Inspection

Collaborating with Environmental Health for Data Gathering and Enforcement

This policy has been proven to be most successful when a collaborative structure is put into place, including participation from community members, local public health agencies and municipal representatives . Public health restaurant inspectors from the Environmental Health Department can support the efforts of communities promoting the policy as well as city staff in enforcing municipal policies. During planning stages of a policy campaign, gathering data about how many restaurants will be impacted is helpful to share with decision-makers and enables campaign staff to conduct outreach to impacted restaurants. Once a policy is passed, public health restaurant inspections provide information on compliance to the city staff tasked with enforcement.

Specifically, the Environmental Health Department is responsible for:

  • 1 Incorporating questions about drinks offered on kids’ meals into the existing inspection system.
  • 2 Reviewing kids’ menu beverage offerings as part of its pre-established restaurant inspection schedule.
  • 3 Including information on the policy and its compliance requirements in the paperwork required for new restaurants to complete.
  • 4 Communicating non-compliance to the agreed-upon partner. This may be city staff or the Community Health staff.
  • 5 Providing restaurants not in compliance with a notice of fines and assessing a monetary administrative citation as outlined in the policy. Best practice is for the first violation first violation to be addressed with technical assistance and subsequent violations result in fines.

Utilizing Public Health Restaurant Health Inspectors

Step by step process:

  • 1 Identify which Environmental Health staff need to be in the conversation to add questions on healthy drinks in kids’ meals to the restaurant inspection process.
  • 2 Meet with the Environmental Health staff to provide an overview of the policy and identify any questions and concerns.
  • 3 Add kids’ menu questions to the restaurant inspection reporting system.
  • 4 Train public health restaurant inspectors on how to gather information.
  • 5 Collect data and identify which restaurants would be impacted.

1. Identify internal public health stakeholders for the conversation

Typically, a Healthy Drinks in Kids’ Meals Policy is initiated by Healthy Eating Active Living (HEAL), Health Promotion, or Community Health staff at a local public health agency. These staff should identify which members of their agency’s Environmental Health division are the decision-makers regarding the restaurant inspection process and database updating. It is important to understand the chain of command within the department and to speak with higher level administration, such as the director of the program, about the policy strategy. Ensuring that your information reaches the appropriate leaders is key to gaining buy-in and in turn, garnering support from the rest of the team. Environmental Health divisions who oversee public health restaurant inspections typically have a lot of responsibilities and therefore it is recommended to approach with patience and kindness to make the incorporation of new work as successful as possible.

A person holding a water bottle in their hand.
Two people shaking hands over a table.

2. Meet with Environmental Health division leadership to provide an overview of the policy and identify any questions, and concerns

Host a meeting with the identified Environmental Health division leadership to provide an overview on the “why” of the policy Be sure to include local data demonstrating the impacts of targeting marketing and associated health outcomes, how a Healthy Drinks in Kids’ Meals Policy can promote children’s health, and how and why to involve Consumer Protection in the process. It is helpful to provide a data-driven presentation to clearly illustrate the need and process. When presenting to the staff, emphasize the importance of their role as public health inspectors- as policy decisions will be made using the data that they collect. To get buy-in from the staff, ensure that the presentation illustrates the impact of the data collection. Utilize the FAQ below to prepare for common questions or concerns environmental health inspections staff may have about adding a question to the process.

Inspection process FAQ:

Why are you collecting this information? What is our role in implementing this policy?

  • We want to determine how many restaurants are offering bundled kids’ meals in the county and how we can support them to have access to healthy options.

What are other counties doing?

  •  In Colorado, these same questions are being used in Adams, Arapahoe, Boulder, Denver, Garfield, Jefferson and Pueblo Counties.

How long will we need to ask this question?

  • We would like to continue to collect data on kids’ meals in the county for as long as possible to ensure that restaurants are offering healthy drinks in their kids’ meals.
  • It is important to consider that not every restaurant will be inspected every year. Consider what strategy to employ even after policy is passed (e.g If the business has been checked in the last year, they may be able to waive the question if their menu has not changed and if it is an option in the inspection system).
    • “Within your data collection system if there is the option to only have this question arise once a year...”

Re: pushback on the amount of work added

  • Menu reviews are part of standard restaurant inspection procedure and so we are hoping that this question can be a simple and seamless addition to the inspection.

What are the mechanics of collecting this data in our system?

  • Each agency has their own inspection system and so this will be answered during training for the inspectors.

3. Add Kids’ Menu Questions To The Restaurant Inspection Reporting System

In Colorado, these same questions are being used in Adams, Arapahoe, Boulder, Denver, Garfield, Jefferson and Pueblo Counties. Using the same questions will ensure data collected can be assessed to understand the impact of the policy and compare across the state.

Sample Questions in Reporting System

A close up of the menu on a table
A pitcher and two glasses of milk on a table.

