Mayor Bill de Blasio's overwhelming election victory emerged from a platform focused on income inequality and A Tale of Two Cities, but income is not the only disparity that deserves attention. It is also an indicator of the greatest challenge affecting public health in New York and nationally.
Low-income communities are disproportionately affected when it comes to health challenges. Addressing these issues at the level of public health, or health for all of us, creates many of the most effective and cost-effective solutions to improving all of our health - raising the floor and raising the ceiling for everyone at the same time.
Former Mayor Michael Bloomberg left an extraordinary legacy in public health, and de Blasio has stated his determination to build on it. In his Inaugural Address, he thanked Bloomberg, noting, "Your passion on issues such as environmental protection and public health has built a noble legacy. We pledge today to continue the great progress you made in these critically important areas."
De Blasio underscored that point with his recent appointment of Dr. Mary Bassett as Commissioner of the city's Department of Health and Mental Hygiene. Dr. Bassett had previously served as Deputy Commissioner of Health Promotion and Disease Prevention in the Bloomberg Administration. She has also been a member of the faculty of the Mailman School of Public Health at Columbia University since 1995.
Bloomberg's great accomplishment in public health was foundational. He transformed the landscape in a way that was both science-based and egalitarian in its impact. He made public health a priority and a topic of debate, and he instituted landmark reforms that have been copied throughout the nation and around the world.
Among other initiatives, he pushed through the Smoke Free Air Act, which made smoking illegal in public places and reduced the toxic impact of second-hand smoke. He instituted calorie counts in restaurants and banned trans fats. His public information campaigns were designed to educate all of us on what threatens health, and what creates it. Even his unsuccessful attempt to ban super-size sodas raised awareness widely of the relationship between sugary drinks and obesity.
He also understood the importance of the built environment to the public's health, including our access to exercise. He created green lanes for bicycles and implemented the bike-sharing system. He recognized that the best way to cut down on healthcare costs is to reduce the likelihood of getting sick - and designed environments good for health and sustainability.
That point should be underscored as public discussion shifts to changes in sick leave and to the nature of healthcare facilities in local communities. The first obligation should be to help the public stay healthy and out of the hospital. Even when it comes to implementing universal pre-K, there's an underlying truth: if a child can't attend because of asthma or some other medical condition, the pre-K won't help enough.
Increasingly, the challenge for elected officials is to improve the health of our entire population. Public health has an outsize impact, yet too little investment is made in it. Further, it's a growing necessity, as population health, more than ever, determines the magnitude of government budgets for healthcare and health insurance.
Despite Bloomberg's accomplishments, much more needs to be done. In New York City, among other things, 60% of adults and 40% of children are obese or overweight, and obesity takes its greatest toll on poor women, according to the U.S. Centers for Disease Control. Asthma is the leading cause of hospitalization for school children - with wide disparities by race, ethnicity, and neighborhood. 15% of adults and 9% of teenagers still smoke.
Life expectancy in New York City grew by 36 months from 2001 to 2010 and is now more than 2.2 years greater than it is nationally: 80.9 years in New York compared to 78.7 nationally, according to City of New York data available in 2012. That's an extraordinary achievement. But the risk factors that cause American adults to lose years of life or that create years of life with illness offer a guide to our population's health needs. In order of impact, according to the NYC Department of Health, they are dietary risks, smoking, overweight/obesity, high blood pressure, high blood sugar, physical inactivity, alcohol use, high total cholesterol, drug use, air pollution, and occupational risks.
These risk factors should focus our attention in coming years, and government has a crucial role to play in addressing them. That is because the most cost-effective solutions involve designing our urban environment to make health the easier choice. Diet, smoking, and obesity should be top priorities. Public health leadership and approaches are essential to be successful, in all aspects of our lives. If we don't tackle them, we will all pay for it.