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Saving Gotham: A Billionaire Mayor, Activist Doctors, and the Fight for Eight Million Lives, by Tom Farley MD
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The inside story of the most audacious public health campaign of the twenty-first century.
In 2002, a dynamic doctor named Thomas Frieden became health commissioner of New York City. With support from the new mayor, billionaire Michael Bloomberg, Frieden and his health department team prohibited smoking in bars, outlawed trans fats in restaurants, and attempted to cap the size of sodas, among other groundbreaking actions. The initiatives drew heated criticism, but they worked: by 2011, 450,000 people had quit smoking, childhood obesity rates were falling, and life expectancy was growing.
Saving Gotham is the behind-the-scenes story of the most controversial―and successful―public health initiative of our time. Thomas A. Farley, MD, who succeeded Frieden as health commissioner, introduces a team of doctors who accepted the challenge of public health: to care for each of New York City’s eight million inhabitants as their own patients. The biggest threats they faced were not cholera or chemical toxins or lack of medical care but instead habits like smoking and unhealthy eating. As these doctors pressed to solve these problems, they found themselves battling those who encouraged those habits, and they reshaped their own agency for a different sort of fight.
Farley shows what happens when science-driven doctors are given the political cover to make society-wide changes to protect people from today’s health risks―and how industries exploit legislatures, the courts, the media, and public opinion to undermine them. With Washington caught in partisan paralysis and New York City’s ideas spreading around the world, Saving Gotham demonstrates how government―local government―can protect its citizens and transform health for everyone.
- Sales Rank: #25434 in Books
- Published on: 2015-10-13
- Original language: English
- Number of items: 1
- Dimensions: 9.60" h x 1.10" w x 6.50" l, 1.10 pounds
- Binding: Hardcover
- 320 pages
Review
“In recent years, New York City adopted a series of bold initiatives to reduce smoking, to combat childhood obesity, and otherwise to promote public health. Tom Farley was there, and he tells the gripping inside story. Think that a public heath department can’t save lives? Think again!” (Cass R. Sunstein, Robert Walmsley University Professor, Harvard University, and coauthor of Nudge)
“For twelve years, Mike Bloomberg was mayor of New York City, and the two Toms (Frieden and Farley) ran the health department. The brash, fearless trio took on Big Tobacco and salt- and sugar-pushers to make New York the healthiest city in America, with a life expectancy three years longer than the nation’s. This great book tells you how they did it.” (Laurie Garrett, Pulitzer Prize-winning writer and author of I Heard The Sirens Scream: How Americans Responded to the 9/11 and Anthrax Attacks)
“There is a reason why people in New York City live longer than average Americans, and this book tells you why. Tom Farley has written a fast-paced chronicle of those exciting years and recounts how a mayor who didn’t have to worry about raising funds for his campaigns told his health commissioners to think big and save lives.” (Richard Besser, MD, chief health and medical editor, ABC News)
“As mayor of NYC, Michael Bloomberg showed the world that an enlightened leader can tremendously improve the health and well-being of his constituents. In this riveting book, Dr. Farley uses his experiences as a member of Bloomberg’s public health team to describe the challenges and opposition faced at every step.” (Walter Willett, MD, DrPH, chair, Department of Nutrition, Harvard T.H. Chan School of Public Health)
“In Saving Gotham the former New York City health commissioner provides the inside story on how the city led the nation by dramatically reducing smoking rates, eliminating artificial trans fats from restaurants, getting calorie information on restaurant menus, and reducing soda consumption and obesity. Those efforts are saving thousands of lives every year.” (Michael F. Jacobson, PhD, executive director, Center for Science in the Public Interest)
About the Author
Tom Farley, MD, served as an epidemic intelligence service officer with the Centers for Disease Control and Prevention before becoming commissioner of the New York City Department of Health and Mental Hygiene. He lives in New York City.
Most helpful customer reviews
1 of 1 people found the following review helpful.
