A recent post covered plans to ban the sales of large sized soft drinks and other sugary drinks at some New York City venues and mentioned that Mayor Michael Bloomberg is high on the list of those to watch when it comes to public health progress.
The rationale and the politics of the proposed softdrink measure has been reviewed by public health lawyer Michele Simon, and she concludes it is smart on both counts. But she warns that things will get ugly as the beverage and restaurant lobbies exert their clout – as is already happening, with ads featuring “Nanny Bloomberg”.
Marion Nestle, professor of Nutrition, Food Studies, and Public Health at New York University, says while critics of the policy argue that education of the public would be a better approach, what’s really needed is education about how the beverage industry operates.
Writing at The Atlantic, she says:
The sugary drink industries have much to answer for their role in obesity promotion.
- They put billions of dollars into advertising, much of it directed to children and minority groups.
- They lobby Congress and federal agencies to prevent laws and regulations that might affect sales.
- They co-opt health organizations to neutralize criticism (hence: the Academy of Nutrition and Dietetics’ advice to focus on “education and moderation”)
- They attack public health professionals who advise “don’t drink your calories.”
- They attack the science and make it appear confusing (see the above ad which does not mention studies that show otherwise).
- They price drinks to favour the largest size servings; an 8-ounce soft drink costs much more per ounce than a 2-liter bottle.
Nestle adds: “If the Beverage Association really wanted to help Americans eat more healthfully, it could change all of those practices.”
Meanwhile, a useful overview of Mayor Bloomberg’s wins and losses in public health comes from The Washington Post’s Wonk blog by Ezra Klein.
Mike Bloomberg is a mayor with a mission. More specifically, a public health mission: Over the course of a decade he has made New York City a laboratory to test policies that manipulate the healthiness of public environments. His much-protested idea for a large-soda ban comes from a long lineage of much-protested smoking bans and trans-fat bans that have tested what, exactly, government can and cannot do to encourage healthier behaviours. Some of Bloomberg’s ideas have proved remarkably effective in making New Yorkers healthier and become models for national policy. Some have flopped, showing little public health impact or running into trouble even getting off the ground.
Klein’s assessment includes details of how many other areas have followed New York in:
• banning smoking in bars and restaurants.
• banning the use of trans-fat in all foods prepared in New York City restaurants
• requiring restaurants to post calorie counts for standard food items.
Bloomberg hasn’t always had his way, however. His plan for congestion pricing for cars entering New York City was blocked, and so were his efforts to limit access to sweet drinks.
Research recently reported in The Lancet suggests that NYC’s public health activism is paying off. It says life expectancy is rising faster in NYC than anywhere else in the USA.
The Institute for Heath Metrics and Evaluation recently estimated the life expectancy for each of the USA’s 3147 independent cities and counties. Manhattan’s life expectancy rose 10 years between 1987 and 2009, the largest increase of any county, and the other four counties that make up New York City were all in the top percentile.
More than 60% of the increase in life expectancy since 2000 can be attributed to reductions in heart disease, cancer, diabetes, and stroke. In the past decade, death rates for heart disease alone fell by some 25%, according to The Lancet report.
One of the researchers involved in the analysis credits the city’s health department and their aggressive efforts to reshape New York’s social environment.
The article also profiles efforts to tackle health inequalities in NYC, including the establishment of three satellite public health offices in disadvantaged areas.
Jane Bedell, the Assistant Commissioner of the Bronx District Public Health Office, worked as a doctor in the area prior to joining the health department in 2002, and says she came to appreciate how much her patients’ health depended not on what happened in her doctor’s office but what happened outside of it.
The article also describes how NYC initiatives are having a much wider impact. For example, after a public school in the Bronx decided to remove whole milk from its cafeteria eight years ago, replacing it with low or non fat milk, this measure was then taken up more widely across the city.
In 2006, whole milk was phased out of the entire NYC public school system, cutting an annual average of 3484 calories and 382 g of fat from the diet of each student. In January this year, the US Department of Agriculture unveiled new rules that will remove whole milk from schools nationwide, affecting 32 million children.
The article also traces the historic roles of cities in enabling connections, ideas and innovation. Ed Glaeser, an urban theorist, is quoted saying: “And even in terms of health, it’s remarkable how often cities have been essentially the laboratories in which people have uncovered major truths about health.”
The article puts a great deal of credit for NYC’s public health progress on “the nation’s first and maybe the world’s first public health mayor”.
All of which makes me wonder: which Australian cities or civic leaders could we hold up as public health beacons?
Does anyone or any particular place come to mind?