Changing People's Behavior
Dr. Topol: The last thing I want to ask you about is probably the most challenging of all: changing people's behavior. I know you've studied that a lot and thought a lot about it. We touched on it already during the discussion, but obviously we have this epidemic of unhealthy lifestyles. One way, of course, is regulating it, but are there things that we are missing today that we could do? Using incentives, for example? [How about] employers using employee health systems to change people's behavior? What can be done to improve this behavioral science and get lifestyles on track?
Dr. Farley: There has always been a lot of focus on how to deal with an individual person to try to help him change his behavior within a given environment. But at the population level it's difficult to do that, and it's certainly not cost-effective to do that. The way that we change the behavior of entire populations, which is the way I think we improve the health of entire populations, is to make healthy choices easier and sometimes to make unhealthy choices a little more difficult. Smoking, for example -- we made it a little bit more difficult to smoke by saying that you can't smoke indoors, and we raised the price of cigarettes.
Dr. Topol: You used some pretty strong images, too, to help convey that.
Dr. Farley: Right; we had an impact on the media environment. People tended to have a very positive image of smoking, as something that was sexy because actors do it on the screen. We associated a negative image with that, that actually it makes you get sick, and it can be kind of disgusting to think of what your lungs look like. But it is that environmental change that makes changing the behavior of populations the easiest. Right now we are in an environment where it is difficult for most people to expend energy, because they have to drive to where they are going to and there aren't other opportunities to exercise where they are. And it's too easy to consume too many calories. Everywhere we go there's food within arm's length, and we are biologically programmed to want to pack away those calories for the next famine. If we can change our food environment, if we can change the way our environment is built so that the calorie balance is naturally a little bit in the opposite direction, then we can reverse the obesity epidemic. Environmental approaches are where I think we have the greatest benefit.
Dr. Topol: This has been fascinating. It is great to get your insights, and I give you a lot of credit for the aggressive stance that you have taken here in New York City since you came on as commissioner. In these 4-and-a-half years, we have learned a lot. The whole world has been watching New York City, and I know so much of it was the efforts that you have done to try to improve public health using this model, this phenomenal model. Thank you so much for joining us, Tom.