Over the 12 years that Mike Bloomberg was mayor of New York City, he centered public health in city policy, with a series of initiatives reported to have contributed to a three-year increase in life expectancy of city residents. Cities around the world are trying to duplicate these initiatives and emulate New York’s success.
“What [Bloomberg] understood more than anybody else is that the prescription for better health is policy, because every one of our conversations in this country around health devolves into a conversation of pills and procedures, where it needs to be a conversation about policies and partnerships,” said Brian Castrucci in an interview with NPQ. Castrucci, president and CEO of the public health nonprofit de Beaumont Foundation and spokesperson for its CityHealth initiative, emphasized the power of this approach: “That’s how we make every city in this country healthier. That’s how we have a stronger economy. That’s how we have thriving communities.”
Globally, 4.2 billion people currently live in urban areas, but that number is expected to rise by two-thirds by 2050. In the United States, over 80 percent of the population lives in urban centers. Here, the prevalence of noncommunicable diseases—heart disease, diabetes, cancers, and obesity—are particularly high, influenced by environmental factors such as toxic air, unsafe roads, limited space for physical activity, and a lack of green space. Yet at the same time, cities have the power to influence people’s health in a positive way.
“There’s this common framing of city governments as places where you can get things done.”
Tom Baker, associate professor at the University of Auckland’s School of Environment in New Zealand, has conducted research on Bloomberg’s city-focused philanthropy. As Baker told NPQ, “There’s a prevailing perspective that [cities are] better attuned to the needs of local populations than national government…and that city governments are closer to their populations, but also less encumbered by bureaucratic processes and inefficiencies than national and supranational institutions are. There’s this common framing of city governments as places where you can get things done.”
As Anne Hidalgo, the mayor of Paris since 2014, told NPQ during an in-person interview, city mayors have the responsibility of ensuring “that the right decisions are made.”
A Complex Legacy
While many criticize Bloomberg—who was New York City’s mayor for three terms spanning 2002 to 2013—for discriminatory stop-and-frisk search policies enacted after 9/11 and the economic disparity that increased during his terms as mayor, many also credit his decision-making for improving city residents’ health.
Bloomberg’s actions included banning smoking in bars and restaurants, mandating that calories be listed on fast food menus, and prohibiting artificial trans fats in restaurants. Policies were also introduced during his tenure mandating the use of clean heating oil, creating a public bike-sharing system, and including public health messaging wherever tobacco products were sold.
During that time, in New York City, infant mortality decreased by almost 17 percent, daily cigarette consumption decreased by 30 percent, childhood obesity declined by 5.5 percent, and life expectancy increased by three years.
Bloomberg framed his city as a place where you could test innovative ideas, not just for the benefit of New Yorkers, but for the benefit of city governments elsewhere, said Baker. New York City has since become a global example of a leader in promoting city-level health.
The Bloomberg Effect in the US and Globally
CityHealth, which rates the 75 largest cities in the country on their policy recommendations package, is supporting US cities to implement evidence-based policy solutions, many of which were inspired by New York City. Those policies include universal access to early childhood education in cities like Boston and Memphis, which, in addition to the inherent positive long-term outcomes of education, expose children to more medical services, such as immunizations and screenings. Other policies include zoning the location of alcohol stores to limit alcohol-related violence and binge drinking in cities like Atlanta and Las Vegas, and implementing paid sick leave in cities like Denver and Minneapolis to support people staying home when sick.
“We believe in the power of cities.”
Bloomberg himself is invested in taking lessons from New York City globally. His philanthropic organization, Bloomberg Philanthropies, has led a series of initiatives focused on improving city health since its inception in 2006.
For example, the Mayors Challenge competition encourages city leaders to improve urban design to meet health challenges, and the Bloomberg Cities Idea Exchange facilitates cities sharing what’s worked in their local context.
In 2017, the organization also established the Partnership for Healthy Cities with global public health organization Vital Strategies and the World Health Organization (WHO). It is a global network of 74 cities that receive $100,000 from the partnership to kickstart policies on tobacco control, overdose prevention, food policy, mobility, surveillance, road safety, and heat.
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Since its inception, the partnership has supported the introduction of over 30 health-enabling policies. Daniel Passerini, mayor of Córdoba, Argentina, mandated eliminating sugary drinks and junk food in school meals. In Bangkok, Thailand, the local government is working to increase sidewalk space and reduce traffic flows; and in Bengaluru, India, the city government pushed forward a ban of hookah pipes throughout the state of Karnataka to lessen tobacco use.
“We believe in the power of cities,” explained Kelly Larson, director of Bloomberg Philanthropies, in an interview with NPQ, adding that all the policies are proven to drive positive health outcomes. “We look for other mayors who are eager to inhabit that role and to embrace public health as a legacy issue for their leadership.”
Global Health Challenges Ahead
While the partnership hopes to continue to add more cities to its portfolio and support them in adopting New York City’s approach to city-level health, it’s a different time than when Bloomberg was mayor. New York itself continues to experience significant health concerns.
Life expectancy decreased over the first few years of the COVID-19 pandemic, while overdoses, chronic diseases, cancers, and suicides remain significant issues, Sara Gardner told NPQ. Gardner is CEO of the Fund for Public Health NYC, one of several city-affiliated funds Bloomberg created during his mayorship, and added that the city still has a lot of work to do to create an equitable approach to health.
Moreover, Bloomberg was a progressive mayor in a progressive city, according to Castrucci. Today, state legislatures are increasingly taking away cities’ dominion over their own futures by limiting the policy options they have, he explained.
“So many of us across the nation are anticipating pretty significant cuts in federal support of public health programs.”
New York City has not been immune to these trends. Zach Hennessey, chief strategy officer at nonprofit Public Health Solutions (PHS), which promotes the health of underserved New Yorkers, told NPQ that while the city health department has the right priorities for residents, it is limited by its mandate, which doesn’t include working on determinants of health such as housing, food security, or the rehabilitation of prisoners. As a result, New York City “continues to have a greater than 10-year gap in life expectancy between the wealthier neighborhoods of the city and…neighborhoods where there’s been historical disinvestment,” Hennessey said.
Bloomberg’s legacy generating data on health issues allows nonprofits like PHS to see where they need to fill the gaps, which will be key as federal support and resources dwindle for public health, said Hennessey. Globally, health budgets are declining amid a drop in overseas development assistance, including from the US government as the Donald Trump administration continues to cut global aid.
At the local level, several US public health institutions, such as the Department of Health and Human Services (HHS) and National Institutes of Health (NIH), are also being dramatically downsized.
Bloomberg shifted New York City’s reliance on government funding during his time as mayor, encouraging partnerships with the private sector and philanthropic foundations, while also establishing city-affiliated funds. Gardner noted that practitioners in other cities like Los Angeles, Boston, and Chicago, have contacted her to learn about this model, “especially in this environment where so many of us across the nation are anticipating pretty significant cuts in federal support of public health programs.”
Importantly, many health-focused interventions promoted by Bloomberg Philanthropies can yield economic gains at a time when cities may be cash-strapped. Improving people’s health and wellbeing often reduces the long-term economic burden on health systems.
“When you are fighting and building policies for a better life for the people, I think it is better also for the economy,” reflected Mayor Hidalgo.
If cities can find the funds to invest in policy changes for health, they could in the long run be much better off.
For More on This Topic
Bloomberg Looks to Become Premiere Foundation for City Governments
Coming to a City Near You: A Partnership to Improve Health through Community Investment
