NYC's Top Doc on Bloomberg's Aggressive and Often Controversial Health Mandates

Dr. Eric J. Topol Questions Dr. Thomas Farley on His Provocative Approach to Population Health

; Thomas Farley, MD, MPH


December 18, 2013

In This Article

New York City Health Commissioner

Dr. Topol: You came on in 2009 to be the health commissioner here in New York City?

Dr. Farley: Right. Before then, from 2007 to 2008, I came up here and worked as an advisor to Tom Frieden, who was commissioner for the Health Department at that time. I did that as a 1-year leave of absence from my position as a professor of community health at Tulane. I went back to Tulane and thought that was over with, but then Dr. Frieden got tapped to be the director of the CDC, and I had an opportunity to interview with Mayor Bloomberg to replace him. So I came up in 2009.

Dr. Topol: You've been working closely with Mayor Bloomberg for these 4 years or so; is that right?

Dr. Farley: Right. It's been almost 4-and-a-half years with the person that I call the "world's first public health mayor." It's been an incredible opportunity, leading what I consider to be the best public health agency in the country.

Dr. Topol: And it's got a big budget -- a couple billion dollars or something like that?

Dr. Farley: The budget is $1.6 billion, and with 6000 employees we do everything from providing healthcare in the city's jail systems, to putting nurses in the city's 1200 public schools, to dealing with smoking and air quality. You name it. We have a very broad portfolio.

Dr. Topol: Before you even took on that position, you had a book, I think it was in 2005 -- Prescription for a Healthy Nation. Was that like a warm-up for this role?

Dr. Farley: Well, it wasn't planned that way, but when I was a professor, I started thinking about the fact that much of our health education efforts weren't working and that much of what drives health these days is behaviors. And so I had a chance to think about what really does determine behavior or what opportunities we do have to influence that. I realized that environmental change is the way to influence behavior. If we can make healthy choices easier, that is the simplest and most cost-effective way to promote health, and so those were not new ideas.

Those ideas were out there in public health, but I put them together in a book that I designed to be for general readers, not for specialists, called, Prescription for a Healthy Nation. It hasn't gotten an awful lot of buyers; it's not exactly flying off the shelves. But it was a nice opportunity to put my ideas together and try to get the general public to understand public health approaches and their value.


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