Dataset Information

Obesity Prevention in a City State: Lessons from New York City during the Bloomberg Administration.

ABSTRACT: OBJECTIVE:To illuminate the key components of multi-sector reform to address the obesogenic environment in New York City during the administration of Mayor Michael Bloomberg from 2002 to 2013, we conducted a case study consisting of interviews with and a critical analysis of the experiences of leading decision makers and implementers. METHOD:Key informant interviews (N?=?41) conducted in 2014 were recorded, transcribed, coded, and thematically analyzed. Participants included officials from the Health Department and other New York City Government agencies, academics, civil society members, and private sector executives. RESULTS:Participants described Mayor Bloomberg as a data-driven politician who wanted to improve the lives of New Yorkers. He appointed talented Commissioners and encouraged them and their staff to be bold, innovative, and collaborative. Multiple programs spanning multiple sectors, with varied approaches and targets, were supported. This study found that much of the work relied on loose coalitions across City Government, with single agencies responsible for their own agendas, some with health co-benefits. Many policies were implemented through non-legislative mechanisms such as executive orders and the Health Code. Despite support from academic and some civil society groups, strong lobbying from industry and an unfavorable media led to some reforms being modified, legally challenged or blocked completely, particularly food environment modifiers. In contrast, reforms of the physical environment were described as highly consultative across and outside government and resulted in slower but more sustained reform. CONCLUSION:The Bloomberg administration was a "window of opportunity" with the imprimatur of the executive to progress a long-term, multi-faceted obesity prevention strategy, which has successfully reversed childhood trends. Through the involvement of external researchers and the extensive use of empirical data from a wide range of participants, this study offers a unique insight into the ways in which this was achieved. While some of the aspects of the reforms in New York City are unique to that setting at that time, there are important lessons that are transferable to other urban settings. These include: strong and consistent leadership; a commitment to innovative approaches and cross-sectoral collaboration; and a context to support and encourage this approach.

SUBMITTER: Kelly PM

PROVIDER: S-EPMC4812825 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Obesity Prevention in a City State: Lessons from New York City during the Bloomberg Administration.

Kelly Paul M PM Davies Anna A Greig Alexandra J M AJ Lee Karen K KK

Frontiers in public health 20160330

<h4>Objective</h4>To illuminate the key components of multi-sector reform to address the obesogenic environment in New York City during the administration of Mayor Michael Bloomberg from 2002 to 2013, we conducted a case study consisting of interviews with and a critical analysis of the experiences of leading decision makers and implementers.<h4>Method</h4>Key informant interviews (N = 41) conducted in 2014 were recorded, transcribed, coded, and thematically analyzed. Participants included offic ...[more]

PMID: 27064755

Similar Datasets

Project description:ImportanceMore evidence on associations between mandated paid sick leave and health service utilization among low-income adults is needed to guide health policy and legislation nationwide.ObjectiveTo evaluate the association between New York City's 2014 paid sick leave mandate and health care utilization among Medicaid-enrolled adults.Design setting and participantsThis retrospective cohort study used New York State Medicaid administrative data for adults 18 to 64 years old continuously enrolled in Medicaid from August 1, 2011, through July 31, 2017. A difference-in-differences approach with entropy balancing weights was used to compare New York City with the rest of New York State to assess the association of the paid sick leave mandate with health care utilization, and for those 40 to 64 years old, with preventive care utilization. The data analysis was performed from June through August 2020.ExposuresTemporal and spatial variation in exposure to the mandate.Main outcomes and measuresAnnual health care utilization (emergency care, specialist visits, and primary care clinician visits) per Medicaid-enrolled adult. Secondary outcomes include categories of emergency utilization and utilization of 5 preventive services.ResultsOf 552 857 individuals (mean [SD] age, 43 [12] years; 351 130 [64%] women) who met inclusion criteria, 99 181 (18%) were White, 162 492 (29%) Black, and 138 061 (25%) Hispanic. Paid sick leave was significantly associated with a reduction in the probability of emergency care (-0.6 percentage points [pp]; 95% CI, -0.7 to -0.5 pp; P < .001), including a 0.3 pp reduction (95% CI, -0.4 to -0.2; P < .001) in care for conditions treatable in a primary care setting and an increase in annual outpatient visits (0.124 pp; 95% CI, 0.040 to 0.208 pp; P < .001). Among those 40 to 64 years old, the mandate was significantly associated with increased probabilities of glycated hemoglobin A1c level testing (2.9 pp; 95% CI, 2.5-3.3 pp; P < .001), blood cholesterol testing (2.7 pp; 95% CI, 2.5-2.9 pp; P < .001), and colon cancer screening (0.4 pp; 95% CI, 0.2-0.6 pp; P < .001).Conclusions and relevanceThis retrospective cohort study of nonelderly adults enrolled in Medicaid New York State showed that mandated paid sick leave in New York City was significantly associated with differences in several dimensions of health care services use.

