Tale of Two Mayors: How Has Healthcare Policy Changed Under the De Blasio Administration?

During his first year as mayor of New York City, Michael Bloomberg broke ground by taxing cigarettes and signing a law forbidding smoking in bars and restaurants. A trans fat ban, an attempt to cap sugary drink consumption and a PR campaign promoting breastfeeding also became hallmarks of his three-term health crusade.

In contrast, Mayor Bill de Blasio’s “tale of two cities” narrative has spun a new direction in the health department. In 13 months, he has launched a five-year plan to prevent those with mental health problems from cycling through the criminal justice system and created a  so-called Center for Health Equity.

Bloomberg was driven by increasing life expectancy and improving other aggregate health indicators through macro-level policies and legislation, health and political experts said. As for de Blasio, he will likely shift personnel and resources in an attempt to cushion those most susceptible to disease and death, said Bruce Berg, associate professor of political science at Fordham University.

“The Bloomberg public health effort was a citywide effort,” said Berg, whose book on New York City public health policy, “Healing Gotham”, comes out this month. “They were gratified to see improvements in health anywhere. The de Blasio folks are much more interested in improving the health of some of those populations who probably didn’t benefit as much.”

Bloomberg’s top-down approach to public health led to new restrictions, including bans on smoking in bars and restaurants as well as in parks and plazas, a prohibition on serving food with obesity-aiding tran fats and restrictions on pouring sodas larger than 16 ounces in many types of businesses. Critics said this so-called “nanny state” approach veered into innapropriate parenting, particularly when city hospitals hid formula and pushed breastfeeding, and city officials required waivers for an Orthodox Jewish circumcision tradition that involves a rabbi sucking blood from the wound of a freshly circumcised infant.

Bloomberg also flooded streets in poor neighborhoods with fruit and vegetable carts, offered health bucks subsidies at farmer’s markets and worked to eradicate deserts where low-income communities lacked access to healthy foods.

During the mayoral race, de Blasio said he would continue or improve upon Bloomberg’s more controversial policies, such as efforts to limit large, sugary drinks, mandating that restaurants post health inspection letter grades and requiring disclaimers for the Orthodox circumcision practice, which puts the infant at risk for herpes transmission.

Now in office, de Blasio has altered the grading system for eateries, but kept it in place. He bemoaned a court ruling that the administration needed the City Council’s approval to cap sugary drinks. De Blasio spokeswoman Maibe Ponet said dialogue with legislators over how to reduce sugary drinks is “ongoing” and the administration soon expects to announce a new circumcision policy that the community is more comfortable with.

The city health commissioner, Dr. Mary Bassett, said the agency is still tackling the leading causes of death, such as obesity and tobacco use. But while the targets may not have shifted, the remedies have changed.

One area is smoking prevention, where de Blasio appears to be taking a more targeted approach than his predecessor. Patrick Kwan, director of NYC Smoke-Free, said he and other anti-tobacco advocates recently met with Bassett and brainstormed ways to get through to populations most prone to smoking, such as Chinese- and Korean-Americans, and the LGBT community, all of which have smoking rates two or three times as high as the general public’s.

“We know the commissioner is not only aware, but also educated and has the parts that will address the disparities,” Kwan said, noting that Bassett helped direct Bloomberg’s signature ban on smoking in bars during her previous department tour as deputy commissioner. “As a Chinese-American and also as someone who is gay as well … there is a general question of how we’re going to reach these crowds of people who are going to be more vulnerable to smoking addiction.”

But the most notable shift for the de Blasio administration has been its sweeping initiatives to assist those with poor access to healthcare.

Bassett, who was appointed in January 2014, said she sought to hold an equity lens up to the agency when she accepted the commissionership.

“I said we were going to focus on engaging the communities more intentionally than we had in the past, particularly communities that bear an excess burden of ill health and preventable deaths,” Bassett said.

Bassett created the Center for Health Equity to address health disparities in communities of color. Its work spans from helping local bodegas more prominently display nutritious food to launching a pilot program that will send medical professionals to Harlem public housing developments to help tenants manage chronic diseases.

Bassett also started a division of child and family development that focuses on maternal-child health, the Early Intervention program for disabled infants and toddlers.

“There are huge language gaps by race and income in children who are as young as 3,” Bassett said. “These might not sound like health outcomes to you, but they are because people who are more educated are more likely to be healthy.”

In December, de Blasio announced a $130 million, five-year plan to assist those with mental health problems who get caught up in the criminal justice system. It entails opening two clinical “drop-in” centers that offer police an alternative to making arrests. The initiative also aims to keep more people in their local communities and in treatment programs by developing a new flight-risk assessment tool and a bail system that's less reliant on money.

Then, last month, First Lady Chirlane McCray announced that the Mayor’s Fund to Advance New York City and the Health Department would create a roadmap to more inclusive mental health care.

Even de Blasio’s first-year push to expand access to pre-kindergarten programs could qualify as a healthcare initiative. Dr. James Colgrove, professor of sociomedical sciences at Columbia University Mailman School of Public Health, said the de Blasio administration has not explicitly framed universal pre-kindergarten and other social welfare programs as health issues—but they could.

“There’s a huge body of literature that shows that societies with very unequal wealth distribution have worse health outcomes,” Colgrove said. “To the extent that de Blasio’s policies aimed at reducing disparities have that effect, than, yes, you could consider that to be a public health agenda.”