After a few drinks health score doesn’t matter

By Audrey Milam and Esther Shim

 

Jerrod leaves Magnolia’s at 2:20 a.m. Thursday night, ready to sober up on a heaping pile of hot food at a 24-hour restaurant. Few full service restaurants are still open downtown, but Jerrod has his sights set on Waffle House. The Washington Street Waffle House received an 87 on its last health inspection, not terrible but not great. “I don’t care,” Jerrod says, “Waffle House is AMAZING.”

“The Grill is disgusting. Steak ‘n Shake is way too far to drive on a couple [of drinks]. That’s just my prerogative,” Jerrod said, explaining his rationale.

After a night of fun and drinks, Jerrod said that he isn’t looking to drive anywhere, especially when Waffle House is only a short walk away. Plus, he enjoys the All-Star Breakfast deal that the joint serves.

Jerrod’s loyalty to his first choice restaurant is typical of downtown visitors. When it comes to picking a dive, cleanliness isn’t a factor. People just don’t care.

In a survey of 50 late-night drinkers, only two people changed their minds about their chosen eatery after learning the health score. Both decided not to go to Waffle House.

Most of the survey subjects commented on the quality and taste of the meals served or the quality of the service provided. Cleanliness didn’t play a large role in altering a subject’s choice of venue.

Multiple people declared that Waffle House had the best breakfast, the most convenient location, and the most food for a few bucks. In terms of pricing, some, such as UGA student Lewis Payne, disagreed.

“I prefer Steak ‘n Shake. Waffle House in Athens is disappointing. They all have bad service and cold food. I’ve never had a good experience at any of the three around campus.”

There are in fact nine Waffle Houses around Athens.

Steak ‘n Shake, a chain restaurant specializing in Steakburgers and milkshakes, was noted the second-most popular restaurant during the survey. The venue boasts half-priced shakes during happy hours from midnight to four in the morning, a prime time for drunken crowds to rush into the diner.

However, half-priced shakes and hot Steakburgers don’t mean that the restaurant is performing at high standards. The Steak ‘n Shake on West Broad Street actually failed a health inspection.

Unexpectedly, no one decided against Steak ‘n Shake, even after learning that it received a score of 71. The Clarke County Department of Public Health cited the restaurant for two critical violations: failure to properly wash hands, and failure to cool food properly.

Employees were seen handling clean dishes right after washing dirty dishes, something you might easily do in your home and never give a second thought. But it’s cross-contamination in the dish room enough to alarm health inspectors.

A representative for the West Broad Street Steak ‘n Shake declined to comment on the branch’s performance.

Steak ‘n Shake’s failure didn’t seem to sway its fans, though.

“I can’t believe Steak ‘n Shake is so dirty. I guess I’d still go, though. I love their fries,” said UGA student Sarah Greene.

The restaurant offers several flavored seasonings for customers to add to their fries. Greene said she constantly craves this dish and often orders “a ton of fries and a shake after a night out with the girls.”

After learning about some of Steak ‘n Shake’s health code violations, Greene shrugged and said, “they must be busy or something.”

Ricoh Black, another UGA student, agreed, “I’d still go to Steak ‘n Shake to get my Steakburger, parmesan fries and my mint Oreo shake. Can’t pass up such a good deal. Why would anyone want to pay 10 bucks for a burger when they can pay four bucks for one?” he said, referring to the higher prices at The Grill.

The long-time Athens diner, The Grill scored the best out of the round-the-clock downtown eateries. It’s score of 93 is exceptional, but not enough to change its perception as a grungy hole-in-the-wall.

“I was never a big fan of The Grill. It’s grody,” said UGA student Matt Thomas. He said the cleanliness was funny because “it’s always gross” when he goes. “I haven’t heard any good things, like ever.”

According Yelp, The Grill scored three and half stars out of five, and four stars on Urbanspoon.

Mike Bradshaw, owner of The Grill since 2009, laughed at the survey’s findings. “I worked my butt off for that [health inspection] score!” he said.

When it comes to dining after a night out and a few drinks, does the health score truly make a difference? In this college town, it’s not about the cleanliness of a diner, but about convenience, large servings, and money left in pockets.

 

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Athens sits in a paradox of poverty and health

Athens residents, among the poorest in Georgia, are healthier than anyone would expect.

