Regulating for the Public Good in New York City

Redesigning choices: A framework of public health reform implementation in New York City

    • March 14, 2013

Dates of Project: August 2010 to September 2012

Field of Work: Public health laws and regulations

Problem Synopsis: New York City health officials under the leadership of Mayor Michael Bloomberg have been unusually successful in passing public health regulations intended to lower the incidence of chronic disease. Such measures are often controversial, in part because they address personal behavior considered by many to be outside the purview of government.

Synopsis of the Work: Researchers affiliated with Columbia University and the Georgia Institute of Technology studied the strategies used in New York to move three measures through the political process—a ban on trans fats; limits on exhaust emissions; and excise taxes on sugar-sweetened beverages. The first two reforms passed; the third did not.

The goal was to determine whether New York's ability to introduce health reforms was unique to conditions there, or whether it might serve as a model for introducing similar measures elsewhere. The research team also developed case studies of attempts to pass similar measures in other cities and states, and made comparisons to determine what steps led to reforms.

Key Findings: Researchers concluded that the public health policies approved in New York did not depend solely on the city's unique circumstances. Many of the strategies offer models for health departments throughout the United States. These dynamics were consistent across the three public health proposals:

  • Although the mayor's strong support was key, leadership in the health department provided the "driving force" necessary to steer reforms through the political process.
  • Public health officials employed creative administrative and regulatory mechanisms to secure passage of reforms.
  • City officials used empirical evidence to support their efforts.
  • Health officials changed the department's internal structure (such as by creating a bureau dedicated to chronic disease and an in-house legal team).

In their multiple-city analyses, the research team concluded:

  • Cities that successfully banned trans fats had the support of a government champion and both local and national advocates, and used empirical evidence and expert testimony.
  • Cities that limited exhaust emissions promoted their image as environmentally progressive and saw regulations as an opportunity to increase demand for cleaner vehicles and comply with existing clean air standards.
  • Ideological and economic objections were common barriers to levying excise taxes on sugar-sweetened beverages.

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How to pass progressive health policies: RWJF study finds lessons in political process from New York and other cities.

The focus on the evidence is there all the time.... People are digging in the literature and asking, 'Ok, would this thing really have an impact on health?' It's got to meet that threshold first."—Project Director Kimberley Isett

Public health departments in the United States generally do a good job of monitoring and controlling the sorts of diseases that killed people a hundred years ago. The problem is that the situation has changed."—Thomas R. Frieden, MD, MPH, former health commissioner of New York City, now director of the Centers for Disease Control and Prevention