Health beyond the headlines
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What Public Health Legacy Does Bloomberg Leave Behind?

Views about the outgoing mayor’s legacy and what the next one should do

Michael Bloomberg has been called everything from a visionary to an autocrat for the sweeping health agenda he carried out as mayor of New York.
From bans to bikes to burger calorie counts, Bloomberg has left an indelible mark on the city, changing New Yorkers’ attitudes and behaviors, and in some cases, their health profiles. His policies often struck up a national dialogue around hot button issues like cracking down on soda serving sizes and going after the gun lobby on gun control.
The 2×2 project asked many different New Yorkers and friends of New York what legacy they think Bloomberg will leave on issues that are important to public health, not only on his signature initiatives related to food, exercise, and reducing smoking but on income inequality, race and policing, climate change and preventive medicine, and what the next mayor should do on these issues. Here is what they said:

Broad Legacy

I think the central legacy of the Bloomberg administration will be the elevation of public health considerations as a core priority of municipal government and the recognition that improving the health of populations needs to involve the engagement of traditional non-health sectors in a concerted, coordinated manner.

Dr. Sandro Galea, Gelman Professor of Epidemiology and chair at Columbia University’s Mailman School of Public Health Department of Epidemiology, chair of the New York City Department of Health and Mental Hygiene’s Community Services Board and member of the department’s Board of Health

It is hard to imagine a mayor who has been more aggressive, innovative or placed more importance on public health. I believe he will be remembered for giving public health the place it deserves in a modern administration.

Dr. Brian Elbel, assistant professor of population health and health policy at NYU School of Medicine and the Wagner Graduate School of Public Service

One of the most important contributions to public health made by Mike Bloomberg and his administration is the profound assertion that the public’s health is, in fact, a relevant priority for local government—that it is not just the purview of the federal government to create health policies from on high. People may not agree with every public health policy promulgated by Mike Bloomberg—I certainly did not—but I greatly admire the idea of the city focusing on issues that are so germane to the public’s well-being.

Dr. Irwin Redlener, director, National Center for Disaster Preparedness at Columbia University’s Earth Institute

The soda and tobacco companies probably hate him for this, but Mike has always been willing to stand up to special interests to protect the health of New Yorkers. Mayor Bloomberg has set a new standard for what it means to be a “public health” mayor and his leadership will be missed.

Thomas Menino, Mayor of Boston

Michael Bloomberg has good reason to take pride in the leadership role he took in his public policy stances on tobacco and fast food consumption, as well as his advocacy of bicycle lanes. These measures stand to improve the health of all New Yorkers, regardless (more or less) of socioeconomic status. The next mayor of NYC will be confronted with a different set of public health needs from those which confronted Michael Bloomberg over a decade ago. Among those will be housing and energy insecurity. Naturally, job creation must be added as well. Also, given (optimistically) the probable decline of mass incarceration and the national War on Drugs, a future challenge will be coordination with state and national government to provide re-entry and drug abuse services for those who otherwise, under the current system, would simply be remanded to criminal justice.

Dr. Samuel Kelton Roberts, associate professor of history and sociomedical sciences at Columbia University’s Mailman School of Public Health

He created a meritocracy in health policy—I’ve served on several mayoral committees for American College of Obstetrics/Gynecology, and the sense was that he hired people based on their talents. He had good people attempting to do good things. Tom Frieden is a good guy, and they are willing to take on obesity, smoking, and bike lanes. He was willing to fight the fight.

Dr. Howard Minkoff, chairman of the department of obstetrics and gynecology at Maimonides Medical Center and distinguished professor of obstetrics and gynecology at State University of New York Health Science Center in Brooklyn, New York

I think that while it always seems more heroic to create new programs, editing back is also useful to ensure that policies are efficient and coherent.

For example, there have been multiple efforts underway to support healthy food access throughout NYC, including green carts and the FRESH initiative. Yet in some cases, the supermarkets incentivized through the FRESH initiative may compete with green carts, such that the joint effect of these separate efforts is less than would be anticipated based on examining one or the other. Further, when editing back programs in the current financial environment, I think it will make sense to prioritize health promotion efforts that are cost-neutral or revenue generating, as well as those that have potential to reduce rather than exacerbate health disparities.

