Inside the Bloomberg public health toolbox

December 19, 2013 —December 19, 2013 -As Mayor Michael Bloomberg's term comes to a close, the latest research conducted by Columbia University's Mailman School of Public Health indicates that he leaves a legacy of ambitious public health policies from pioneering restrictions on trans fats and smoking to investments in green spaces and bicycle lanes that have improved the health and increased the life expectancy of New Yorkers. The paper takes a behind-the-scenes look at the Bloomberg Administration to evaluate the evidence and build public support for improving health in the city—which also can serve as a blueprint for health policy in cities across the country.

The researchers interviewed 27 current and former civil servants, elected officials, advocates, and staff of think tanks, and interest groups familiar with Bloomberg-era policies with a focus on the prevention of chronic disease, including trans-fat use in restaurants, transportation policies and tobacco control policies, as well as opponents of the Mayor's policies. The resulting article in the peer-reviewed journal Frontiers in Public Health Services and Systems Research reports on the themes that emerged.

"The notable aspect of the Bloomberg approach is not just the high-profile public health policies but also the way they went about developing, evaluating, and advocating for the policies," says Miriam J. Laugesen, PhD, the article's lead author and assistant professor of Health Policy and Management. "In addition to learning from the policies themselves, urban leaders should look at how those policy decisions were made, particularly how scientific evidence can help make good policy. "

Mayor Michael R. Bloomberg has a personal interest in public health, and interviewees described him as a "linch pin" for policy and "willing to take risks." However, the Mayor's support was contingent on data. "He was not a cheerleader for all proposals: staff learned that he would scrutinize their data before embarking on new policies, and in some cases he would ask questions that required fundamental revisions," the researchers write.

Dr. Laugessen and co-author Kimberly R. Isett, PhD, associate professor in the School of Public Policy at Georgia Tech, identified five strategies used by New York City policymakers:

1. Rigorous appraisal of published studies. Health officials didn't limit themselves to top-line findings from studies but looked "under the hood" at the methodology and granular data.

2. Collection of health survey data. Survey data at the local level provided an evidence-based foundation for developing interventions and served as a benchmark for evaluating their effectiveness.

3. Shoe-leather research. The New York City Department of Health and Mental Hygiene conducted smaller-scale research to tailor findings to local contexts and to make heath issues more concrete to the public.

4. Inter-agency collaboration. Collaborations helped broaden available data and policy options. Example: The Departments of Police, Health, Parks and Recreation, and Transportation collaborated to research bicycle fatalities and guide the creation of bicycle lanes.

5. Research dissemination. Between 2004 and 2008, city health officials published more than 300 articles in peer-reviewed public health and medical journals. They also used opinion pieces and commentaries to reframe the issue.

"Especially with innovative policies, it is necessary to develop an information base and make policies that are evidence-based," adds Dr. Laugesen.

While some policies were challenged in the courts with some questioning the depth of evidence behind policies like the ban on trans fats or the link between soda consumption and obesity, interviewees did not question the quality of health data collected by the City.

Strengthening public health policymaking on the local level is particularly important since it is there that innovative health policies like bans on smoking and trans fats are most likely to succeed, observed Dr. Laugesen. "I would surmise that there's going to be more support for policies at the local level with local leadership where it is not seen as imposed from outside," she says. "Cities are uniquely able to bring people together to change the environment and shape our choices in support of health."

Support for the study was provided by the Robert Wood Johnson Foundation.

The article is one of a suite of research studies now underway at Columbia's Mailman School looking at health policies undertaken by the Bloomberg Administration. New York Community Trust has provided a grant to Gina Lovasi, Ryan Demmer, and Y. Claire Wang to look at how effective the policies were in preventing chronic disease in the city. (Drs. Lovasi and Demmer are assistant professors of Epidemiology; Dr. Wang is assistant professor of Health Policy and Management.) The Robert Wood Johnson Foundation has also funded research conducted by Dr. Peter Muennig, associate professor of Health Policy and Management, on life expectancy. Adding to this portfolio of urban health policy research, Dr. Wang has already published on the caloric impact of a 16-ounce portion size cap on sugar-sweetened beverages served in restaurants and on the potential impact of a tax on the beverages.

Founded in 1922, Columbia University's Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Mailman School is the third largest recipient of NIH grants among schools of public health. Its over 450 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change & health, and public health preparedness. It is a leader in public health education with over 1,300 graduate students from more than 40 nations pursuing a variety of master's and doctoral degree programs. The Mailman School is also home to numerous world-renowned research centers including the International Center for AIDS Care and Treatment Programs (ICAP), and the Center for Infection and Immunity. For more information, please visit http://www.mailman.columbia.edu