Will Restaurant Grades in New York Mean Fewer Visits to the Hospital?

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When food poisoning announces itself, it’s sudden.

“I think I had a sip of Diet Coke, and I sat there, and sort of felt my stomach grumble a little bit,” says Forrest Jessee, a Manhattanite who was in a movie theater when he noticed the first signs of a bug. Jessee quickly decided to walk out of "Forrest Gump," though he was enjoying the film.

“I got home and I remember running up the stairs and I just went into the bathroom and threw up,” Jessee says. He felt better the next day, and attributes the illness to some bad lox on a bagel.

And that’s usually how it goes. In most food poisoning cases, the victim recovers quickly and never learns the name of the virus or bacteria that made him sick.

But not always. When Myra Ruiz started to feel ill, she knew it was serious because the whites of her eyes had turned yellow. Ruiz’s friends took her to the hospital, where she was diagnosed with Hepatitis A, which can be transmitted through food, though the specific source is usually hard to pinpoint.

Ruiz was put on an IV and given antibiotics. She had to stay home from work for a week. In the meantime, the pain was excruciating.

“I felt like I couldn’t breathe, like my liver was actually being torn apart,” says Ruiz, who lives in the Bronx.

Dr. Thomas Farley, New York City’s Commissioner of Public Health, believes about 10,000 New Yorkers visit the hospital every year because of food-related illnesses originating in the city’s restaurants. That figure, however, reflects only a fraction of the total number of people who get food poisoning.

In an effort to reduce those illnesses, New York City has decided to follow the lead of Los Angeles County, which requires restaurants to prominently display letter grades based on their health inspections.

A 2003 study by two economists found that after letter grades were introduced in Los Angeles, there was a 20 percent decline in hospital admissions for food-borne illness.

In the world of public health, that was a dramatic result. Yet this study is the only academic work to date that shows a connection between restaurant letter grades and rates of food-borne illness. And even in its own explanation for why it is adopting the new rules, the New York City Department of Health concedes the “association is not proven.”

One of the study’s co-authors, Stanford University Economics Professor Philip Leslie, hopes policymakers will nonetheless take note.

“I don’t mind admitting that I’ve written a lot of papers so far in my career – empirical papers – and I don’t always believe the findings in a way that I would feel comfortable about policy being implemented on the basis of that,” Leslie says.

But he’s confident in his study of letter grades for restaurant hygiene because it also included counties surrounding L.A. where letter grades were not adopted. His research found that those areas did not see improvements in hospitalization rates for food-borne illnesses.

Leslie’s research also showed that restaurants earning higher marks increased their revenues; "C" restaurants saw sales drop, suggesting people shunned riskier eateries and chose to eat more in cleaner ones.

Leslie is now looking for a grant to study the effects of letter grades in New York City.

Dr. Farley says public health officials seldom get to make policy based on proven facts. Instead, they draw conclusions from what’s worked in other places.

“[Los Angeles] saw a reduction of food-related illness hospitalizations, and that’s the best prediction we can get of what is going to happen in New York City,” Farley says.

In the 10 years since Ruiz contracted Hepatitis A, she says she’s hardly eaten any meals in restaurants. 

If the letter grade system seems to be working, Ruiz says, she’ll reconsider. And she says giving diners more information is a good idea.

“People need to know what are they eating,” Ruiz says. “That’s your health.”