What can a city do to fight cancer and heart disease?
Local health departments once battled epidemics: cholera, yellow fever, whooping cough.
The departments were founded back in the mid-1800s, and they instituted new policies in cities across the country. They made clean water available, they pushed for proper sewage disposal and they regulated unhealthy living conditions.
More than a century later, diseases like cholera have essentially been eliminated in the U.S. But what about the new threats? Cancer, diabetes, stroke?
Can a local health department help fight those?
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"Most people, before the Bloomberg years, had very low expectations of local health departments," Tom Farley told MPR News host Tom Weber. "They were about restaurant inspection and rat control."
Farley, a medical doctor, served as the commissioner of the New York City Department of Health and Mental Hygiene from 2009 to 2014. His time as commissioner overlapped with Michael Bloomberg, who was the mayor of New York City from 2002 to 2013.
Bloomberg and his administration changed people's perception of a public health department when they decided to combat the modern leading causes of death: Heart disease, diabetes, cancer. To do so, they spearheaded initiatives like a smoking ban and the moderation of soft drinks.
Farley's new book, "Saving Gotham," looks at how the city tried to improve the health of its citizens — and how the backlash from citizens and corporations thwarted some of their efforts.
The city succeeded in banning smoking in restaurants and bars — an idea that seemed radical at the time, Farley noted. Opponents warned that diners would flee to New Jersey if they couldn't smoke in New York City venues. Such fears proved unfounded, and now a bar where you can smoke seems far more radical than one where you can't.
The city did not succeed, however, in moderating soda consumption. Widely publicized as a "ban on soda," the city's proposed rule was actually more moderate, Farley said.
"What the rule would have done was put a limit on the size of the container of sugary drinks that were sold in restaurants." That limit would have been 16 ounces. If a customer still wanted a 32-ounce drink, they could get it — just in two cups.
"One of the reason why we have tripled our consumption of sugary drinks during the run-up of the obesity epidemic is that the industry started serving it in larger and larger portions," Farley said. "The 20-ounce bottle is more than twice what the large drink at McDonalds was when McDonalds first opened."
Though the New York City Board of Health succeeded in issuing the container size rule, it was invalidated by the New York Court of Appeals, which ruled that the board had exceeded its authority.
Still, Farley noted, the publicity around the so-called "soda ban" helped spread awareness, even if the rule never came to pass.
"Sugary drink consumption fell about a third in New York City during this time," Farley said. "In a way, in the thing that mattered most, we won."
To hear the full discussion about how New York City tried to battle obesity, heart disease and other leading causes of death, use the audio player above.