Thomas Farley: NewPublicHealth Q&A
Thomas Farley, MD, MPH, Health Commissioner of the New York City Department of Health and Mental Hygiene, is the keynote speaker at the opening session of the Public Health Law Research annual meeting that started yesterday afternoon in New Orleans. In advance of the meeting, NewPublicHealth spoke with Dr. Farley about the role of legal research in moving the public health agenda forward, how New York City is doing in the weeks following Hurricane Sandy, and the flu epidemic hitting the city that prompted New York State Governor Cuomo to declare a public health emergency earlier this week.
NewPublicHealth: What will you focus on during your address at the Public Health Law Research Program annual meeting?
Dr. Farley: I will be going through a number of policies that we have put in place here in New York City to promote health. Most of those will be around food, but some will be around tobacco. So that includes things such as our raising of tobacco taxes, our smoke-free air rule and around our prohibition on the use of trans fats in restaurants, our calorie labeling initiative and our portion rule [limits on beverage sizes at some food outlets]. And I will share some thoughts about the role researchers can play in policy development for an agency like ours.
NPH: How important has legal research been for some of the recent public health initiatives that have been introduced in New York City?
Dr. Farley: The research is extremely important to us in developing all of our policy approaches. When we are looking into a particular problem we think, what are the things driving the problem? What are general policies that might tend to lessen the problem? And then we think in a very practical sense, what is the feasibility of those policies? What is their impact? And what is our legal authority to enact them or what is the legal authority for different legislative bodies to enact them? That all plays a very key role here, and then we look at a variety of other research too about the potential public response to it and put all of that together in deciding on what policies to promote.
NPH: During a NewPublicHealth interview earlier this week with Scott Burris, JD, director the Public Health Law Research Program, we asked what key questions he had for you. He asked what are some of the critical questions you currently have for the legal research community?
Dr. Farley: The target for policy enactment to promote health falls in just a few categories that have potential for the biggest health impact. They include: smoking, things around food, things around physical activity and things around alcohol. Then one could think of a variety of different policies that might have a benefit in those areas, but then there is the question of what is the authority of different government entities to enact those policies? I have learned that laws are very complicated in this country. We have federal laws, state laws, local laws, we have regulations of different agencies that are often overlapping and sometimes conflicting. Providing clarity to localities primarily and states secondarily about what sort of policies they have the authority to enact that would have a big impact on health is very helpful. The New York City health department has a general counsel’s office with several lawyers and a lot of resources to try to research things – most local health departments don’t have this. So they can greatly benefit from ideas generated and disseminated from gatherings like this.
NPH: A second question from Scott Burris is: what legal issues should health departments across the country be thinking about in order to move the public health agenda forward?
Dr. Farley: There are certain tobacco policies that are proven to be effective that are inadequately used around the country. Many areas need to have stronger smoke-free air laws. Those cost essentially nothing and in terms of taxes they can actually bring revenue that can be used for tobacco control programs. I think when you get to diet and physical activity it is less clear as to what is effective. But I think that the Public Health Law Research Program can provide ideas that are presented so that local jurisdictions can be told ‘this is an idea which might work’ and then encourage innovation. I think the history of tobacco control has shown that innovation happens best at the local level and if you have many jurisdictions around the country trying to innovate then some of them will hit upon something that really works and others will then be able to take that idea.
NPH: How is New York City doing in its recovery from Hurricane Sandy?
Dr. Farley: Hurricane Sandy was the biggest storm on record for New York City. It caused tremendous amounts of property damage and some very unfortunate loss of life; we had about 40 people who died in the storm. There has been a lot of work that has been done post-storm and overall given the magnitude of the storm I think the city has done very well. There are an awful lot of people who are still suffering and have lost their houses and lost their jobs. So there is still an amount of disruption here, but as far as the health impacts we feel like they have been relatively contained. So there is a lot of work to do, but we feel like we are moving in the right direction.
NPH: New York State this week declared a public health emergency because of the numbers of influenza cases in your state. What’s an innovation that other health departments could find valuable in the short or long term?
Dr. Farley: The flu levels are peaking in New York City right now. We have a flu epidemic every year, but this is a bad year. The main recommendation we have for everyone is that it is not too late to get your flu shot. This is actually an example of where policy change has given us a big advantage. In New York State, but not in every state, pharmacists can administer vaccines. We now have in New York City more than 600 locations where people can go in and easily get vaccinated. That is much more available than it is in other states that don’t allow pharmacists to have this role.