The 2009 Mary Woodard Lasker Award for Public Service honors a government figure, thought leader, and philanthropist who has employed sound science in making political decisions and advanced public health through enlightened philanthropy. Michael R. Bloomberg has led the way in reducing the scourge of tobacco use and promoting good eating habits. He has held his course in the face of fierce opposition from powerful vested interests. By relentlessly translating knowledge about public health into bold government action, he has benefited a large urban community and set an example — and a new standard — for cities and countries across the globe. Bloomberg has fueled advances not only through his activities as an elected official, but also by backing higher education in public health with unprecedented levels of support and initiating a global program to combat tobacco use.
Bloomberg's first signature program as mayor of New York City has slashed the use of cigarettes. The cornerstone of this enterprise is a ban on smoking in restaurants and bars. This measure initially encountered hostility from smokers and owners of these establishments, but Bloomberg forged ahead, justifying it on the grounds of occupational safety for waiters, bartenders, and other workers. The restriction, in combination with high cigarette taxes, an aggressive anti-smoking advertising campaign, and free nicotine-replacement therapy has sparked the sharpest drop in smoking since record-keeping began in 1993. Three hundred thousand fewer New Yorkers are lighting up now than when Bloomberg took office in 2002, and the impact on adolescents is especially impressive. Tobacco use in teenagers has dropped more than 50 percent and is currently less than half the national average. Because most addiction takes hold in young people, this triumph will deliver lasting benefits to New York's citizens. Bloomberg has shown that the new law did not snuff out nightlife or douse tourism, as critics predicted. A great city could not only survive, but it could thrive, with such a restriction — and he thus established a model for other civic leaders worldwide. When New York City went smoke free, only one state and no countries had similar statutes. Now many states and nations have imposed such laws.
Bloomberg's many other public health initiatives in New York have delivered an impact to people far beyond his jurisdiction. He set his sights on fighting heart disease, the leading cause of death in New York City and the world. Before Bloomberg's initiative on trans fats, the substances — which are typically used to make oils more solid — laced the city's restaurants and posed an unnecessary hazard. The artery-clogging fats, popular in fried and processed foods, raise blood levels of the 'bad' cholesterol and lower levels of the 'good' cholesterol. Because a third of Americans' calories come from eating out, New York City residents had little control over their consumption of these unhealthy fats, which posed an entirely preventable risk. Under Bloomberg's leadership, the city banned food-service enterprises — including restaurants, street stands, caterers, school cafeterias, and bakeries — from cooking with trans fats. This measure forced manufacturers to switch to healthier ingredients and pressured restaurants to devise new ways of producing menu items. According to a July 2009 research study, use of trans fats in New York City restaurants dove from 50 percent before the rules took effect to 2 percent two years later. During this same period, dozens of national chains changed their recipes for items such as french fries. In addition, 13 jurisdictions, including California, adopted laws similar to the one in New York. The measure is reverberating across the country and around the globe.
Bloomberg further strengthened his efforts toward promoting healthy eating when he forced restaurant chains to post calorie counts as prominently as they display names of menu items and prices — an ordinance that prompted legal challenges from the industry. Bloomberg prevailed, and this innovation now provides consumers with the information they need to make healthy decisions. Furthermore, it encourages commercial food establishments to offer low-calorie items. This mandate provides a potentially powerful way to attack the growing epidemics of obesity and diabetes.
Bloomberg's activities are helping to keep New Yorkers safer on the streets as well as in restaurants and taverns. He co-founded an alliance of mayors that is working to keep handguns out of the hands of criminals. The group now boasts more than 450 members from all over the country.
Bloomberg's dedication to upgrading public health has extended beyond his role as an elected official. He has made substantial philanthropic contributions to a range of activities, including education, research, and an international program to fight tobacco use.
The Johns Hopkins University recognized Bloomberg's initial gift to its School of Public Health by renaming the institution in his honor, and his generous donations have continued to flow. Bloomberg's munificence has ensured the training of public health leaders for generations to come and profoundly enhanced the endeavors of the entire Johns Hopkins research enterprise. The University's new major research initiatives include a self-standing malaria research institute and an institute of bioengineering.
In addition to his donations to The Johns Hopkins University, Bloomberg has committed more than $350 million to a global tobacco control initiative that he founded in 2006. This program aims to curb tobacco use in low- and middle-income countries, where more than two-thirds of smokers live. It functions under a coalition of prominent agencies that include the World Health Organization and the World Lung Foundation. The initiative is working to raise tobacco taxes, help smokers quit, ban tobacco advertising, protect nonsmokers from second-hand smoke exposure, and improve the effectiveness of tobacco control policies.
Bloomberg's leadership has demonstrated that a city government can markedly improve the health of its residents by enacting inventive and daring policies that stem from solid scientific evidence. He has empowered people by offering information, safer environments, and better choices — and by bolstering one of the world's finest institutions of higher learning, the Johns Hopkins Bloomberg School of Public Health. As a champion of public health in his public and private lives, he has tackled multiple causes of chronic disease and premature death, achieving extraordinary success locally and across the planet.
by Evelyn Strauss
As chair of the Lasker Foundation's Public Service Award Committee, it is my privilege to provide an introduction to this year's Lasker Public Service Award.
When it comes to advancing the public's health, no city or state has enjoyed more enlightened, courageous, and effective leadership than New York City under Mayor Michael Bloomberg. The mayor has earned a reputation as a powerful champion for health, and he has demonstrated how science-based decision-making in government can serve the public good.
