Big-picture thoughts on a healthier region

As the star of public service commercials widely aired in Boston and New York City, he was filmed at a baseball field, at a swimming pool and in his shower, the monotone of his mechanical voice box describing a life forever altered by throat cancer at 39.

“I almost died,” he says in a voiceover, the camera focused on a bib around his neck to cover the hole in his throat as he showers, in one ad. “Nothing will ever be the same again.”

The ads were part of a multimillion-dollar campaign of the New York City Public Health Department that was credited with smoking rates diving from 22% in 2002 to 14% in 2014. That represents nearly half a million fewer smokers.

The fight against smoking was the opening salvo in a deliberate, 12-year movement under former New York Mayor Michael Bloomberg to change the health of New Yorkers by making it easier for people to make healthy choices. New York City leveraged the power of mass-media marketing and local government to target cigarettes, trans fats and rising obesity rates with calorie counts on fast-food menus and improved access to fresh produce.

The efforts paid off in better health for 8 million New Yorkers. Between 2001 and 2010, residents’ life expectancy increased three years, to 80.9 years, compared to a 1.8-year life-expectancy gain to 78.7 years in the United States. This was not due to poorer people moving away. New York City’s poverty rate was stable during that time.

Dr. Tom Farley, former NYC Health Commissioner, speaks at City Club
Photo courtesy of Donn R. Nottage/The City Club of Cleveland

In his recent talk at the Cleveland City Club, Dr. Tom Farley, a former health commissioner in the Bloomberg administration, said the city used a “wholesale” approach to improve the health of millions, rather than a “retail” model of one person at a time.

Changing the physical and social environment is the best way to prevent behaviors that put people at high risk for avoidable, costly and debilitating chronic conditions like diabetes, heart disease and obesity — the leading 21st-century killers. Public health interventions that reach a large population save more money — and lives — than health care that typically focuses on individuals when they already are sick, Farley said.

“We can have a pretty big impact on people by changing the world around them,” Farley said.

In a private event just before his City Club talk, Farley spoke with more than 50 Northeast Ohio leaders from government, health care, academia and community organizations. What lessons can a passionate posse of public health leaders working for a billionaire former mayor offer to improve better health in Northeast Ohio?

Think big, Farley said: “We need to think as big as the problems we are trying to solve.”

In Northeast Ohio, we have big problems. Cuyahoga County ranks 65th of Ohio’s 88 counties in health outcomes; 78th in social and economic factors related to health and 68th in health-promoting physical environment, according to County Health Rankings for 2015. In Cleveland, 19% of adults are smokers.

Better Health Partnership, which partnered with the City Club to bring Farley to Cleveland and convened the local leaders, posed a question to the group: What is the single most important thing that can be done to improve the health of the population in Northeast Ohio?

The two most prominent themes in the responses suggest a promising start in thinking big: 1) Health and equity are things we all have to think about in policies across sectors, and, 2) The importance of unified approach. Together, we are so much better when we’re less focused on competition and instead focused on population health.

“You don’t need a billionaire mayor to improve population health,” Farley assured attendees. “It takes unity of purpose.”

Could a group of cross-sector leaders come together to take bold action to prevent killer diseases that are taking their toll on Northeast Ohio?

Perhaps some airings of Ronaldo Martínez’s public service announcements would be a good place to start.

This blog entry was originally published February 22, 2016 in Crain’s Cleveland Business editorial pages. It was co-authored by Dr. Dave Margolius, MetroHealth Medical Center, and Heidi Gullett, MD, Associate Program Director, Public Health/General Preventive Medicine Residency in the Department of Family Medicine and Community Health at Case Western Reserve University School of Medicine.



One thought on “Big-picture thoughts on a healthier region

  1. Dave! Love your sharing your thoughts on primary care. I just started my post-residency job and am loving the challenges/rewards. Looking forward to learning from and with you!


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