That story is from a recent book by Dr. Tom Farley, former Commissioner of New York City's Department of Health and Mental Hygiene. The book is
Saving Gotham, with a long subtitle that suggests what it takes to effect change in health laws:
A Billionaire Mayor, Activist Doctors, and the Fight for Eight Million Lives.
The "Gotham" in the title calls to mind Batman battling Joker, Riddler and Catwoman. But in this story, the nemeses are Smoking, Trans Fats, Sugar, and anti-vaccine sentiments -- collectively killing tens of thousands of NYC citizens each year.
Some of us are old enough to remember when smoking in restaurants, office buildings and even airplanes was acceptable behavior. We also recall when Crisco was practically one of the five main food groups and when flu was simply remedied by chicken soup. Meanwhile, smoking, trans fats, sugar and flu were shortening the lives of millions of Americans each year. Changes in attitudes and policies over the past quarter century are in part thanks to those in New York City who had the courage to take on the industries, politics and the court of public opinion. These few committed doctors and public health staff members took on mass killers of the city's citizens - a fight that changed the way our government and our people now think about these villains.
Dr. Farley's successful battles led to what he calls the "wholesale" saving of lives. The "wholesale" part is not through the use of surgery and drugs, but by leveraging information, implementing policies and facilitating laws. The stories make clear that it's the power of data that was his "superpower" in provoking change. That data was so compelling it enabled controversial and polarizing legislation to be enacted - legislation that was subsequently adopted nationally and across the world due to the cultural changes that occurred resulting in measurable population-based outcomes.
One example is when NYC tried to make changes to the Supplemental Nutrition Assistance Program, or SNAP (formerly known as the Food Stamp Program). Following the collapse of the mortgage security system and the subsequent recession that started in 2008, SNAP started to grow exponentially. By 2013, it reached 48 million people nationally (14% of Americans) and paid for over $76 billion in food. From public health studies performed between 2008 and 2013 that analyzed what was being purchased, it was estimated that in 2010, "
about $5 billion a year from SNAP paid just for sugary drinks. That was five times CDC's budget to prevent chronic diseases." (The book goes to great lengths to provide evidence to show how high sugar consumption results in long-term chronic diseases such as hypertension.) That led to the experiment with limiting soda servings, and while that law failed, the public awareness of the sugar-disease connection changed the national conversation.
My Reflections & Take-aways
Saving Gotham
is an inspiring book that should be required reading for anyone who works directly or indirectly in health care or public health.
Public health is and always has been about navigating around obstacles. Having been in public health for over 25 years, I always knew this is what I signed up for. I never truly appreciated however the importance of perseverance such as that shown by Mayor Bloomberg and a few doctors dedicated to the mission of our industry, and how this perseverance could impact so many lives. Having the courage to act in order to intentionally save lives of an unknowingly victimized population is what our work is all about.
With flu shots being seasonal, they are one of the easiest immunizations to advise on with patients. The clinical community could therefore move the needle (pun intended) on more complicated, multi-dose vaccines that are underachieving across our population and causing a catastrophic number of illnesses and deaths... sickness and death we know is preventable. For those of us who focus on immunizations, I believe the book will leave you dreaming about what we could accomplish if doctors, pharmacists, and all other clinical providers were fully engaged partners in the use of immunization intelligence provided by public health.
About the author
Todd Wat
kins is President and co-owner of STC. When he isn't out meeting with STC clients, Todd is in his hometown of Albuquerque, where he's a member of the New Mexico Immunization Coalition, the Medical Society Immunization Practices Advisory Council, and a Board member of Albuquerque Health Care for the Homeless.
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