A Bloomberg presidential bid would reignite feisty public health debate

Former New York City Mayor Michael Bloomberg is contemplating a presidential bid that could shake up the political landscape — and kick start a rowdy national conversation on how far government should go to protect public health.

Bloomberg has focused in recent years on pressing for gun control and aggressive moves to tackle climate change. He frames both issues as public health imperatives.

But during his three terms as mayor, ending in 2013, Bloomberg also pushed a series of bold and bitterly contested policies aimed at prodding New York City residents to adopt healthier lifestyles. He wouldn’t let them smoke in most bars or buy potatoes fried in trans fats. He even tried to ban big sodas.

Bloomberg’s foes cried “nanny state.” His fans praised his vision. Expect more of the same in any presidential bid.

“It would be exhilarating to have a presidential campaign where the issues that promote health are front and center, where we discuss how we can change the social, cultural, and economic conditions that contribute to the promotion of public health,” said Dr. Sandro Galea, dean of Boston University’s school of public health, who served on New York’s board of health under Bloomberg.

So, how well did the Bloomberg policies work? Here’s a look at the evidence:

Banning trans fat in restaurants

In 2006, the Bloomberg administration pushed through a provocative regulation: A ban on artificial trans fats in New York restaurants. The move forced chefs to redo recipes for everything from donuts to stir-fry.

The ban did cut down on the amount of dangerous trans fats consumed by customers at fast food chains in New York City, according to a study conducted by city health officials and published in the Annals of Internal Medicine. And it became a national model; the US Food and Drug Administration is moving to phase out trans fats in processed foods across the country.

Banning trans fat is meant to protect consumers from heart disease and strokes. Evidence from Europe suggests it could help: In the three years after Denmark limited trans fats in 2004, mortality from cardiovascular disease dropped more than researchers would have expected without the ban. But it’s not clear how the New York City regulation has affected residents.

Forcing customers to consider calories

The Bloomberg administration also required many restaurants, especially fast food chains, to post calorie counts on their menu boards.

That move, too, was copied by the FDA, which will require restaurant menus to include calorie counts by the end of the year.

But it, too, had mixed results. A study published last year in Health Affairs found that posting calorie counts did not lower the amount of calories consumed at a selection of fast food restaurants.

That finding overshadowed an earlier, more optimistic result, which showed that after Starbucks posted calorie counts, the amount of calories purchased in an average transaction dropped 6 percent, as consumers altered their food (but not their beverage) selection.

And indeed, the obesity rate in New York City is still increasing. Fully 27 percent of adults in the state were considered obese in 2014, up from 17 percent in 2000, according to the Robert Wood Johnson Foundation.

Enacting broad bans on smoking

Back in 2002, Bloomberg successfully pushed through the Smoke-Free Air Act, which banned smoking in many public places, such as restaurants, most bars, and public transportation. Smokers, and some business owners, protested loudly, calling the rule “brutal,” “Stalinesque” and a sure-fire way to kill all fun in New York City.

But Bloomberg persisted. He called the ban one of the most important things he’d ever done. The city council later banned smoking in city beaches and parks.

In the years after the indoor smoking ban took effect, the smoking rate did decrease  in New York City — but it also decreased across the country.  The rate of decline is larger in New York, but’s an open question as to how much of that is attributable to the ban.

One of the last bills Bloomberg signed banned the smoking of e-cigarettes everywhere that smoking regular cigarettes was forbidden. He may have been ahead of his time on that one: E-cigarettes have recently become a topic of national debate.

But some research suggests that tough e-cigarette regulation could be counterproductive by driving people to conventional cigarettes. A Yale study published last month found that adolescent smoking rates increased in states that banned the sale of e-cigarettes to minors relative to states that didn’t. 

Taking on Big Soda

Among the general public, Bloomberg may be best known today for his quixotic attempt to ban giant sodas, which was fodder for comedians and political activists alike. (Sarah Palin famously drank a Big Gulp from the podium at the the Conservative Political Action Conference in 2013, to thunderous applause — even though Bloomberg’s initiative would not have applied to drinks served at 7-Eleven.)

The New York City Board of Health did approve a ban on the sale of sugary drinks larger than 16 ounces in many food establishments, but that was soon struck down by a Manhattan judge. The judge ruled that the portion control rule would “create an administrative Leviathan and violate the separation of powers doctrine” — which, he wrote, “has the potential to be more troubling than sugar-sweetened beverages.”

Since then, the national debate has refocused on the merits of levying extra taxes on soda and other sugary beverages. 

Correction: An earlier version of this story mischaracterized the relationship between trans fat and obesity and misstated the status of New York City’s outdoor smoking ban.