Blair Horner: Mayor Bloomberg's Public Health Legacy

Dec 23, 2013

Next week New York City will have its first new Mayor in 12 years.  Michael Bloomberg, the billionaire Mayor, will leave office.  Bloomberg who was elected Mayor as the City was reeling from the September 11th terrorist attacks, dramatically changed both the politics and policies of New York.

In the city, the Mayor changed education policies, dramatically changed real estate development, and oversaw a stunning reduction in crime.  In short, a City still smoldering from the ruins of the World Trade Center is now a cleaner, safer, world-class metropolis on the scale of London, Paris and Rome. 

Mayor Bloomberg’s tenure is not without controversy.  His data-driven, analytical approach to policymaking made him appear to be aloof.  Income inequality grew during his years. The number of homeless soared. And some ethnic and religious minorities have complained that a steep drop in crime has come at the expense of their civil liberties.

Yet, the Mayor’s achievements in public health were stunning.  The Mayor successfully enacted a ban on smoking in all bars and restaurants. 

As a result, New York City has driven down smoking far faster and to far lower levels than the nation as a whole. The adult smoking rate has declined 31 percent since 2002, from 21 to 14 percent, while youth smoking has been cut by more than half since 2001, from 17 to 8 percent. In contrast, 19 percent of adults and 18.1 percent of high school students still smoke nationwide.

New York's progress is saving and extending lives. The City's life expectancy is at an all-time high of 80.9 years, above the national average of 78.7 years, thanks in large part to its success in reducing both smoking and exposure to secondhand smoke.

New York City's smoke-free law helped inspire a movement that has swept the nation and the world.

New York City showed that smoke-free laws are easily implemented, achieve almost universal compliance and quickly improve air quality and health. New York's experience also added to the overwhelming evidence that smoke-free laws protect health without hurting business.

And action in the City spurred changes at the state level.  Following on the actions in New York City, the state enacted a similar ban.  And the state had similarly impressive public health benefits.

A recent study conducted by the Department of Health showed that since passage and implementation of the Clean Indoor Air Act in 2003, hospitalizations for heart attacks has decreased significantly. It is estimated in the first year alone, there were approximately 3,800 fewer hospital admissions for heart attacks with an estimated cost savings of $56 million. Exposure to secondhand smoke has also been reduced. The percentage of middle and high school students exposed to cigarette smoke decreased by at least one-third from 2003-2010.

The study also revealed that ten years later, statewide compliance with the law by bars and restaurants is nearly universal. In 2003 before the law took effect, fewer than 50% of restaurants were smoke-free. In 2013, compliance was 100%.  Just 11% of bars were smoke free prior to the law in 2003.  In 2013, 99.4% of bars in the sample were compliant and entirely smoke free.

Of course, more needs to be done.  Tobacco still kills more than 25,000 New Yorkers every year, more than any other cause.  Nearly one in every five deaths is attributable to tobacco use, and more than half a million New Yorkers currently suffer from a chronic illness such as cancer, cardiovascular disease or chronic obstructive pulmonary disease that was caused by smoking.  Unless current trends are changed, 389,000 children under 18 and now living in New York will eventually die prematurely from diseases caused by tobacco – diseases that can be avoided.

And the economic costs are still staggering:  The U.S. Centers for Disease Control & Prevention (CDC) estimated New Yorkers spend over $8 billion annually on direct medical care to treat smoking caused illness, including $5.4 billion on tobacco-related Medicaid costs. 

But the benefits are undeniable.  Thanks to the actions of Mayor Bloomberg, New Yorkers are living longer, are healthier, and saving health care dollars.  History will look on these smoking bans as one of the greatest public health achievements, right up there with the polio vaccine.

That’s quite a legacy – lives saved, in New York City, New York State, and across the nation.  Hopefully, our current political leadership will continue to build on those actions.

That’s all for now.  I’ll be keeping an eye on the Capitol and will talk to you again next week.