Dr. Gina Lovasiassistant professor of epidemiology at Columbia University’s Mailman School of Public Health, investigator with Columbia’s Built Environment and Health Research Group and the Columbia Population Research Center

[Michael Bloomberg's public health legacy as mayor was]

Process: Increased public responsibility for personal habits

Outcomes:  reduced mortality rate, reduction in weight, and stabilization of diabetes rates

Dr. Jack A. DeHovitz, distinguished service professor in the department of medicine and director of the HIV Center for Women and Children at SUNY Downstate Medical Center

I think that Michael Bloomberg used his position as mayor as an opportunity to create lasting structural changes to promote the health of New Yorkers. Stemming from his willingness to proactively address public health issues beyond what is usually within the city government’s responsibility, I see him as an innovator in public health policy and a quintessential role model for other mayors.

Madelaine V., master’s student at Columbia University’s Mailman School of Public Health

In a world that is becoming increasingly cautious about the overall health of populations, Mayor Bloomberg significantly contributed to improve the lives of New York City residents. He focused on important issues, some of which were controversial, and should be remembered for re-imagining public health in New York City.

Tanush S., environmental health sciences master’s student at the Mailman School of Public Health

Though challenging, additional effort should be placed on dissolving the image of administration versus community.

Tameir H., master’s student at Columbia University’s Mailman School of Public Health

Many of Bloomberg’s policies ignited controversy in the city, but I think he was influential in establishing New York as a city ready to challenge the public health injustices of our society.

Andrea S., teacher

Disaster Preparedness and Climate Change

A major part of Mayor Bloomberg’s public health legacy will be the contributions to climate-related public health understanding in the city. The New York City Panel on Climate Change (NPCC), a group of experts convened by the mayor to provide and explain climate risk information, was initiated and codified in Local Law 42 by the Bloomberg administration. The work done by the NPCC provides decision-makers with the science needed to prepare for the health effects of climate change, as well as other climate impacts.

The continuation of the NPCC and its human health working group will ensure that cutting-edge science is applied in collaboration with decision-makers. Increasing future climate risks on health, including augmented heat stress and potential injuries related to coastal flooding, are important for all future administrations to consider.

Dr. Cynthia Rosenzweig, co-chair of the New York City Panel on Climate Change; senior research scientist at NASA’s Goddard Institute for Space Studies, Professor at Barnard College and a senior research scientist at the Earth Institute

Evidence-Based Public Health

As the health department’s deputy commissioner of epidemiology, I believe that Michael Bloomberg’s public health legacy as mayor is using rigorous and objective data collection for public health decision-making. Under his tenure, the health department launched several major surveys (e.g. Community Health Survey,2004 NYC Health and Nutrition Examination Survey (HANES) and 2013 NYC HANES) that have informed the city’s innovative public health policies and programs for more than a decade. The health department already has developed Take Care New York, a strategic public health agenda which establishes goals to help all New Yorkers live healthier and longer lives. Continuing to value the collection and analysis of high quality survey data will be critical to monitor the city’s progress towards achieving these goals.

Dr. Carolyn Greene, deputy commissioner in the New York City Department of Health and Mental Hygiene’s division of epidemiology

Exercise and Green Space

Mayor Bloomberg’s public health legacy has been an innovative commitment to changing the environments in which New Yorkers make everyday decisions that affect their health. To accomplish this, his administration has gotten a variety of city agencies to collaborate in building a healthier city. Whether it’s building bike lanes and Play Streets to make it safer for New Yorkers to regularly engage in physical activity, bringing free fitness programming to parks or offering business incentives for grocery stores to locate in food deserts, the Bloomberg legacy has been all about making healthy choices more accessible and affordable for all New Yorkers.

Jennifer So Godzeno, planning director, Transportation Alternatives

Perhaps the new mayoral administration can propose a tax rebate for people who exercise?

Jeremy Merrin, president of Havana Central Restaurant & Bar, board member of the New York State Restaurant Association
Mandela Day

Photo credit: Mandela Day

Food and Obesity

His support for creative initiatives like Healthy Bodegas, Green Carts, Green Markets, and Health Bucks has increased access to healthier foods for populations living in underserved areas.

Dr. Bruce Armstrong, associate professor of population and family health at Columbia University Medical Center and founder and director of the Young Men’s Clinic at New York Presbyterian Hospital

I think that calorie labeling did not cause the anticipated behavior change, perhaps because there was an invalid assumption that calorie minimization was a goal for all. If some subgroups had a goal more focused instead on value (calories/dollar), it would be interesting to revisit our assumptions and our definition of success. Perhaps an initiative that gives people information to reach their varied goals is a success, even if not an obesity-prevention success.