Project description:ImportanceThe first government-sanctioned overdose prevention centers (OPCs) in the US opened in New York City (NYC) in November 2021 amid concerns that they may increase crime and disorder, representing a significant political challenge to OPCs.ObjectiveTo identify whether opening the first 2 government-sanctioned OPCs in the US was associated with changes in crime and disorder.Design, setting, and participantsIn this cohort study, difference-in-differences Poisson regression models were used to compare crime, residents' requests for assistance for emergencies and nuisance complaints, and police enforcement in the vicinity of NYC's 2 OPCs with those around 17 other syringe service programs that did not offer overdose prevention services from January 1, 2019, through December 31, 2022.Main outcomes and measuresChanges in the volume of crimes reported by the public or observed by police; arrests for drug possession and weapons; 911 calls and 311 calls regarding crime, public nuisances, and medical events; and summonses issued by police for criminal infractions in both the immediate vicinity of the sites (ie, a hexagonal area spanning about 6 city blocks) and their wider neighborhoods (ie, a tesselated 3-hexagon array spanning about 18 city blocks).ResultsNo significant changes were detected in violent crimes or property crimes recorded by police, 911 calls for crime or medical incidents, or 311 calls regarding drug use or unsanitary conditions observed in the vicinity of the OPCs. There was a significant decline in low-level drug enforcement, as reflected by a reduction in arrests for drug possession near the OPCs of 82.7% (95% CI, -89.9% to -70.4%) and a reduction in their broader neighborhoods of 74.5% (95% CI, -87.0% to -50.0%). Significant declines in criminal court summonses issued in the immediate vicinity by 87.9% (95% CI, -91.9% to -81.9%) and in the neighborhoods around the OPCs by 59.7% (95% CI, -73.8% to -38.0%) were observed. Reductions in enforcement were consistent with the city government's support for the 2 OPCs, which may have resulted in a desire not to deter clients from using the sites by fear of arrest for drug possession.Conclusions and relevanceIn this difference-in-differences cohort study, the first 2 government-sanctioned OPCs in the US were not associated with significant changes in measures of crime or disorder. These observations suggest the expansion of OPCs can be managed without negative crime or disorder outcomes.

Project description:New York state implemented the first state-level sepsis regulations in 2013. These regulations were associated with improved mortality, leading other states to consider similar steps. Our objective was to provide insight into New York state's sepsis policy making process, creating a roadmap for policymakers in other states considering similar regulations.DesignQualitative study using semistructured interviews.SettingWe recruited key stakeholders who had knowledge of the New York state sepsis regulations.SubjectsThirteen key stakeholders from three groups included four New York state policymakers and seven clinicians and hospital association leaders involved in the creation and implementation of the 2013 New York state sepsis regulations, as well as two members of patient advocacy groups engaged in sepsis advocacy.InterventionsNone.Measurements and main resultsWe used iterative, inductive thematic analysis to identify themes related to participant perceptions of the New York state sepsis policy, factors that influenced the policy's perceived successes, and opportunities for improvement. We identified several factors that facilitated success. Among these were that policymakers engaged a diverse array of stakeholders in development, allowing them to address potential barriers to implementation and create early buy-in. Policymakers also paid specific attention to the balance between the desire for comprehensive reporting and the burden of data collection, narrowly focusing on "essential" sepsis-related data elements to reduce the burden on hospitals. In addition, the regulations touched on all three major domains of sepsis quality-structure, process, and outcomes-going beyond a data collection to give hospitals tools to improve sepsis care.ConclusionsWe identified factors that distinguish the New York sepsis regulations from less successful sepsis polices at the federal level. Ultimately, lessons from New York state provide valuable guidance to policymakers and hospital officials seeking to develop and implement policies that will improve sepsis quality.

Dataset Information

Obesity Prevention in a City State: Lessons from New York City during the Bloomberg Administration.

Publications

Obesity Prevention in a City State: Lessons from New York City during the Bloomberg Administration.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets