Saturday, September 1, 2007

Nanny NYC Kicks Butts

(This blog was posted on Huffington Post on August 23. It attracted some amazing comments.)

Starting in his first year as mayor, 2002, Mayor Michael Bloomberg has sought to discourage smoking by New Yorkers. His efforts were opposed by many smokers, bars and cigarette vendors, and the City was derided by Human Events as “Nanny NYC”. But the Mayor’s efforts have paid off well. One-fifth of NYC smokers have quit smoking since 2002, a higher quit rate than in the nation. The Mayor crowed about this in his third annual public health report, noting that NYC had already reached its 2008 targets for lowering smoking and increasing colonoscopy screening – two years ahead of schedule. Unlike his predecessor Rudy Giuliani, who avoided drawing attention to his failures, the Mayor also admitted that he had failed to lower drug deaths and raise the number of breast-cancer screenings. The Mayor’s appetite for health activism was exceeded by the City Council when it voted earlier this year to ban metal baseball bats from schools. The Mayor vetoed the bill and the City Council overrode the veto. However, he is pressing on to help the great majority of City smokers who have tried to quit but have failed. The facts are in a new report, Who’s Still Smoking, which is based on the Community Health Survey, an ongoing telephone poll of New Yorkers. NYC is campaigning for better health by learning more about who is trying to quit and who is succeeding. The new report identifies emotional distress and binge drinking as obstacles to quitting. More surprising, it finds that fewer than one-fifth of NYC smokers are using nicotine-replacement therapies (such as patches and gum) to help quit, despite evidence that these therapies double the probability that a smoker will quit successfully.

Many Americans are increasingly dissatisfied with the high cost of medical care – yet smokers put their health at risk while spending $2,500 a year on cigarettes if they smoke one pack per day. Studies show that the United States spends by far the highest proportion of its gross product on health care but its residents have a lower life expectancy than other large developed countries like the UK, Canada, France, Germany, Japan and Sweden. Within the United States, how much Americans spend on health care per capita seems to have little connection with their longevity. A study by Christopher Murray and others on mortality disparities among “Eight Americas” in Public Library of Science - Medicine (Sept. 12, 2006) concludes that life expectancy is explained primarily by chronic illnesses (for example, heart disease and cancer) and injuries from alcohol-related traffic accidents in the 15-59 age group – and not by the relative mortality of infants or elderly people, incomes, violence or lack of health insurance.

Despite its high spending on health care, New York State ranks a surprisingly poor 19th out of 51 with an average life expectancy of 77.7 years. Hawaii has the highest life expectancy at 80 years, whereas Washington, D.C. residents have a life expectancy of only 72 years, a gap of eight years.

The size of the gap is even larger at the county level. Asian-American women in Bergen County, N.J. live the longest with an average life expectancy of 91 years. Native Americans in several rural counties in South Dakota have a life expectancy of under 67 years, a difference of 36 years.

These and other statistics point to the cost-effectiveness of public-health spending, the Nanny NYC derision notwithstanding. To support preemptive public-health activism against chronic illnesses worsened by smoking and poor nutrition, and against traffic accidents, NYC’s Department of Health and Mental Hygiene, headed by Commissioner Thomas R. Frieden:- publishes comparative data on health status in NYC's community boards,- urges colonoscopy screenings,- has alerted residents to the 75 percent increase in diabetes since 1990, and how to prevent it, - has researched safety factors for bicyclists,- has prohibited smoking in restaurants, - in a battle for better nutrition, proposes that all restaurants cut down on use of trans fats,
- proposes that 2,000 (about 10 percent) of NYC’s restaurants with standardized menu items list nutritional information, and
- is drawing attention to the fact that one million adult NYC residents do not have health insurance, even though 700,000 of them have jobs.

NYC men smoke more than women (20 percent versus 15 percent), but men and women quit at similar rates. Black and Hispanic smokers are more likely than whites to try quitting, but are significantly less likely to succeed. More low-income smokers tried to quit in 2006 than high-income smokers (68 percent versus 60 percent), but fewer succeeded. New Yorkers without a high school education were more likely to try to quit than those who have a college degree (70 percent versus 62 percent), but fewer succeeded (14 percent versus 20 percent).

Quitting rates vary by borough. Staten Island’s smoking rate has been stuck since 2002, while the citywide rate dropped by 20 percent, whereas rates in the Bronx, Manhattan and Queens have all declined more than 20 percent. So NYC’s Health Department is declaring the public health equivalent of a war on smoking in Staten Island, giving away nicotine replacements at the Staten Island ferry's Whitehall terminal Tuesdays-Thursdays, 3-6 p.m. from August 21 through September 20.

Every New Yorker should look at NYC’s surveys and alerts and should sign up for email alerts regarding health issues and emergencies. Non-New Yorkers should look at this survey as a model for what their community might do.