Review of the Evidence

Student Name

Chamberlain University

MPH 599: Professional Writing

Instructor Name

Month Day, Year

Would Posting Inspection Grades at Restaurant Entrances Reduce Foodborne Illness in Larkin County? A Short Review of the Evidence

The Question

Larkin County, the fictional setting of this course's assignments, inspects about 1,900 restaurants a year and publishes the results on its website, where few diners look. The county's board of health has asked whether it should require restaurants to post a letter grade at their entrances, as New York City and Los Angeles County do. This paper asks whether the evidence shows that posting grades at entrances reduces foodborne illness, and what the county should expect if it adopts the practice. The answer matters because foodborne illness is common: one widely cited estimate attributed about 9.4 million episodes a year in the United States to 31 major pathogens (Scallan et al., 2011), and some of that illness is acquired in restaurants.

What Inspection Scores Measure

Posting a grade assumes that the grade reflects food safety. The evidence on that is mixed. In a review of 167,574 restaurant inspections in Tennessee, Jones et al. (2004) found that restaurants linked to foodborne disease outbreaks had the same average inspection scores as restaurants with no reported outbreaks. They also found that average scores differed widely between individual inspectors, from 69 to 92, and that none of the 12 most commonly cited violations was a critical food safety hazard. If scores depend partly on the inspector and focus on minor violations, a posted grade may tell diners less about safety than it appears to.

Evidence From Places That Post Grades

Two cities have been studied closely. In Los Angeles County, which began posting grade cards in January 1998, Jin and Leslie (2003) found that restaurant hygiene scores rose after the cards were introduced and that consumers responded to the grades. Using hospital discharge data, Simon et al. (2005) found that foodborne disease hospitalizations in the county fell by 13.1% in the year after the program began, compared with the rest of California and after adjustment for earlier trends, and that the decrease was sustained for the following two years.

In New York City, which began letter grading in 2010, Wong et al. (2015) analyzed inspections of 43,448 restaurants from 2007 to 2013. Three years after grading began, the probability that a restaurant scored in the A range on an unannounced inspection was 35% higher than three years before, after accounting for repeated inspections, season and chain status. Specific practices improved, including having a certified kitchen manager on site. In a 2012 telephone survey, more than 91% of residents approved of the program, and 88% said they considered grades when deciding where to eat.

How Strong the Evidence Is

Both bodies of evidence come from comparisons before and after a program began, not from randomized trials. Each tried to account for trends that were already under way: Simon et al. (2005) used the rest of California as a comparison, and Wong et al. (2015) adjusted for features of restaurants and inspections over six years of data. But other changes in the same years, such as new food safety training rules or changes in how hospitals coded illness, could explain part of the improvement. The New York study measured inspection results, not illness, so it shows that restaurants changed their practices but not that diners got sick less often. Only the Los Angeles analysis connects grading to illness directly, and it is a single county studied over a few years, more than two decades ago.

Table 1

Studies Bearing on Posting Restaurant Grades

Note. Note. Findings as reported by each study.

What Larkin County Should Expect

The evidence supports a qualified answer. Posting grades at entrances is likely to improve inspection results, because restaurants respond when customers can see their grades, and it may reduce foodborne illness, though the evidence for that is limited to one county. The county should not expect a large or certain fall in illness, and it should address the weakness Jones et al. (2004) identified: if scores vary by inspector and reward minor fixes, grades will be unfair to some restaurants and will tell diners little. Before posting grades, the county would first need to train inspectors to score consistently, weight the scoring toward the violations most closely tied to illness and offer a quick re-inspection for restaurants that fix problems.

Conclusion

Posting inspection grades at restaurant entrances has been followed by better inspection results in two large jurisdictions and by fewer foodborne disease hospitalizations in one. The evidence is observational, and the link to illness rests on a single study. Larkin County should adopt grading only together with steps to make scores consistent and meaningful, and it should measure both inspection results and foodborne illness before and after the change, so that its own experience adds to the small body of evidence.

What Grading Would Cost and Who Would Bear It

Grading is not free. Inspectors would need training and periodic checks on scoring consistency, which takes time from inspections. Restaurants that receive a B or C would bear a real cost in lost customers, which is the mechanism by which grading works but also a reason it must be fair. Small restaurants with owners who speak limited English may struggle most to understand the scoring and to request re-inspection, so the county would need to explain the program in several languages and offer quick re-inspections. In New York City, where most residents approved of grading, the program also included a way for restaurants to contest grades before posting (Wong et al., 2015). A county that adopted grading without these protections would risk punishing restaurants for an inspector's habits rather than for unsafe food, which is the weakness Jones et al. (2004) documented in Tennessee.

References

Jin, G. Z., & Leslie, P. (2003). The effect of information on product quality: Evidence from restaurant hygiene grade cards. The Quarterly Journal of Economics, 118(2), 409-451. https://doi.org/10.1162/003355303321675428

Jones, T. F., Pavlin, B. I., LaFleur, B. J., Ingram, L. A., & Schaffner, W. (2004). Restaurant inspection scores and foodborne disease. Emerging Infectious Diseases, 10(4), 688-692. https://doi.org/10.3201/eid1004.030343

Scallan, E., Hoekstra, R. M., Angulo, F. J., Tauxe, R. V., Widdowson, M.-A., Roy, S. L., Jones, J. L., & Griffin, P. M. (2011). Foodborne illness acquired in the United States: Major pathogens. Emerging Infectious Diseases, 17(1), 7-15. https://doi.org/10.3201/eid1701.p11101

Simon, P. A., Leslie, P., Run, G., Jin, G. Z., Reporter, R., Aguirre, A., & Fielding, J. E. (2005). Impact of restaurant hygiene grade cards on foodborne-disease hospitalizations in Los Angeles County. Journal of Environmental Health, 67(7), 32-36.

Wong, M. R., McKelvey, W., Ito, K., Schiff, C., Jacobson, J. B., & Kass, D. (2015). Impact of a letter-grade program on restaurant sanitary conditions and diner behavior in New York City. American Journal of Public Health, 105(3), e81-e87. https://doi.org/10.2105/AJPH.2014.302404