Cities Ranked by Dirty Restaurants

Consumer Group's 'Dirty Dining' Report: Unhealthy Towns or Tough Inspectors?

From the WebMD Archives

Aug. 7, 2008 -- Is your city a haven for restaurant health hazards?

A consumer group has ranked 20 U.S. cities for restaurant health. Austin, Texas, and Boston rank worst, while Tucson, Ariz., and San Francisco rank best.

But it's not at all clear whether diners are dirtiest in Austin and Boston, or whether these towns simply have the toughest inspectors -- or if inspectors in Tucson and San Francisco are more lenient.

The report, "Dirty Dining," comes from the consumer group the Center for Science in the Public Interest. CSPI food-safety attorney Sarah Klein, JD, is co-author.

"How do you know whether it is a robust inspection force really uncovering the bad practices, or whether restaurants in that city have poor health practices?" Klein tells WebMD.

The CSPI ranking considers how often city inspectors found five major health hazards and five less critical concerns in 30 high-end, medium-range, and fast-food eateries in each city.

The major health hazards:

  • Food held at an unsafe temperature. According to a 2004 FDA report, 65% of restaurants don't fully comply with federal Food Code guidelines on food temperature. Perishable foods should be cooled to 41 degrees Fahrenheit. And bacteria multiply in warming pans if the temperature is not high enough and if foods are left there long enough.
  • Hand washing. According to a 2007 CDC report, 20% of food-borne illnesses caused by bacteria come from infected workers.
  • Improper cooking. The 2004 FDA report estimated that about 16% of full-service restaurants don't fully cook their food. Two of the most harmful food-poisoning bacteria -- salmonella and E. coli -- lurk in undercooked meats.
  • Contaminated food-contact surfaces. The FDA report found 56% of full-service restaurants were not were not compliant.
  • Food from unsafe sources. The FDA report suggested that 13% of full-service restaurants don't comply with food-source guidelines.

Less serious concerns include:

  • Substandard employee cleanliness and hygiene
  • Rodents and insects
  • Improper use of wiping cloths
  • Presence of sick restaurant workers
  • Bare-hand contact with raw food

Can rodents and roaches really be less of a concern than, say, improper food temperature? Yes, Klein asserts.


"The presence of rodents and insects is certainly disgusting and certainly shows a restaurant is not focusing on food safety," she says. "But the things most dangerous to consumers are the things we would never see. Unless we had the tools and the training, even if we went into the kitchen we would not be able to see the things that would really harm us."

That is why the CSPI urges every city and state to adopt a restaurant grading program. As is done in Los Angeles County, restaurants would be required to post -- in their front window -- a letter grade from inspectors showing whether they got an A, B, or C. Lower grades would result in the restaurant being closed.

"The result in L.A. County has been a 20% reduction in food-borne illness," Klein says. "Right now, a poor inspection is a hidden shame for a restaurateur. With public grading, food safety comes out of the shadows and becomes a priority for the restaurant, the same way a four-star rating from the Zagat Guide would be."

And consumers pay attention. Klein says that in Los Angeles, only 3% of consumers say they'd eat at a C-grade restaurant. And restaurants that got a C saw revenues dip by 1%, while those that got an A saw their income rise by 5.7%.

Mary Adolf, president of the solutions, products, and services group of the National Restaurant Association, warns that health inspections provide only a snapshot of what's going on in a restaurant at a specific point in time.

"Ninety-nine percent of critical violations are corrected before the inspector leaves the restaurant," Adolf tells WebMD. "That is important."

Adolf says the National Restaurant Association supports a method of restaurant health-inspection reporting that is standardized across the U.S.

"Whether it is a letter grade or some other method, it needs to be standardized so it can be truly meaningful, and inspectors need to be trained against those standards," she says. "And these standards should be based on the latest FDA Food Code."


Are restaurants really dirtier than private homes? Klein notes that over 40% of food-borne illness can be traced to restaurants, vs. 22% traced to private homes.

The problem isn't that dining out is dirty, Klein concedes. The same sloppiness that sickens one or two people in a private home at can sicken dozens or more people at a restaurant. And you can't take the same precautions at a restaurant that you can at home.

But Adolf notes that restaurants have a very good safety record.

"Every day, 133 million Americans eat away from home, yet there is a very low number of reported food illness outbreaks from restaurants," she says.

Dirty Dining Cities Ranked

Here's the CSPI's ranking of restaurants in 20 U.S. cities. It's not an entirely fair contest. Some cities were more reluctant to report than others were and did not provide routine reports on all 30 restaurants requested. Baltimore, for example, did well in the rankings but withheld the requested information on 16 of 30 restaurants.

The ranking here lists cities according to a weighted value assigning demerits for major and minor violations as reported by city health inspectors. The "best" cities may, in reality, simply have the most lenient inspectors; the "worst" cities may have the strictest inspectors.

The CSPI's city rankings, from "worst" to "best":

  • Austin, Texas: 58 violations in 30 restaurants
  • Boston: 63 violations in 30 restaurants
  • Milwaukee, 27 violations in 20 restaurants
  • Colorado Springs, Colo.: 46 violations in 30 restaurants
  • Kansas City, Mo.: 41 violations in 30 restaurants
  • Pittsburgh: 40 violations in 30 restaurants
  • Denver: 35 violations in 30 restaurants
  • Las Vegas: 30 violations in 25 restaurants
  • Washington, D.C.: 27 violations in 25 restaurants
  • New York: 32 violations in 30 restaurants
  • Atlanta: 19 violations in 20 restaurants
  • Portland: 25 violations in 27 restaurants
  • Baltimore: 14 violations in 14 restaurants
  • Minneapolis, Minn.: 31 violations in 29 restaurants
  • Chicago: 22 violations in 30 restaurants
  • St. Louis: 17 violations in 27 restaurants
  • Seattle: 16 violations in 30 restaurants
  • Philadelphia: 16 violations in 23 restaurants
  • San Francisco: 15 violations in 30 restaurants
  • Tucson, Ariz.: 14 violations in 29 restaurants
WebMD Health News Reviewed by Louise Chang, MD on August 07, 2008



Klein, S. and DeWaal, C.S. "Dirty Dining," Center for Science in the Public Interest, released Aug. 7, 2008.

Sarah Klein, JD, food safety staff attorney, Center for Science in the Public Interest, Washington, D.C.

Mary Adolf, president, solutions, products, and services group, National Restaurant Association, Chicago.

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