1. RESTAURANT GRADING SYSTEMS Rhonda Gerritts, Brae Surgeoner May 31, 2004

2. Introduction February 19, 2000,Toronto Star, Robert Cribb began series headlined Dirty Dining 4 month inspection crackdown to follow: –50+ restaurants closed –100 charges laid January 8, 2004 DineSafe implemented

3. Dirty Dining: Toronto Star Headlines Citys Health Inspection System for Restaurants a Menu of Failure and Inaction (Feb 19, 2000) Many Cities Release Restaurant Reports; Why cant Toronto; Theres Nothing World Class about Citys Food Safety and Industrial Training Record (Feb 20, 2000) Torontos Inspection System gets an F; Thousands Register Outrage over Restaurant Health-Code Violations (Feb 21, 2000) Lastman Orders Blitz on Dirty Dining; Clean Up Your Act in Week or be Shut Down, He Warns After Star Probe (Feb 21, 2000) Restaurant Inspection Crackdown Starts Now Lastman Pledges to Have Inspection Results Posted in Windows (Feb 22, 2000)

4. The people are fed up. They want to know what the hell theyre eating Mel Lastman, Toronto Mayor, 2002

5. 1998-1999: 2 Years Prior to Media Blitz 6,895 restaurants in old city of Toronto 750+ cited for critical violations 11 fines ($35-$125) Avg. $45 No closures 6,147 of the 13,281 mandated inspections completed (1999)

6. Board of Health Compliance Measures Food premises assessed annually to establish risk status –High Risk (3) –Medium Risk (2) –Low Risk (1) Inspection frequencies based on risk status; risk = inspection

7. Foodborne Disease - Ontario Distribution of foodborne disease outbreaks between 1993 and 1996 11% outbreaks did not report no. of associated cases Remaining outbreaks reported 3,057 cases; avg. 12 cases/outbreak (Health Canada, 1993)

8. Identifying a Food Safety Problem Cases and outbreaks of FBI; restaurant point-of-origin (ca. 42,500/yr in Toronto) Repeat non-compliance to food-safety health standards Info not routinely available to public; FOI not consumer friendly (Star invest. cost $350 and took 6 months) Under funded/understaffed health departments

9. Reasons to Implement a Grading System Communicate risk to stakeholders Improve legal compliance of restaurants Reduce the no. of FBIs Establish incentive for organizational change

10. Risk Management Options 1.No form of on-site disclosure 2.A B C letter grade cards 3.Colour coded cards 4.Positive achievement plaques/card of recognitions 5.Info statement cards (various options) 6.Posting of inspection report – consumer view 7.Posting of inspection report – employee view 8.Posting of inspection report – website 9.Periodic media blitz 10.Toll free number – telephone hotline

11. Evaluation of Torontos DineSafe Program: Inspection Notices

12. Green Yellow Red cards Strengths accessible for consumers timely heightened sense of security consumer $ drives compliance promotes public awareness crosses international barriers improves compliance with regulations decreased need to re-inspect over time Weaknesses expensive to implement/evaluate pressure to re-evaluate grade inflation consumer misinterpretation public education barriers snapshot in time inspector inconsistencies improved grade vs. underlying food safety issues loss of right to appeal

13. Evaluation of DineSafe – 1 yr after Implementation (Toronto Staff Report – January 9, 2003) Public 98% of general public support program 95% of public report choosing place to eat based on color sign 84% experience sense of safety 63% of public understand yellow sign as intended by TPH 10.5% and 9.9% aware of DineSafe website and hotline Operators 71% of operators support program 94% of businesses indicate not affect by program 27% indicate in business 89% operators said inspectors explained why infractions were problem 81% reported timely re- inspections 82% reported inspections fair/impartial; operators given yellow cards less likely to agree 51% operators of inspection publication on DineSafe website

14. Inspection Completion Rates: Jan 8 to Dec 31, 2001 (Toronto Staff Report – January 9, 2003) Overall completion rate of 67% (post-implementation) compared to 46% (pre-implementation) Addresses food safety problem of under funding/understaffed High Risk Medium RiskLow Risk Total No. of Premises3,8497,6686,49318,010 Inspections Conducted 8,31211,6212,26922,202 Inspections Required 11,54715,3366,49333,376 Completion Rate72.0%76.0%35.0%67.0%

15. Inspection Compliance Rates: Jan 8 to Dec 31, 2001 (Toronto Staff Report – January 9, 2003) Compliance rates increase with each successive inspection Addresses problem of non-compliance

16. What About Reducing the Cases and Outbreaks of FBI? Access to reliable health data across TO regions Difficult to determine cause-and-effect relationships Difficult to draw conclusions after only 1 year Los Angeles County research: 1.Grading card program causes restaurants to make hygiene quality improvements 2.Number of FBI hospitalizations decreases

17. Preferred Management Option On-site disclosure Mandatory food handler training Movement toward mandatory HACCP-like system

18. Evaluation of DineSafe – 1 yr after Implementation (Toronto Staff Report – January 9, 2003) Public 98% of general public support program 95% of public report choosing place to eat based on color sign Operators 71% of operators support program 94% of businesses indicate not affect by program

19. No. of Food Premise Infractions: Jan-Dec 01 – Post DineSafe (Toronto Staff Report – January 9, 2003) Highlights the need to mandate certified food handler training program Maintenance/Sanitation of Non-Food Contact Surfaces Employee Hygiene and Handwashing Maintenance/Sanitation of Food Contact Surfaces Food Protected from Contamination Maintenance/Sanitation of Washrooms Food Temperature Control Storage/Removal of Waste Pest Control Conditions for Closure Posting By-Law 574-2000 18 HPPA

20. Relevant References Basrur, S. 2003. Evaluation of the Food Premises Inspection and Disclosure System. City of Toronto. Available at: http://www.toronto.ca/legdocs/2003/agendas/committees/hl/hl030127/it004.pdfhttp://www.toronto.ca/legdocs/2003/agendas/committees/hl/hl030127/it004.pdf Boehnke, R.H. 2000. International Survey on Public Posting of Restaurant Inspection Reports, and/or Grade Card Posting Schemes based upon Health Inspections. RHB Consulting & Associates. Available at: http://www.foodsafetynetworl.ca/food/8b.pdfhttp://www.foodsafetynetworl.ca/food/8b.pdf Campbell, M.E. and C.E. Gardner, et al. 1998. Effectiveness of Public Health: Interventions in Food Safety: A Systematic Review. Canadian Journal of Public Health. 89: 197-202 Jin, G. and P. Leslie. 2003. The Effect of Information on Product Quality: Evidence from Restaurant Hygiene Grade Cards. Quarterly Journal of Economics. 118: 409-51. Available at: http://www.stanford.edu/%7Epleslie/restaurants.pdf http://www.stanford.edu/%7Epleslie/restaurants.pdf Unnevehr, L.J. and H.H. Jensen. 1999. The Economic Implications of Using HACCP as a Food Safety Regulatory Standard. Food Policy. 24: 625-635