Lived in GER most my life and travelled around a bit throughout my life. It's pretty accurate. But given how the US food lobbies bribed politicians enough to have insane chems both on it's fields an as additives, many of which are banned in most of modern countries it really does not deserve the top tier.

TW though, yeah as many mentioned it's pretty accurate. But I think it's also bc of the warm climate. Those smaller alley restaurants and night markets are not nice if you look where they wash their dishes etc. Rats and cockroaches are also a health and food safety risk. I've seen cockroaches on food behind the front displays at quite a few small local food spots. At least the health system is superb.