An important book for health advocates and the general public
By DB
I'm a medical student very interested in public health and health advocacy, and read a good deal on the subject. But I've yet to find a book as interesting, well-written, informative, and inspiring (not to mention funny) as Saving Gotham. This book tells the story of the public health warriors at the New York Public Health department as they battle Big Tobacco, Big Soda, Big Food, standing in front of these behemoths and trying to turn back the tide of preventable death and disability from the obesity and vascular disease epidemics. And the inspiring thing is that they succeed- not always, but enough to make a difference that we feel in everyday life. From calories on menus to smoking bans in bars and restaurants, the stories of laws and policies many of us now take for granted, policies that have saved thousands of lives, is told right here- in a form that is friendly to beginners while holding important pearls for even seasoned health advocates.
The book is fascinating because it does several things well. It explains the details- legal structures, how to run an ad campaign, the importance of sound research- that need to be worked through to make change happen. It explains the science behind the laws that were passed. It explains the strategies employed by the activist doctors and their colleagues, and how these evolve. It delves into politics local, global, and national, and explains their intersection. In doing these things, it acts like a playbook for current and future advocates.
It also delves into the people behind the work- their characters, successes and failures. It shows us how the way relationships unfold can change the course of policy. You really feel like you get to know the people at the Public Health department by the end. And it does all this with unflinching honesty- failures are examined as much as successes; difficult and often questionable decisions are presented as such; people's pettiness and self-interest is openly discussed. You get a real sense of the weight placed on the shoulders of the people the book talks about- both by the responsibility to save lives, and by the corporate, political, and public pressure they dealt with.
This is an easy, engaging read that will first make you understand the hypocrisy and corporate interests that inform our public policy, and then get you railing against it. It will put a fire in your belly, especially because of the constant reminders that the work being described saves lives- not theoretically, but concretely and measurably. There is also a very useful section on sources that lays out the science behind everything in the book.
It's an excellent reminder to medical professionals in particular that individual patient work, while important, is often a last line of defence that is activated when public health initiatives are not enough. There is also an interesting side-story about using data-driven computer software to improve primary practice that should get many of us in the medical world thinking hard and long about how we do charting and patient management.
This book is written in a very 'public health' mindset- a mindset clearly explained at the beginning of the book. It's a mindset of using data to understand how to influence peoples' decision-making to steer them in healthier directions. For those not yet comfortable with these kinds of ideas, the book makes an excellent case for them- and backs up that case with results.
I heartily recommend this book. For people doing public health and health advocacy I recommend it as a playbook from those who've made changes most of us dream about- and as fair warning about what one is getting themselves into when one decides to advocate for the people's health. Short of having been part of Frieden and Farley's teams, this is the best way to experience what will certainly be looked on as one of the most productive periods in North American public health history. For my fellow health professionals in training, I recommend this as required reading to get us ready for the world we are going to be treating patients in. For the lay person I recommend this book as a great guide to the world of health policy- to the rules that govern basic things in life, like what companies can sell you and where you can smoke.
This is, altogether, an important book.
1 of 1 people found the following review helpful.
A good introduction to what the NYC Department of Health & ...
By Robert A. Padgug
A good introduction to what the NYC Department of Health & Mental Hygiene has been doing to improve the health of the city's populations. Focuses on the battles against smoking, excessive sugar and salt in our food. Well-written and fast-paced work by a former Commissioner of Health. Somewhat triumphalist -- the city did succeed in many of these endeavors, but perhaps not quite as much as the author would have us believe, and somewhat hero-worshipping of his predecessor, Tom Frieden, whose leadership was indeed import and but appears exaggerated here. It also leaves out discussion of some of the more serious arguments and controversies around the DOH policies, politics, and priorities. A more thorough, more academic account, with a longer historical perspective, is available in James Colgrove, Epidemic City: The Politics of Public Health in New York (New York: Russell Sage Foundation, 2011), a fine book indeed.
1 of 1 people found the following review helpful.
I wish this book had been published earlier so I could have assigned it for a course I'm teaching
By PoliSciProf
I wish this book at been available earlier this fall, so that I could have assigned it for my class on state and local government! Dr. Farley's book reads like a fast-paced thriller recounting the health and well-being of New Yorkers. Farley's book is a useful text for understanding the particulars of New York City's most innovative public health solutions, however, more importantly, the book also offers unique insight into the jostling that goes into getting policies through at the local level. Dr. Farley's commentary regarding relations between state, local, and federal government is fascinating and highlights the complexity of associated with addressing public health crises.
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