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Public Health Campaigning, Like A New Yorker


This is WEEKEND EDITION from NPR News. I'm Scott Simon.

Mayor Michael Bloomberg unveiled another plan to try to promote healthier living this week. He wants New York to be the first U.S. city to make stores that sell tobacco keep those products out of sight. Cigarettes for sale are now kept in Plexiglas cubbyholes in bodegas and other convenience stores that also sell beer, candy, lottery tickets. Under this proposal, the cigarettes would have to be kept in a drawer or behind a curtain.

Concealed cigarettes is the latest measure proposed by Dr. Thomas Farley, New York's health commissioner, who is also the man who targeted Big Gulps for elimination - that plan for overturned by a judge - and has banished trans-fats from restaurants, and required chain restaurants to put calorie counts on their menus.

Dr. Thomas Farley joins us from his office in Long Island City. Thanks very much for being with us.

DR. THOMAS FARLEY: Good morning.

SIMON: Doctor, cigarettes are legal. Their sale is already highly regulated, they're certainly highly taxed. So what's to be gained by putting them out of sight?

FARLEY: Well, right now, every time you would send a teenager into a bodega or a pharmacy to pick up a carton of milk, they're going to be seeing at the checkout counter big racks of cigarettes; probably well over 100 packs of cigarettes. And studies show that the more that they see those cigarettes there, the more they see that cigarettes and smoking are normal and acceptable, and the more likely they are to smoke.

And many countries around the world have addressed that problem by requiring that those cigarettes be hidden. And that was put in place in Canada; afterwards they saw reductions in teen smoking.

SIMON: Now, beer and lottery tickets are visible, right?

FARLEY: Yes, they are.

SIMON: Do you think that that encourages people to drink and/or gamble?

FARLEY: Well, we don't have the same data on that than we do for cigarettes. And those also are not responsible for the number of deaths we've seen from cigarettes; the number one underlying killer in America today. Because of that, that's particularly important for us to protect our kids from that kind of marketing.

SIMON: How did your thinking on this develop, Doctor?

FARLEY: Well, over the years I learned that people who are at great risk for one health problem are at great risk for a variety of health problems. The same people who are dying of heart disease or who have obesity, also are at great risk for violence. They're at risk for alcohol and drug use. And so, I've learned that people's environment around them has a big influence on their health.

The poor in particular live in unhealthy environments. And so, rather than simply telling people how they can be healthy - and we do tell people how they could be healthy - we also should be trying to those healthy choices easier. And so, our kids shouldn't be - every time they going to store, be given very strong messages of what they shouldn't be doing, that is smoking.

SIMON: Dr. Farley, what role do you see for government in trying to, if you will, nudge or steer people towards a healthier way of living?

FARLEY: Well, I think the reason we have government in the first place is to help, collectively, solve problems that we can't solve individually; or that the free market won't solve. Or even sometimes if the free market is contributing to that problem. So, you know, government is there to protect us from invasion from foreign countries with an army, and it protects us from each other with the police force.

But it also protects us from a variety of environmental hazards. That would be making sure we don't have cholera in our water, or salmonella in the food when we go to a restaurant. But it also means the environmental hazard of marketing of cigarettes to children. So I think it's entirely appropriate for government to be in the role of trying to protect people's health, which it's been in that role for years.

And, you know, with food, I should say that the government has been in the food business for a long time, and regulates the food industry in many ways at every level. Everything from farm subsidies to food stamps to inspection of restaurants.

So the question is not should government be in the business of having an involvement in the food industry, but should we update the way in which government is involved in the food industry to the modern health problems of today, like obesity, diabetes and heart disease?

SIMON: With this initiative and some of the others that we mentioned in introducing you, are you using New York City as some kind of a lab or incubator, if you please, to see if government policies can work on this and other fronts?

FARLEY: Well, my responsibility is just New York City and I continue to focus on that. But it is true that what we do here in New York City is followed around the rest of the country, and to some extent around the rest of the world because we have unique opportunities here. Our health department is very big, which means we can afford to have experts who are on staff here who spend their full time thinking about how to grapple with these very big problems.

At the same time, we are local. So that we can see a problem, put in place a solution and evaluated its impact in a relatively short period of time, so they can't do it in state and federal level. And then third, this is most important, is that we have a mayor, Mayor Bloomberg, who's willing to take big risks and big political risks who thinks it's good for the health of their citizens.

So we innovate and often those ideas spread to other areas. So our smoking policies, particularly smoke-free bars, have been picked up around the rest of the country, and to a lesser extent around the world. Our ban on trans-fat is going to other cities. Our calorie counts are going national, as part of health care reform. So people do look to us for leadership.

SIMON: Do you ever worry that people might just begin to think you're a scold and start disregarding you?

FARLEY: You know, I keep on getting that sort of question. But I have to say I've been in this position for four years. And during those times, not a single person has ever come up to me and said, please, put trans-fat back in my food. Nobody has ever come up to me and said, please put secondhand smoke back in my restaurants.

When you create a healthy environment, people like it. And I should also point out that, you know, Mayor Bloomberg at the end of his third term, specifically the time when people are tired of politicians and they don't like them very much. But Mayor Bloomberg continues to have very high approval ratings. So even the people who don't agree with specific initiatives that he's done, give him great credit for just tackling what are really our biggest problems.

So I hope that other elected officials around the country take a look at that, and realize that maybe this isn't such a bad way to maintain their popularity.

SIMON: Dr. Thomas Farley, New York City's health commissioner speaking with us from his office. Thanks very much for being with us.

FARLEY: Thank you. Transcript provided by NPR, Copyright NPR.