The poverty is well known. Clarke County has the seventh highest poverty rate in the state out of 159 counties. Nationally, Athens contains the fifth highest poverty rate among counties with populations higher than 100,000 people, according to recent census data.

And, experts say, that with this level of poverty comes poor health. This is the outcome for most counties in Georgia. Nearly 80 percent of Georgia’s counties with high poverty rates contain health statistics that match up just as poor.

But, a new study shows just the contrary for Athens. Clarke County ranks 14th for the best health rates in the state. They sit just above Henry County who oppose Clarke with the eighth lowest poverty rates.

An assembly of experts offered a range of explanations as to why these statistics contest one another. They include: a UGA Public Health professor, the state’s most well-known demographer, a volunteer physician, and an office manager at a health clinic for the underprivileged.

Three primary explanations from experts:

  • Athens is a young town with a small percentage of the population 65 years or older, which lowers the mortality and morbidity rate.
  • Athens has a large number of highly educated people who make smart health decisions.
  • Athens is a social and economic hub with two regional health centers that attract commuters. There are also free health clinics that help the uninsured.

Athens is a young town.

Multiple news sources, from CNN to Kiplinger, have ranked Athens, Ga. as one of the top places in the country to retire, yet only 8 percent of the population is 65 years and above. That is lower than the rest of Georgia where an average of 11 percent are in their retirement years. In Clarke County, 74 percent of the residents are between the ages of 19 and 64 years old.

“If you have a population that is on the younger end of things,” said Dr. Monica Gaughan, UGA assistant professor in the College of Public Health, “than you are going to have lower mortality rates because older people are the ones who tend to be sicker.”

The University of Georgia plays a slight role in this statistic; however, only a small percentage of students declare Clarke County as their permanent residence so they do not effect the census results.

Almost two-thirds of UGA students come from about ten counties in the metro-Atlanta area, said Dr. Doug Bachtel, UGA professor of demographics. A significant number of these students drive back and forth from school each day or live in university dormitories.

The facts are simple. Younger people tend to be healthier people. Athens has a significant number of young to middle aged citizens who push the mortality and morbidity rate down; therefore, the overall health rate of the county is elevated.

Athens entices the highly educated. 

“Better educated populations are going to live longer and they are going to be healthier while they are living,” Gaughan said. “One of the weird things about Athens-Clarke County is that we have extremely low income levels and extremely high education levels.”

The high school graduation rates of Clarke County are at 66 percent, which is only one point lower than the rest of Georgia; however, there is an overwhelming number of of the population with a bachelors degree or higher. The University of Georgia, located in the center of Athens, obviously plays a part in this statistic. A large portion of the population consists of highly educated professors and professionals, all who contain premiere health insurance and can afford to live healthy lifestyles.

Athens has a bimodal distribution of education and poverty levels, meaning there are large populations of people resting on two extremes of the spectrum. Forty percent of the Clarke citizens have a bachelors degree or above, which is twice the percentage of rest of the state.

“If you aren’t poor in Athens you are actually very well-off,” Gaughan said. “These are the people who are going to have access to good health care. They have money to buy healthy food. Yes, poor people are going to be unhealthy people and they are going to be more likely to die, but if half of the population is extremely wealthy, which is what happens in Clarke County, than they can pull that statistic up.”

Those classified within the 34 percent who live under the poverty line are not all uneducated. Gaughan stressed the necessity to remember the people who contain a college degree, but are voluntarily poor.

“Think about all of the musicians, and the artists and the hanger-oners that are part of Athens,” Gaughan described. “You have the education which will reduce your mortality and reduce your morbidity, but it doesn’t necessarily mean that education is translating into higher income.”

Athens is a medical hub.

Athens is a lively town with shops and shows that people from all parts of the state travel to be a part of. They also commute in for medical care because of the two regional hospitals: Athens Regional Hospital and St. Mary’s Hospital.

“It’s all about the location,” Bachtel said. “There is a large number of state and federal agencies that are headquartered here. You’ve got a large number of people with Blue Cross and Blue Shield health insurance. Plus Clarke County and Athens tends to be a social, retail, service and educational hub in northeast Georgia. That’s why a lot of things cook here.”

About 20 percent of Athens’ residents contain Medicaid. Another 23 percent contain jobs but are still uninsured because they are ineligible for Medicaid and make too little to afford insurance. Most of the private physicians in town refuse to see either type of person, choosing to only care for those on the upper half of the bimodal distribution.