Dr. Gina Lovasi

End child hunger in all communities of the city.

Dr. Irwin Redlener

In the next administration, we need to keep hammering away at primary prevention—reducing caloric intake and smoking rates while increasing physical activity. It should also be a priority to carefully evaluate and quantify the effectiveness of policy initiatives in the past 10 years.

Dr. Ryan Demmer, assistant professor of epidemiology at Columbia University’s Mailman School of Public Health

Mandating calorie counts, while sometimes unpleasant to display, assists in deterring obesity by making the public aware of what they are consuming…. Ultimately, while I support the Bloomberg’s initiatives, the one point of contention is that we need to be careful not to impose these initiatives with severe penalties such that New Yorker’s feel like they live in a “nanny” state. Obesity will continue to be a major issue and should be addressed with public service announcements similar to the anti-smoking campaigns. We need to begin doing away with non-biodegradable packaging, and we need to serve healthier meals in our schools.

Jeremy Merrin

Bloomberg’s Green Cart Initiative brought fresh produce to hundreds of thousands who reside in areas designated officially or commonly as food deserts, a measure which improves the options for those of us who lack geographic or economic access to healthy foods.

Dr. Samuel Kelton Roberts

The health problems resulting from obesity and lack of exercise may soon rival the devastation caused by tobacco use. The new mayor must pick up where the Bloomberg Administration left off and boost the physical activity levels of the city’s school kids as well as develop new ways to curtail the impact of junk foods on the health of New Yorkers.

Blair Horner, legislative director at New York Public Interest Research Group

I think that addressing obesity, particularly in children, should be the biggest public health priority of the new mayoral administration. While the soda ban set an important precedent, I believe that public health policy can potentially have a much greater impact on ensuring that healthier food options are available for all New Yorkers.

Madelaine V., master’s student, Columbia University’s Mailman School of Public Health

I think Bloomberg’s tenure as mayor will be noted by many as highly successful in improving public health through large-scale measures like reducing salt and trans fats in foods, targeting mass consumption, and promoting a platform to make the city a healthier place to live through focusing on what people can consume in certain places. A programmatic shift to chronic and often preventable illnesses (including obesity, cancer, and heart disease) should also occur, with food deserts, fresh fruits and vegetables, and exercise becoming the key highlights of any new campaigns.

Christin G., master’s  student, Columbia University’s Mailman School of Public Health

The new mayor should focus on fixing the holes in the food inspection system. It is important that this system works for us and not against us because in the end we all (food service operators and the food inspection agency) want the same thing and have the same goal in mind.

Edgar B., coffee cart owner

Guns

For years I have worked beside Mayor Bloomberg, pushing for common-sense gun reforms and demanding our lawmakers in Washington take action to make our communities safer. Mike has dedicated his personal time and resources to make sure that victims and their families have a place in the debate against the [National Rifle Association] and their powerful lobby.

Thomas Menino

Healthcare and Preventive Medicine

Do whatever the city can do to help accomplish universal access to health care for all New Yorkers.

Dr. Irwin Redlener

[New York City's public health priorities be in a new mayoral administration] should be expansion of primary care.

Dr. Jack A. DeHovitz

The Affordable Care Act will still leave many New Yorkers uninsured and under-insured. I believe that our next mayor should prioritize the needs of this population at least in part by strengthening our public hospital system.

Dr. Teddy N., student at Columbia University’s Mailman School of Public Health

With an aging population, the focus on healthcare access and prevention in the elderly is also highly important.

Christin G.

Homelessness

There are thousands of young people who have run away or been pushed out of their homes who are forced to live on NYC streets and subways every night, yet there are only a few hundred beds available to provide them with adequate and appropriate shelter. Many are LGBT youth. This is morally unacceptable, and constitutes a public health nightmare. Unlike his efforts to ban smoking and increase access to healthy foods, this is an area where Mayor Bloomberg failed to provide leadership. Under the new administration, NYC can and must do far more to provide these resilient and vulnerable young people with nutritious food and safe shelter.

Dr. Bruce Armstrong

Hospital Closures

As for the Brooklyn hospital closures, they have to take it out of the political arena. If a hospital isn’t working, the money can be used to develop health systems that do, like community health centers. It’s better to walk the extra five blocks and get good care than to a closer place that can’t provide it.

