"We're out to tell the truth and change the status quo."

BY Sari Harrar

(New York City Health Commissioner Thomas A. Farley '77 will speak at Haverford on April 6th. This profile of Farley originally appeared in the Spring/Summer 2011 issue of Haverford magazine.)

With 795,000 YouTube hits, the New York City Health Department's anti-soda video“Pouring on the Pounds” is an Internet sensation—but beware. Viewing it (or even reading the next sentence) could make you queasy. As calypso music plays in the background, the 33-second clip begins with a close-up of globby yellow fat cascading from a soda can into a tall glass. A smiling young man then gulps it all down. He winks at the camera, and this message appears: Drinking One Can of Soda a Day Can Make You 10 Pounds Fatter a Year.

It's difficult to watch—but too grossly fascinating to stop watching. And that's just the point, says New York City Health Commissioner Thomas A. Farley '77, health czar of America's biggest city. Farley's aggressive crusades against soda consumption, smoking, binge-drinking and salty food have been at times so outrageous and visceral and activist that he's riled up a Who's Who of opposition. Big Tobacco and political conservatives have blasted him, along with antihunger activists and even some health experts. Farley's been called a food nanny, a scold, even“Gotham's Dr. No.” And his shock-jock campaigns have been described as gruesome, grisly, nauseating and, in the case of that soda video,“the most disgusting commercial of all time.”

Mild-mannered and self-effacing, Farley admits to being aggressive when it comes to battling the big health threats of our time: obesity, smoking, and the woes that they trigger— heart disease, diabetes, high blood pressure, strokes, cancer. In media-saturated New York, where one in five adults is obese and two in five children and teens are overweight, sometimes you have to shout to be heard.“If you turn on the television or watch a movie these days, everything is very graphic and gory and hard-hitting,” Farley notes.“We're out to tell the truth and change the status quo. You won't be noticed at all if you're not hard-hitting.”

But Farley's not simply the Howard Stern of public health. At the forefront of a national movement that advocates“healthscaping”—using government to build healthier environments— he's pushing the political, legal and philosophical limits of public involvement in personal health. He's at the helm of a national coalition of government officials, food makers and restaurants working to slash the sodium in the food supply, and has proposed limiting the use of food stamps to buy sodas, taxing sugary drinks, requiring stores that sell cigarettes to post grisly anti-smoking posters, subsidizing produce carts in neighborhoods with few supermarkets, and more.

“Our day-to-day environment is the biggest determinant of our health,” says Farley, who has a master's in public health as well as an M. D.“It influences all the little decisions we make. It's difficult for one person to resist alone. That's why government can and should step in to reshape our environment in ways that make healthy choices easy. This doesn't take away any freedom. Government already shapes our world in many ways. The real question is, Why wouldn't government want to promote health?”

Tall and thin, Farley, 56, sits in the austere Lower Manhattan office he will be vacating when the Health Department completes a move to Long Island City, Queens. The only decor is a large (and healthy-looking) ficus tree and a blackand- white photograph of a parade in New Orleans. (Farley was chair of Tulane University's community health sciences department from 2000 to 2009 and headed the division focusing on sexually transmitted diseases at the Louisiana Office of Public Health before that.)

At 6 feet 2 inches tall, he credits his railthin physique to regular swimming, cycling, four-mile runs and plenty of low-calorie, highfiber produce. Farley, who lives on the Upper West Side, rides his bike to work occasionally And finished the 2010 New York Marathon in a respectable 3 hours, 18 minutes. He says his running skills and eating habits are nothing out of the ordinary— he was a member of Haverford's cross-country team but says he was a“lousy” runner.“If you put something unhealthy in front of me, I might eat it, just like everybody else,” he confesses.“But I don't have a list of forbidden foods that I never eat. I just try to keep healthy stuff around me by buying lots of fruit and vegetables at the supermarket.”

Putting healthy stuff within reach of all New Yorkers is his ultimate goal. At Tulane, his research found that obesity rates were, indeed, higher when people lived close to corner stores that sold more junk food and slightly lower when produce was available. In his 2005 book Prescription for a Healthy Nation, coauthored with RANDCorporation Senior Scientist Deborah A. Cohen, he outlined the manifesto of the healthscaping movement— and seemed to also predict his future work in New York City:

Most people believe that being overweight represents a personal failure, a lack of discipline and willpower. Accepting that argument, when six out of ten Americans are overweight, means believing that we are a nation of losers. Americans are not irresponsible or lazy ... The character of Americans has not changed in the past forty years—our environment has.

The fix? Re-engineering towns, schools and workplaces, Farley and Cohen wrote, so that everyday activity becomes“as unavoidable as an encounter with a vending machine is now.” They also suggested taxing junk food and using the proceeds to fund counter-advertising“with the same slickness and saturation as the ‘got milk' and ‘Beef: It's What's for Dinner' campaigns.”