Those struggling in the lower half are not left completely uncared for. A multitude of free clinics are offered through Athens Health Network, an organization committed to filling in the holes of medical care within the health system of Athens. The program started from an umbrella organization through UGA called OneAthens, and then broke off in 2010 to be more focused on underprivileged healthcare.

“Its confusing because most populations have a much more normal distribution than our population,” Gaughan said. “Athens-Clarke County is comprised of extremely affluent, white retirees and professors and professionals, and extremely poor African American people who clean our toilets, and that is the ugly little secret of Athens. These clinics constitute the health safety net in town so poor people, who don’t have insurance, can use these practices to get access to the system.”

The two most popular clinics are Mercy Health Center and Athens Nurses Clinic. Both care for those who are completely uninsured, with no way of paying for health services.

One their main goals, said Dr. Paul Buczynsky of Mercy in a World Magazine article, is to get their patients involved in their own health by educating them on their illnesses. When a patient is treated for diabetes, one of the most perpetual chronic diseases seen at the clinics, he or she is required to take a six-week course that teaches the patient about the illness in order to get a prescription refill. The volunteer physicians highly enforce lifestyle changes over quick treatment so that more patients can be seen over time.

Not a perfect system.

Despite the glowing census numbers, not all experts agree on the accomplishments of Athens’ healthcare system.

Dr. Bachtel feels confident in the success of the services provided by the faith community and free clinics; however, Dr. Gaughan and those at Athens Health Network know the harsh reality.

“We do not have enough resources for the poor,” Gaughan stated. “I think it is a convenient little fiction that we tell each other when we say, ‘There’s so much charity care. Athens is just too busy to hate.’ That’s crap.”

Demand for free healthcare in Athens is rising, according to an AthensPatch article. The clinics are first-come, first-serve, and only have the resources to see a limited number of patients per day, said Mary Baxter, office manager of Mercy.

When the clinics are closed, 75 percent of the patients go to the Athens Regional ER, even though most of their health issues are not emergencies. This increases their wait time and many leave without being treated.

“The poor have pretty hard lives and don’t have a lot of access to care,” Gaughan said. “They go to the emergency rooms which is not necessarily the highest quality of care. If you have diabetes and you are having a diabetic episode than you don’t need to be in the emergency room, you need to be with a physician that has been managing your care. Very few physicians take people who don’t have health insurance, or even take people with medicaid.”

Athens-Clarke County is one of the few places in Georgia who has defied the standard of poor people with poor health rates. However, as seen nationally and locally, there is always room for improvement in the public healthcare system.

Statistics taken from: CountyRankings.orgCensus.gov, GeorgiaStats.uga.edu


Restaurant Health Inspections Anything but Consistent

By: Colson Barnes and Whitney M. Wyszynski

“It could be as simple as an open soda can in the kitchen,” said Kyu Lee, manager of Wingster.

He shook his head and shrugged, thinking about the health inspection score of 70 percent Wingster received on Nov. 13, 2012.

A window behind the cash register showed the cook busy preparing a variety of sauces.  The phone buzzed with delivery orders.  Anxious customers ordering delivery are unable to see the health score mounted next to the door.

“Simple things will deduct points from the score,” Lee said, looking at the kitchen. “We all have different responsibilities to clean this place.”

Restaurants like Wingsters are inspected one to two times per year by the Clarke County Health Department.  An analysis of restaurant scores in Athens revealed:

■      The Northeast Georgia Health District does not update the restaurant inspection website regularly.

■      There is no consistent system for documenting the scores online, and past scores are not archived online for public access.

■      The time of day, inspector, and time of year can affect a restaurant’s health score.

Nationwide Trends

According to the New York Times, many restaurant operators complain that numerical scores “can be confusing or deceptive.”  Customers often do not know the specific policies that detracted from the optimal score.

The Times-Picayune determined that Louisiana’s restaurant inspectors were more lenient than national counterparts.  The paper determined that “the difference seems to be in how each municipality enforces its safety regulations.”

“But restaurateurs complain, reasonably, that it’s a racket for the city to squeeze more money out of them,” Forbes writer, Josh Barro said. “A restaurant that gets a bad grade is inclined to pay for a re-inspection so it can display an A, but it still has to pay penalties based on the negative results of the first inspection.”