In his first big health initiative as mayor of New York City, Mike Bloomberg took on tobacco — the leading preventable cause of premature death and the only legally available product that is harmful when used as intended. A cornerstone of this enterprise was a ban on smoking in restaurants and bars that went into effect in 2003. At first, Mayor Bloomberg encountered hostility from some smokers and bar owners — he began to notice, if not directly acknowledge, their one-finger salutes at parades. But when then Health Commissioner Tom Frieden brought the mayor the proposal to ban tobacco smoking in restaurants and bars, Mike Bloomberg asked only one question: "Are you certain this is going to save lives?" When the answer was "Yes," the mayor declared, "Then do it." Frieden, perhaps wanting to be sure, went on to say there would be opposition and political risks and — the mayor cut him off: "The first rule of salesmanship," Bloomberg explained, "is when you have made the sale, leave."
The restrictions on smoking in New York City — in combination with higher cigarette taxes, an aggressive anti-smoking advertising campaign, and free nicotine-replacement therapy — sparked a sharp decline in smoking. Three hundred thousand fewer New Yorkers are lighting up now than when Bloomberg took office in 2002. The impact on adolescents is especially impressive: tobacco use in teenagers has dropped more than 50 percent and is currently less than half the national average. Because most tobacco addiction takes hold at a young age, this triumph will deliver lasting benefits to New Yorkers. Even the mayor's critics had to admit that the effect on nightlife and tourism was not as bad as they had hoped. And New York's success inspired others. At the time of the ban on smoking in restaurants and bars, only one state and no countries had similar bans. Today, most states and more than a dozen countries have followed suit. (And the mayor's not done with cigarettes yet.)
In a second initiative against heart disease, the world's leading cause of death, New York City in 2006 became the first US jurisdiction to ban trans fats in restaurants. These artery-clogging substances were developed to make oils more solid, and they help retard development of a stale taste in processed foods. Because a third of Americans' calories come from eating out, New York City residents had little control over their consumption of these unhealthy fats. Since the ban on trans fats in New York City, more than 50 national chains have eliminated trans fats in their recipes for items such as French fries, thus protecting not only New Yorkers, but fast-food patrons throughout the land. Since New York's action, 13 US jurisdictions adopted similar laws, and consumption of trans fats in North America is estimated to have declined by half.
When New York City took steps to require restaurants to label the calorie content of food, legal challenges delayed the ordinance for a year, but New York eventually became the first city in the world to put this consumer-information policy in place. Similar measures were subsequently adopted in other jurisdictions, and if Senator Tom Harkin has his way, new legislation will spread this sensible practice nationwide.
As if cancer and heart disease— tobacco, trans fats, and excess calories— were not enough, Mike Bloomberg has taken aim at illegal handguns. In 2006, he co-founded an alliance of mayors to keep handguns out of the hands of criminals. The group has attracted more than 450 members from all over the country. You may wonder why such an initiative required political courage, but why else did it have to wait until Mike Bloomberg faced the facts and took action?
There is a recognizable pattern here: Mike Bloomberg goes where science-based evidence leads. He is rational, disciplined, and persistent. His actions are dominated by what is the right thing to do for health, not by who cares one way or the other. Where he can, as in going after illegal handguns, he finds ingenious solutions that bring people together. He is willing to go first, and he measures results. In government, as in business, his modus operandi is to find the best people and let them do their job. In the first month of his first term, the mayor called in the heads of all his agencies and told them: "It's your agency. Don't screw it up." (Well, he may not have said "screw," but you get the point, and this is, after all, a decorous event.)
Even before he became mayor, Michael Bloomberg established an enduring legacy in public health. Through generous and far-sighted philanthropy, marked again by a willingness to invest in the right thing for the right reasons, he left a leading educational institution — now known as the Johns Hopkins Bloomberg School of Public Health— more strongly positioned than ever to educate a new generation of public health leaders and find new solutions to long-standing health problems.
In recent years, Michael Bloomberg embarked on a major new initiative to curb tobacco use in 15 low- and middle-income countries where more than two-thirds of smokers reside. Bloomberg Philanthropies committed $375 million to this initiative. Mike Bloomberg enlisted global partners from the public and private sectors, international agencies, and non-government organizations, and last year inspired Bill Gates to add another $125 million to the effort. Effective tobacco control measures now newly reach almost 400 million people worldwide, an important step in the right direction attributable in part to the resources made available through the Bloomberg Initiative.
Michael Bloomberg also tackled another major, and underappreciated, threat to global health: the more than 1.2 million deaths that occur every year on the world's roadways. A few years ago in Vietnam, for example, the per-passenger-mile rate of traffic fatalities was 10,000 times that of the United States. A Bloomberg-sponsored pilot project in Vietnam concentrates on getting motorcyclists to wear helmets, and serious injury and death in this group have declined by almost 20 percent.
Just last week, the mayor received an exceptional tribute for his work in global health. At the U2 concert in Giants Stadium, before a crowd of 85,000, Bono took a break in the program to acknowledge the mayor and thank him for his support of public health. It hardly gets better than that! Even though the Lasker Luncheon draws a much smaller and less rowdy audience — not to mention less talented entertainers — we want you to know, Mr. Mayor, that today's recognition is no less heartfelt.
When it comes to advancing the public's health, Mayor Bloomberg not only talks the talk and walks the walk — he blazes new trails that others can follow. Directly and indirectly, through public service and philanthropy, Michael Bloomberg's leadership saves lives and preserves health. Please join me in congratulating the recipient of the 2009 Lasker Public Service Award, the mayor of New York City, The Honorable Michael R. Bloomberg.