Farley's an innovator, but he's not alone. In 2008 he was an adviser to his predecessor, New York City's then-Health Commissioner Thomas R. Frieden. Frieden made waves by banning trans fats from city restaurants, forcing eateries to post calorie counts on menu boards—a project Farley worked on—making bars smoke-free, and getting the slogan“Get Some!” printed on tens of millions of free condoms. Farley was already a fan of New York Mayor Michael Bloomberg's own health activism. (According to The New York Times, Bloomberg“wants to be to health what former mayor Rudolph Giuliani was to crime.”) So when President Obama appointed Frieden director of the Centers for Disease Control and Prevention and Farley was offered the city's top health job,“it took less than a minute to decide. This is the best public health job in the world,”he says.

Trained as a pediatrician, Farley gravitated to public health early in his career because“I could see it was a good fit with my skills and personality. It has such potential.” Even at home, where he and his wife, Alice Farley (BMC '77), a pediatrician, raised four daughters (their third, Helen, will be a Haverford sophomore in the fall), he says he was more likely to“make healthy choices available rather than to restrict or lecture.”

The swine-flu epidemic was at its height in New York when Farley stepped into the health commissioner's post. But he and Bloomberg quickly set their sights on soda, tobacco and sodium—drawing support from nutrition and obesity experts as well as yelps of opposition.

Conservatives quickly called their proposal to bar the use of food stamps to purchase soda intrusive. Anti-hunger activists like the Washington, D.C.-based Food Research and Action Center denounced the plan as patronizing and stigmatizing. Among the idea's supporters was New York University nutrition and public health professor Marion Nestle. She told The Atlantic that while she felt“general discomfort” telling people what to eat or drink, she came to agree with the ban after considering the intense marketing of soda to kids and teens in lowincome neighborhoods, higher rates of obesity in the same communities, and evidence that sugary drinks increase obesity risk.

The proposal is still being considered by the U.S. Department of Agriculture.“Food stamps is a nutrition program,” Farley explains.“You can't use it to buy alcohol or cigarettes or pet food. Adding sugar-sweetened drinks to that list isn't patronizing. It acknowledges that these drinks are a big contributor of empty calories to the diets and waistlines of Americans.”

When it comes to smoking, The city Health Department's campaigns have pitted Big Tobacco against the nation's biggest health and medical groups. Two riveting TV commercials, which aired during the city's March 2011 give-away of nicotine patches and gum, depict the suffering smoking causes— in one, shot in low light with no soundtrack, the camera focuses on the labored breathing of a bedridden woman who's had a smoking-related stroke.“We wanted to show the truth, the real effects of smoking,” Farley says.

But when the city required stores that sell cigarettes to post grisly anti-smoking posters (one shows a diseased lung, another a stroke-damaged brain), tobacco companies filed suit and the program was struck down. The city has appealed. In April, 25 groups filed a brief in support of the ads, including the American Medical Association, American Cancer Society, American Lung Association of New York, American Thoracic Society and the Campaign for Tobacco-Free Kids.“We're right,” Farley says.“I think we'll get the ads into stores.”

It's not all confrontation. Farley's biggest accomplishment may be spearheading a voluntary, nationwide coalition of government officials and food-industry giants aimed at slashing sodium levels by 25 percent by 2015. A few critics have Called it an“uncontrolled experiment,” but studies show that similar strategies in Finland and Japan have been associated with reduced rates of high blood pressure, heart attacks and stroke.“Sodium intakes have been climbing since the 1970s— we're just trying to help people get back to a healthier intake,” Farley says.“Almost 80 percent of the sodium in the diets of New Yorkers and Americans comes from processed foods and restaurant foods. This has the potential to save hundreds of thousands of lives.”

Kelly D. Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University, praises Farley's willingness to take the lead on this, and other public health issues.“Dr. Farley and colleagues have led the way on stopping the use of trans fats in restaurants, labeling of calories on restaurant menus and attempting to reverse the damage done by consumption of sugar sweetened beverages,” Brownell says.“There is no question these efforts will improve public health, save lives, and reduce health care costs for all of us. What begins in New York City is very likely to spread first to other cities, then to states, and finally to the national level.”

Meanwhile, in the giant jigsaw puzzle of public health, no target is too small. Before the opening of the 2011 baseball season, Farley and 14 other health commissioners from around the country asked Baseball Commissioner Bud Selig to ban smokeless tobacco from Major League Baseball. Selig says he's on board, but needs the Players' Association to agree to nixing dip and chew. If it's ever approved, one more small piece of the healthy-living puzzle that Farley envisions would fall into place.“Smokeless tobacco was banned in the minor leagues in 1993,” Farley says.“Baseball players are role models for kids—and so smokeless tobacco can be a gateway to smoking cigarettes. It's not a small thing at all.” #