Philadelphia comes out in the top quarter of America's 40 biggest cities on a new health-related  scorecard released Wednesday. But the city could do even better if it required restaurants to post health inspection grades at the door – and if politicians in Harrisburg would let the city set its own rules on alcohol and tobacco sales.

The new CityHealth scorecard examines the potential impact of public policy. Most past  comparisons relied on measures of residents' health and behavior, both heavily influenced by poverty. They also judged Philadelphia – a rare municipality that is also a county – against other counties rather than its big-city peers.

It is big cities like New York and Los Angeles that are leading the way with consumer-friendly A-B-C-D letter grades for food safety posted outside restaurants. Many eateries don't like them but residents and tourists do.

Leaders of the new public policy scorecard, which was based on two years of research, said signs grading restaurants had been shown to have an effect, with consumer pressure forcing food establishments to pay more attention to safety.  Those that do are more profitable.

"Nearly half of the money we spend on food is in restaurants," according to the scorecard, CityHealth. "Policies that require food establishments to publicly post food safety inspection grades empower consumers, reduce foodborne illness and save on health care costs."

Even without a letter-grade policy, Philadelphia was given an overall silver rating, as were four other cities. Five got gold, nine bronze, and the remainder – more than half – did not medal.

The overall ratings were based on medals awarded for each of nine public policies, from clean indoor air (Philadelphia got silver) to "complete streets" (gold), a combination of  road safety, pedestrian and bike lanes, and public transit.

CityHealth is a project of the private de Beaumont Foundation, whose stated mission is to work with states and localities to improve public health.

If there was a theme to Philadelphia's score, it would be success in the face of limitation.

Two policies that helped other cities come out on top – setting the minimum age for tobacco purchases at 21 and controlling the number and locations of outlets that sell alcohol – are preempted by state law.  A third – paid sick leave, which took effect in 2015 – is the target of a bill recently introduced in  the state Senate. Yet a fourth, the brand-new expansion of prekindergarten, is funded by Mayor Kenney's soda tax, which is being challenged in court.

"I think the biggest preventable cause of death in the city is smoking," said public health commissioner Thomas Farley. His first priority, if the city had the power, would be to convince City Council to raise the legal age for tobacco purchases.

Farley enthusiastically oversaw New York City's 2010 rollout of food safety letter grades posted outside restaurants when he was health commissioner there. To be fair to restaurants, he said, inspectors must be available to revisit places that scored poorly on a particular visit.

"Right now we simply do not have the manpower," Farley said.

Marla Gold, a member of the national blue-ribbon panel that oversaw the scorecard, said she would like to see Philadelphia move toward grading but that the project recognized that political realities vary from place to place.

"CityHealth is all about local policy as a lever for good health for everyone who lives there," said Gold, a former dean of Drexel University's Dornsife School of Public Health.

In developing the scorecard, which she said appeared to be the first comprehensive attempt to compare big cities, the team paid attention to the increasingly strong evidence that "your zip code is more important to your health than your genetic code." One of the measured policies that Philadelphia lacks is zoning to require affordable housing.

Gold was clearly proud of Philadelphia. The most highly publicized annual comparison, announced every year by the Robert Wood Johnson Foundation, compares counties within states and emphasizes measures that are influenced by income.

"Year after year, we are number 67 in the county ratings," she said. "For us to get a silver medal in local health policy is like a silver medal at the Olympics the first time, when you were never able to compete in the past."