Cataloguing New York City Legislation Relevant to Chronic Disease Prevention, 2002-2013.

Author(s) Brennan Rhodes-Bratton1, Gina Lovasi2, Ryan Demmer3
Affiliation(s) 1Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health , New York , United States, 2Department of Epidemiology, Columbia University, Mailman School of Public Health , New York, United States, 3Department of Epidemiology, Columbia University, Mailman School of Public Health , New York, United States.
Country - ies of focus United States
Relevant to the conference tracks Governance and Policies
Summary The overall aim of this project is to systematically detail the timing and substance of health-relevant New York City (NYC) policies and initiatives from 2002-2013. This is the initial phase of research proposing to evaluate the effectiveness of these efforts in reducing chronic disease morbidity and mortality rates. Local governments around the United States have taken policy action to mitigate the adverse effects of health determinants beyond the health care sector, such as tobacco smoke, physical inactivity, low dietary quality, and air pollution. NYC has been at the vanguard of municipal efforts to decrease the chronic disease using a multi-sectorial approach.
Background Chronic diseases represent the leading causes of death and disability among developing and developed nations (Yach et al, 2004; Beaglehole & Bonita, 2008). Among the most deadly chronic diseases, are atherosclerotic cardiovascular disease (CVD) and cancer, accounting for >65% of global mortality in 2002. This is projected to remain stable through the year 2020 at which point CVD and cancer together will account for nearly 40 million global deaths – nearly twice the number of deaths projected due to injuries and infectious disease combined (Yach et al, 2004). Respiratory diseases including emphysema and chronic obstructive pulmonary disease (COPD) are projected to become the third most common cause of death by 2020, accounting for another 10% of global mortality. It is well established that leading modifiable risk factors for chronic disease development include tobacco use, excess adiposity, low dietary quality, and exposure to particulate air pollution. The increasing concentration of populations in urban centres, while previously discussed as potentially contributing to risk (Vlahov, 2002), also represents an opportunity to enhance the public’s health through the enactment of local health promotion efforts in densely populated cities such as New York City.
Objectives Over the past twelve years, NYC has been led by the Michael Bloomberg administration, which has prioritized public health initiatives in response to the chronic disease burden of New Yorkers. Bloomberg worked closely with Health Commissioners, but the efforts were not limited to Department of Health and Mental Hygiene. A variety of governmental approaches including taxation, regulation, marketing/advertising campaigns, and infrastructure investments were proposed and implemented throughout the five boroughs. If the Bloomberg administration significantly decreased the chronic disease burden of the city dwellers, such policies can guide the nation to similar results. Currently, a comprehensive catalogue of all health-related NYC policy proposals, enacted laws and implemented initiatives does not exist.The aim of this research project was to systematically catalogue the nature and deployment of policies and initiatives relevant to public health. We will specifically focus on policies and programs enacted in NYC during the Bloomberg Administration, 2002-2013, related to the following four chronic disease risk factors: 1) tobacco, 2) obesity, 3) diet quality, and 4) air quality.
Methodology This study identifies policies and initiatives relevant to public health proposed and enacted in NYC. Specifically, it addresses the following research questions: (1) How many policies and initiatives related to public health were proposed and enacted in NYC legislation during 2002-2013 (2) Which local governmental agencies and departments were involved in the enact of such efforts.The systematic development of the catalogue of relevant policies and initiatives was generated in three phases. First, online state and city legislative record portals (assembly.state.ny.us, nyc.gov, legistar.council.nyc.gov/Legislation.aspx) and the PubMed database have been used with search terms for each of the selected chronic disease risk factors. Secondly, the searches were narrowed by selecting specific terms for each of the four chronic disease risk factors. For example, when searching legislation in regards to air pollution, the following terms, (air quality, air pollution, and greenhouse gases) were systematically used to provide consistency and a thorough assessment of relevant policies. Lastly, the search was restricted to include only the years of 2002-2013, the Bloomberg Administration’s term in office. The final catalogue includes the policy legislation number, date created, date enacted (if applicable), data enforced (if applicable), current status (as of August 2013), the primary agency that sponsored the bill, and a brief description. Note only citywide policies and regulations were included in the final catalogue.
Results Overall during 2002-2013 there were a total of 113 policies relevant to public health that were introduced and 33 enacted. Legislation that reduced the risk factor of tobacco included 33 introduced and 7 enacted policies. The New York City Council’s committee of health sponsored the majority of this legislation. The most notable legislated passed includes: Smoke Free Act of 2002, Cigarette Tax Increase, Smoking Ban at Abatement Sites, Smoking Ban at Construction Sites, Smoking Ban at Hospitals, Tobacco Product Regulation, and Smoke Free Act of 2002 (Amendment). Legislation that reduced the risk factor of air quality included 32 introduced and 12 enacted policies. The New York City Council’s committee of environmental protection sponsored the majority of this legislation. The most notable legislation passed includes: Use of clean heating oil in New York City, Requiring retrofitting and the use of ultra-low sulphur diesel fuel for school buses that transport fewer than 10 students at one time, and City's purchase of cleaner vehicles. Legislation that reduced the risk factor of physical activity included 13 introduced and 2 enacted policies. The New York City Department of Health and Mental Hygiene sponsored the majority of this legislation. The most notable initiatives include the increase of bike lanes throughout the city as well as the Citi Bike public bike sharing system. Legislation that reduced the risk factor of diet quality included 35 introduced and 12 enacted policies. The New York City Council’s committee of health sponsored the majority of this legislation. The most notable legislated proposed was the Sugary Drink Size Ban and Minimally nutritious food ban in schools. The most notable legislation passed includes Maximizing the enrolment of eligible New Yorkers in the food stamp program and the Trans fats ban.The process of developing the catalogue of public health related polices and initiatives is limited by the information that was available on the online city and state portal as of August 2013. In addition, some citywide initiatives were programs that did not require legislation thus those projects and programs are not included in the presented catalogue. Moreover, at this time the health outcome data has not been analysed thus it is not possible to quantify the impact of such polices on the health of New Yorkers which is our overall goal.
Conclusion This initial effort has highlighted that changing temporal trends in chronic disease outcomes may be attributed to one or many of the concurrent efforts, and evaluations of any one approach should be at once cautious and clever. The catalogue presented is the preliminary phase of an on-going research project to identify the magnitude and effect municipal policies impact health outcomes. Our future research includes strategies to place the temporal patterns of legislation relevant to each risk factor (Figure 2) in the broader context of other local or citywide efforts. Through this work, it will be possible to describe the cumulative “dose-response” relationship of municipal policy initiatives with population health outcomes. Strategies are also proposed using outcome specificity, differential latency periods, and multiple control comparisons that may help us to distil some evidence on the relative effectiveness of particular policies or risk factor targets. Further, we hope through an examination of scientific citation networks to shed light on the evidence base supporting such efforts. This consensus building analysis aims to provide a clearer picture of the stages at which scientific knowledge may inform decision-making, and the opportunities for municipal policies to serve as natural experiments to foster the generation of new scientific knowledge. Upon the completion of this research information about how local policies are developed, implemented can be applied to the future development of disease prevention polices.

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