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Mayor Mike Bloomberg, public health autocrat: A brief history

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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 behaviors.

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. From smoking to soda bans, here’s a quick tour through Mayor Mike Bloomberg’s public health crusade.

Makes New York the first major city to ban smoking in bars and restaurants.

POLICY: New York City’s Smoke Free Air Act of 2002 banned public smoking in virtually all restaurants and bars. Some smaller cities had enacted such bans; Colorado resort town Aspen was the first to do so in 1985. California followed in 1998 with a statewide ban. When New York City passed its law four years later, it was the largest individual city to pursue such a policy.

While the smoking ban encountered significant opposition, it also won some unlikely allies: The New York City Restaurant Association, for example, dropped its opposition to the ban when it found that most member restaurants were actually in favor of it.

IMPACT: Public health improvements were almost immediate: Within a year of enactment, one review found an 85 percent drop in nicotine by-products in the air at restaurants and bars. Research on international smoking bans has shown significant health care improvements for bar workers. Adult smoking rates in New York City, which had held constant for over a decade around 21.6 percent, dropped from 21.6 percent in 2002 to 18.4 percent in 2004.

States and cities have adopted similar policies in droves. Twenty-seven states now ban smoking in restaurants and bars, 3,469 cities have similar restrictions on a more local level. Bloomberg recently expanded on his own smoking ban: In 2011, New York City outlawed smoking in public places such as beaches and parks.

Bans the use of trans-fat in all foods prepared in New York City restaurants.

POLICY: In 2006, Bloomberg made “trans-fat” the new public health enemy number one. It’s the stuff created when hydrogen gets added to vegetable oil through a process called “hydronation,” which has the benefit of making oil less likely to spoil, but also more likely to raise harmful cholesterol levels. New York City’s ban on “trans-fat” barred restaurants from using hydrogenated vegetable oil in cooking. It took full effect in 2008.

IMPACT: Numerous headlines declared that New York City’s trans-fat ban was “working” when a 2009 study found that the percent of restaurants using trans-fats had decreased from 50 percent to less than 2 percent.

Compliance is one thing, but researchers say they’re still waiting for the other shoe to drop: They want data on whether New Yorkers’ cholesterol levels have actually dropped. Without that, some argue, it’s difficult to assess whether or not the trans-fat ban has actually been a success.

Thirteen cities and states, meanwhile, have copied New York City’s ban, enacting similar restrictions on their own restaurants.

After two years of legal wrangling, requires restaurants to post calorie counts for standard food items.

POLICY: Another New York City original, the city passed a 2006 law that required all chain restaurants with more than 15 outlets to post information on the number of calories in standardized food items. The law took two years to come into effect, held up by lawsuits that challenged the requirement as a violation of commercial free speech.

IMPACT: Twenty cities have followed in New York’s footsteps, requiring chain restaurants to post information on calorie content. The Affordable Care Act will soon take the policy national, requiring all chain restaurants with more than 20 locations to post calorie labels.

It’s far from certain, however, that mandatory calorie counts will help make us healthier. A 2008 study compared purchasing habits of New York residents to those in neighboring Newark (which had no calorie labeling) and found no significant difference in foods purchased. That, some public health researchers say, may have to do with the information posted: It doesn’t always provide information that can help consumers make smart decisions about what to eat.

Columbia University researchers looked at calorie postings across New York City; they found restaurants listing a bucket of chicken as containing “3,240 to 12,360 calories” depending on which pieces of chicken were ordered. “Although most postings were legally compliant, they did not demonstrate utility,” the authors say.

Proposes a voluntary effort on behalf of Americans’ food producers to reduce salt consumption by 20 percent.

POLICY: With Americans consuming twice the recommended levels of sodium — and sodium is associated with increased risk for high blood pressure — New York City launched in 2009 the National Salt Reduction Initiative. The initiative sets targets for sodium levels in 62 food categories and 25 types of restaurant foods.

IMPACT: If successful, a major push to reduce salt consumption could have a big health impact: If Americans reduced salt intake by 3 grams per day, one New England Journal of Medicine study projects it would prevent as many as 120,000 new, annual cases of cardiovascular heart disease. Whether this effort can produce such results remains unclear. Right now 35 food companies, places like Subway and Hostess food, have signed on to meet certain sodium targets in 2012 and 2014. A more aggressive proposal from New York State assemblyman Felix Ortiz, to ban salt in New York City restaurants, was quickly rejected.

Congestion pricing for cars entering New York City never gets off the ground.

POLICY: In 2008, Bloomberg rolled out a congestion pricing policy that would have charged an $8 fee to cars entering or leaving Manhattan during business hours. The fee looked a lot like programs in place in London and Singapore and, among other outcomes, aimed to make New York City a healthier place by reducing vehicle emissions.

IMPACT: The proposal proved popular among New Yorkers, who supported congestion pricing by a 2-to-1 margin. The policy, however, ultimately died in Albany after state legislators declined to bring the issue to a vote. If it had passed, the law may have had a significant public health impact: A study of Stockholm’s congestion pricing scheme found reductions in car emissions that hovered around 10 percent after its policy came into effect.

Unsuccessfully pushed for policies that would limit access to sugary sodas.

POLICY: Bloomberg achieved the rare feat of angering both the soda lobby and advocates for the poor and underfed when he proposed barring the use of food stamps to purchase sugary drinks. The Obama administration rejected the idea this past fall, largely due to “logistical issues” that made it too difficult to sort sodas from other purchases made with food stamps. On the state-level, Bloomberg advocated for an 18 percent tax on sodas. It was roundly rejected by the New York State Legislature.

IMPACT: It’s difficult to know what impact either policy would have had on public health largely since neither has ever been tried. Most soda taxes that exist now hover around 3 percent and haven’t shown to reduce consumption; economic modeling, however, suggests that an 18 percent surcharge would be high enough to affect behavior. As to the food stamp ban, there is some evidence that creating economic barriers to soda reduces consumption among a low-income population: In one study, a 10 percent increase in soda prices correlated with an 8 percent drop in consumption.

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