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restaurant’s entrance. 10 Restaurants fought this regulation, complaining they would lose business if they got less than an A. Because the county supervisors agreed that knowing whether a restaurant met hygienic standards was a critical right-to-know issue, the health department prevailed. Food establishments that score below C (70 percent) twice within a twelve-month period are now subject to closure until all the violations are corrected. A low grade remains posted until the inspector returns to confirm that conditions have improved.
    This rating system has changed both restaurant and consumer behavior. 11 Within one year of the program’s initiation, restaurants improved their preparation standards, and the number of those performing at an A level (above 90 percent) on the inspection scores increased from about 25 percent to more than 50 percent. Improved scores were generally maintained on subsequent inspections. Restaurants with low grades reported a loss in revenue and customer patronage. Sales at restaurants receiving an A grade rose 5.7 percent, or about $15,000 a year, whereas B-level restaurant sales increased 0.7 percent, and sales at C-level establishments decreased 1 percent. The system also focused efforts on restaurants with lower ratings, which were inspected more frequently than establishments with higher scores. The rate of closures decreased.
    In the year after the restaurant rating system was introduced, the number of patients admitted to hospitals in Los Angeles for food-related illnesses dropped by 13 percent. 12 When restaurant ratings are posted or published, consumers become aware of how well outlets meet standards and can avoid outlets with lower ratings. 13 Grades serve as a heuristic—or shortcut—that will help people automaticallymake a better choice, but they do not prevent anyone from eating what they want.
    If the inspection standards included assessing the quality of prepared foods, menus in restaurants, the design of food stores, and their use of promotional strategies, with the goal of limiting the risk of nutrition-related chronic diseases, it would help people choose healthier restaurants and eat a healthier diet. Food-borne infectious diseases are now relatively rare because hygienic standards are rigorous and compulsory. Just think of what similar regulations could do to reduce chronic diseases.
    Making Regulation of Restaurants and Supermarkets for Chronic Disease Prevention a Reality
    Politically, adding regulations is always difficult because it upsets the status quo. Historically, change is always accompanied by protest, even for such changes that we now consider as common sense, like requiring adherence to sanitary codes. Yet we need to demand that the government initiate a process to move a chronic-disease-prevention agenda forward. This includes building a consensus on feasible standards, developing product labels and marketing practices that allow people to make healthy decisions rapidly and that delay impulse purchases, allowing them only after thoughtful deliberation, creating certification and incentive programs, and instituting evaluation and monitoring protocols.
    It would be the government’s job to establish a set of minimum performance standards and facilitate compliance among stakeholders, including food industry and nutrition experts. To help disseminate the standards, the adoption of tried-and-true marketing techniques like branding would be useful. A symbol identifying adherence to the performance standards (e.g., like a LEED * standard for a green building) must become widely recognized and easily understood by consumers.In addition, local governments should certify restaurants whose practices conform to the performance standards; provide incentives (e.g., tax credits, fee rebates, marketing) to outlets that meet or exceed performance standards; and sponsor industry learning and dissemination of best practices.
    Labeling for away-from-home food could borrow