4. Train inspectors on how to gather information

In order to support public health inspectors training on how to gather this information, be sure to include a guide that clarifies the language used for the Healthy Drinks in Kids’ Meals policy strategy. Refer to the FAQ below to prepare for common questions on the language of the policy strategy.

FAQ re: Language of the inspection questions
  • The “kids’ menu” can be on the main paper menu, on a menu board, or on a separate paper (like a coloring sheet). For any of these mark: “Yes.”
  • “Kids’ meal” means a combination of food items and a beverage, sold together at a single price, intended for consumption by children.

Please note: Some public health inspections systems do not have branching logic that allows their inspectors to move on with the inspection if the restaurant does not have a bundled kids’ meal. If there is no branching logic and the restaurant does not have a kids’ meal, inspectors should put “N/A” for the rest of the questions.

Place a check by all sugary drink choices listed on the menu.

  • 100% Juice = only 100% juice
  • Flavored Milk = any milk that lists a flavor with it (i.e. chocolate, strawberry, vanilla)
  • Juice Drink = any juice drink, fruit punch, etc. that is not 100% juice
  • Lemonade = any flavor of lemonade
  • Soda = any soda product

If the menu only says “juice” and there is not time to ask or look at the product, mark the juice drink checkbox.

Ensure inspectors know that if there is not a drink included in the kids’ meal, it is not necessary to check off sugary drinks that are offered at that restaurant.

  • We want to determine how many restaurants are offering kids’ meals in the county and how we could potentially support them to have healthy options .
  • The data will not be publicly identified to your restaurant. It may be shared in aggregate form, such as [X] number of restaurants in [city] have kids’ meals.
  • This is low effort and sends the positive message that your restaurant supports youth health. Many chains have already made similar changes, including McDonald’s, Wendy’s, Dairy Queen, Burger King, IHOP/Applebee’s, Jack in the Box, so it helps your restaurant be seen as a leader.
  • Healthy drinks on children’s menus are cost neutral to consumers and food services alike, since your kids’ meal already includes a drink in the one price. If concerned about re-printing menus community health may have grant funds to help.
  • This supports caregivers by giving them easy access to healthy options. People stick to default healthy drinks 66% of the time. Any drink can still be ordered.
  • Children who drink at least one sugary drink a day are at increased risk of heart disease, type 2 diabetes, tooth decay/cavities, and more.
  • We also know that a preschooler’s drink of choice remains their same one in adulthood, so if they start off usually having a healthy drink they will keep up the good health habit.
  • “Above all things, we want our customers to be healthy. And if a parent chooses to give a child a sugary drink, we want that to be a conscious decision and not just something to be unnecessarily offered by our restaurant. In the end, a healthy customer is a good customer.” Chris Womack, Miller’s Bar and Grille, Lafayette, CO.

5. Collect Data!

Each Environmental Health department will use a specific reporting system for their public health restaurant inspections and many of these reporting systems vary by jurisdiction. This is the system in which you will want to add the specific questions regarding kids’ meals in restaurants so that the public health inspectors collect the necessary data during their restaurant inspection.

Updating the reporting system will require time to 1. identify the person or team that has the ability to modify the reporting system 2. ensure the proper branching logic is applied to the questions 3. test out the updated investigations report and 4. have the community health staff or policy team train the inspection teams on how to use branching logic for effective data collection. Building out this timeline in coordination with your policy will be critical as some departments can take upwards of six months to have the report updated and functional.

It is recommended to add the kids’ meals questions with branching logic to capture data effectively. Branching logic creates a custom path in a survey, based on user response, displaying only relevant questions based on specific answers. For example, if a restaurant does not have healthy kids’ meals, the inspector would answer “no” to that question and no further questions would appear regarding kids’ meals. If a restaurant does have a kids’ meal menu, the next question that appears should be if the kids’ meal is bundled, followed by a question regarding beverage choices if the answer is “yes.”

Data Analysis and Sharing with Decision Makers

Each Environmental Health Department will have a different approach in their role of collecting and analyzing data. It is recommended that you set up a system to be able to receive the data on kids’ meals on a regular basis. Once you have the data you will be able to demonstrate which restaurants would be impacted by a Healthy Drinks in Kids’ Meal policy. This will support conversations with different stakeholders and will help make the case for the policy with decision makers. Below is an example of how data can be displayed in presentations and fact sheets.

Sample Data

Conclusion

The guide provides an overview of collaborating with public health restaurant inspections to support a Healthy Drinks in Kids’ Meal policy. It is meant to support communities and agencies to set up a system to collect baseline data on restaurants prior to a municipal policy being adopted. Successfully setting up a process for collecting drinks in kids’ meal data through local public health’s restaurant inspections sets up the pathway for enforcement of a Healthy Drinks in Kids’ Meal policy. This guide does not share all of the steps for setting up a campaign or the policy pathway.

Two young girls in baseball uniforms and hats.