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October 13, 2008

Thomas Frieden's Data-Driven Activism For a Healthier New York City

new york health commissioner tom frieden Commissioner of New York City’s Health Department Thomas R. Frieden is frequently labeled as an “activist” when it comes to improving the health of New Yorkers. In a recent talk at the Bloomberg School, however, he stressed that good public health begins with basic shoeleather science—epidemiology, surveillance, measurement—in a word, data.

Frieden, MD, MPH, who spoke at the School on October 2 as part of the Bloomberg Leadership Series, said it’s an approach he’s relied on to tackle some of the most pressing public health problems of the day, including tobacco use, cardiovascular disease, tuberculosis and colon cancer.

“Local epidemiology is critically important,” said Frieden in his talk, “Making the Data Count: Public Health Strategies and Practice.” “We did the first health and nutrition survey of any community in the U.S. It led to us finding mercury poisoning from two different sources and gave us a lot of good data on secondhand smoke exposure and understanding cardiovascular risk factors in certain populations.”

Frieden’s most celebrated public health victory as health commissioner is his campaign to control tobacco use in New York City. Smoking is the leading preventable cause of death in the U.S., and he made reducing tobacco’s public health toll his top priority when he became New York’s health commissioner in 2002.

With the support of Mayor Michael R. Bloomberg—who has committed $375 million from his foundation toward reducing global tobacco use—Frieden attacked the problem with steep increases in cigarette taxes, smoking bans in restaurants and bars, expansion of smoking cessation programs and anti-smoking advertising. The department closely monitored individual programs to measure their effectiveness, based on timely data.

The tactics have yielded results: Since 2002, when the first of successive cigarette tax hikes took effect, New York’s smoking rate has dropped by 21 percent. According to Frieden, there are 300,000 fewer smokers in the city, estimated to prevent 100,000 fewer smoking-related deaths in coming years.

 But the battle continues. “We’d love to stop point-of-sale advertisements,” he said, “and we’re a long way from banning marketing to kids and restricting the nefarious influences of the tobacco industry.”

Frieden drew scattered laughter from his audience when he brought up the topic of rodent infestation.

“You can trivialize it, but it’s an emblematic urban blight issue,” he said, recalling that when the health department opened offices in the city’s poorest neighborhoods, health workers reported that residents viewed the problem as a major concern and one that contributed to a sense of hopelessness.

A project to measure the impacts of rat control programs showed that they were not effective, Frieden said. His department responded by improving training for exterminators, employing handheld computers to index the severity of rat infestation and deploying appropriate resources based on new data.

“We may be able to reduce rodent infestation substantially,” he said. “No one had really taken a rigorous approach to doing it before.”

Frieden’s most recent public health cause is reducing New Yorkers’ consumption of trans fats, a synthetic fat linked to heart disease and the leading cause of death in New York city and the U.S. As he began to confront the issue, the key question was “What can public health do on a societal basis?” In 2006, the city’s Board of Health imposed a ban on the use of trans fats in city restaurants. The move sparked a nationwide movement against trans fats and several states and cities have recently enacted similar bans.

In closing, Frieden said that good public health is data-driven. “It’s always important to ask, ‘Does the data support the policies you’re implementing?’ --Jackie Powder