The Georgia Department of Community Health, through the county health departments, sends an inspector to inspect facilities where food is consumed on or off the premises.

Six inspectors monitor restaurants in Athens, and they do not notify the restaurants before the inspection occurs.  The names of the inspectors are not provided to the public.

Restaurants are given a numerical score from 0-100 based on the cleanliness of the facility. A score less than 70 is considered a failing grade; however, the restaurant will receive a follow-up inspection within 10 days.

Restaurant inspection scores are listed on the Clarke County Health Department website, with the date and brief explanations of violations.

After interviewing representatives at restaurants with the five lowest health ratings, many agreed that the regulations have become more difficult.  Wingster, Johnny’s New York Style Pizza, Plantation Buffet, Jimmy John’s, and Waffle House scored the lowest, as of Mar. 7, 2013.

[Would your kitchen pass a health department inspection?]

Some of the most popular restaurants fall short of a passing grade due to wrong food temperature control, improperly marked foods and poor employee health.

Food inspections are divided into two categories—critical and non-critical.  Deductions that have risk factors outlined by The Centers for Disease Control (CDC) are considered critical. The non-critical categories include factors that are designated by the Federal Food and Drug Administration.

[What are the most common violations?]

Success Stories

Howard Anderson, manager of the Jimmy John’s on Baxter Street, has worked with Jimmy John’s since 2006.

“We are very systematic here. We have a punch list that comes from Jimmy John’s corporate, but it doesn’t take into account the Georgia health regulations,” Anderson said.

Jimmy John’s scored 75 percent on its Mar. 7, 2013 inspection.  Anderson headed for the Health Department a mere day after the original inspection.

“I went to talk to the health inspector about what we can do to improve our score,” he said. “I retrained everyone on hand washing and the basic lessons about diseases.”

Anderson believes it was a lack of training that was the problem, but he also noted that this inspection was different than past inspections.

“It was more difficult this past time,” Anderson said.  He noted that some other restaurants may not be following some of the lesser known policies.

“She [the inspector] was specific about things like needing to spray the floor before we sweep it,” Anderson said.

Jimmy John’s on Baxter St. worked to improve. The restaurant’s score skyrocketed to a 100 percent on the follow-up inspection.

Herschel’s Famous 34, a new restaurant on Broad Street, received a 100 percent on its first inspection.

“I think it definitely makes a difference [to have a good health score],” said Lee Purser, Herschel’s Famous 34 manager.

Health inspection scores are a glimpse of the restaurant’s performance, but most establishments want a perfect score, according to Andrea Kerr, the environmental health manager at the Clarke Country Health Department.

“It is unrealistic to expect that a complex, full-service food operation can routinely avoid any violations,” the health department website highlighted. “An inspection conducted on any given day may not be representative of the overall, long-term cleanliness of an establishment.”

Ms. Kerr said the food service inspection scores are uploaded to the Northeast Health District website nightly.  However, Jimmy John’s follow-up inspection score from Mar. 13, 2013 was not updated until Mar. 26, 2013, per this blog’s request.

There is no consistent system for denoting follow-up scores.  Some restaurants, like Wingster, display the most recent score, whereas other restaurants, such as Wok Star, display both the original and follow-up score.

Psychology in Decision-Making

Many psychological studies have determined the effects of extraneous factors on decision-making.  Factors, such as the time of day, day of the week, and weather conditions, can affect a person’s decisions.

“Even patently false or irrelevant information often affects choices in significant ways,” according to the New York Times.

A recent study at the California Institute of Technology determined that people’s value judgments affect decision-making.  Value-based decisions occur in the prefrontal cortex, which affects personality expression and social behavior.

The prefrontal cortex is known for the executive function.  This function differentiates between conflicting thoughts—better and best, good and bad, and correct and incorrect.

Inspector discretion plays a key role in restaurant health scores.  Local restaurants complain that certain inspectors are tougher than others.

Possible Solution

The names of inspectors are not released publically, and past scores are not archived on the Northeast Georgia Health District website.  Assigning ID numbers to inspectors could be a possible solution.

ID numbers could be disclosed on the website, and if citizens spotted suspicious score fluctuations, they could report findings to the health department.  This would protect the inspector’s identity while monitoring the consistency of the scores.

Inspector discretion affects the public’s view of a restaurant, and this system could make the process more transparent.