Dr. Howard Minkoff

Race and Policing

His sponsorship of Young Men’s Initiative programs has been an important contribution that calls attention to the strengths and assets of young men, and addresses health, education, and social disparities that adversely affect young men of color.

Dr. Bruce Armstrong

Mayor Bloomberg’s legacy is complicated. He has been more public health-conscious than any previous mayor on record, but his support of stop and frisk policies has substantially increased the public health risks associated with incarceration…too many young black and Hispanic young men have been caught up in the criminal justice system as a consequence of that policy. What do I want from the new mayor? I want him to forge new and improved relationships between the police and poor communities of color in New York City, one that reduces the perception of the cops as an occupying army in such communities.

Dr. Robert Fullilove

His stalwart defense of “stop and frisk” reveals the limits of his public health vision, his inability to understand the public health implications of police harassment (and when so few stops produce weapons, for the innocent remainder who usually are ethnically profiled it can be called nothing better than harassment). This policy extracts a literal toll (as in the price some must pay for transit) on its victims. These usually hostile encounters produce elevated levels of stress whose cumulative effects—many individuals report being stopped multiple times per year—we cannot measure. For many in possession of small and legal amounts of marijuana, these encounters have resulted in arrests and subsequent incarceration or job loss. Worse, as a recent Vera Institute of Justice report has revealed, black and Latino trust for law enforcement has been greatly diminished as a result, threatening a criminal justice crisis. As a historian, I fear that Michael Bloomberg will be remembered as the first public health big-city mayor, but one of the last to stick intransigently to his guns—ironic pun certainly intended, since so proportionately few stops produce illegal weapons—on a practice which has supported the rise of the New Jim Crow.

Dr. Samuel Kelton Roberts

Smoking

The mayor’s extraordinary leadership in securing legislation to ban smoking in bars, restaurants, and other public spaces improves the health and quality of life for countless New Yorkers.

Dr. Bruce Armstrong

Undoubtedly, the mayor’s efforts to combat smoking will go down in history as his greatest public health achievement. The mayor’s efforts to ban smoking in all indoor work and public places will end up saving the lives of thousands of New Yorkers. His legislation not only helped spare New York City residents of the inevitable disease and misery that comes from tobacco use, it also turbocharged the debate in Albany, and across the nation. New York State’s approval of similar legislation came on the heels of city action. The mayor’s success in this area is one of the greatest public health achievements in the history of the city.

Blair Horner

I think Bloomberg’s attention to smoking will have him most remembered. Some people may not be happy with Bloomberg’s policies, but the city will be better off in the long run because of his accomplishments.

Edgar B.

Socioeconomic Inequalities

The foundations of population health are unavoidably social and economic. Public health has historically, and recently, focused on behavioral changes (as in, for example, targeting smoking) as a way of improving population health. However, longer lasting, more pervasive population health improvement will need structural changes in the fundamental causes of population health over the lifecourse. Such a lens can be truly transformative for a municipal government—healthier cities  for healthier people.

Dr. Sandro Galea

A political leader has to define health like the World Health Organization: to ensure that people aren’t excessively socially or physically disadvantaged. The new administration has to maintain the degree of focus on health that Bloomberg set.

Dr. Howard Minkoff

Transportation

According to the health department’s own research, the biggest fatal threat to our city’s children is motor vehicle crashes. Much independent data also suggests that reckless drivers deter people from being physically active on their streets. However, gathering data on how to prevent crashes has not been a high priority of the [New York City Department of Health and Human Services] or the [New York Police Department], which does a poor job of investigating crashes and catching reckless drivers. If we are to stem the tide of thousands of car-related injuries and fatalities each year that shatter lives and detract from the health of our city, this must become cross-agency priority that includes health, enforcement and engineering stakeholders.

Jennifer So Godzeno
Read our feature on how the mayoral candidates view Michael Bloomberg’s legacy.

Contributions from Kathleen Bachynski, Joshua Brooks, June Kim, Patches Magarro, Ambereen Sleemi, and Christopher Tait.

Photo credit for featured image: the Prime Minister’s Office

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The views and opinions expressed on this website are solely those of the authors and do not represent those of the Department of Epidemiology, the Mailman School of Public Health, or Columbia University.