Mayor Bloomberg has made several attempts to improve public health in NYC. Many policies have been emulated by other states and some have had a tangible positive impact on public health. For example, a study of restaurant diners in New York last Spring showed that NYC’s ban on trans fats actually improved resident’s diets as they chose healthier options and cut their consumption of trans-fat after the ban.
Since the ban of trans fats, Bloomberg has continued limiting or banning other unhealthy substances. In January he proposed limiting the number of prescription opiates doctors could give patients in an attempt to reduce the high abuse rate of opioids in the city. Last month he proposed a ban on sales of sugar sodas larger than 16oz by restaurants, movie theaters, pushcarts and sports arenas to curb the high rate of diabetes and obesity. Last week he proposed hiding tobacco products from customers in gas stations, bodegas and other stores where cigarettes are sold.
Each policy has glaring oversights which the public has criticized by pointing out things like patients who have real pain will have to pay high medical expenses to see another doctor for pain medication, soda enthusiasts will just buy a second 8oz soda and youngsters prone to smoking will be more influenced by seeing the act of smoking rather than the cigarettes themselves – and so far smoking on the streets of NYC has yet to be banned.
The overarching theme of the criticism over Bloomberg’s policies is that they fall short of creating real lasting outcomes for those that need critical change the most. The policies work well for those who fall into the consumption category of “out of sight out of mind” – if they can’t see large sodas or cigarettes then they won’t think of consuming them. But there is a different facet of the population these policies do little if anything for – those who are truly addicted.
Therefore, Bloomberg’s policies highlight that he may not understand substance dependence or addiction well at all. Addiction is extremely powerful and works on the cerebral cortex of the brain – the same region that drives the primal urges of survival, the “fight or flight” part of the brain that overpowers rational thought and logic. In short, once addicted, an addict will somehow obtain their substance much like cavemen went to extreme lengths to get food and survive.
The power of addiction is stronger than the policies that limit or hide away the supply of addictive substances. An opiate addict will find other sources for their pills if they can’t get enough from an ER doctor, a food addict will pursue soda and trans fat in the grocery store rather than the fast food restaurant and the avid young smoker will still purchase the cigarettes, even when hidden behind the counter. In short, those with addictive tendencies won’t forget their urge to smoke or eat excess sugar just because it isn’t in their immediate view.
Therefore, many of Bloomberg’s policies only run as deep as addictions do. If an addiction is non-existent and someone can take or leave a substance – especially if it is out of their view – then the policies work. However, for the addict, much more than limiting the visual availability of a substance is needed to help them overcome their addiction. This is evidenced by the thousands of alcoholics in recovery in NYC, who walk by bars and liquor stores all-day and still don’t pick up a drink. They can see the alcohol and have access to an endless supply of it but don’t engage in it – because the solution for those who are addicted to substances is in treatment and recovery, not in banning access to the supply of substances.
Unfortunately, the high rates of obesity, diabetes and opioid consumption in cities like NYC are not comprised of those who can “take it or leave it,” to which policies can help, but of those who are truly addicted – those who the policies do little for despite Bloomberg’s best intentions. However, if these policies were coupled with those that run deeper – such as helping addicts access addiction treatment resources – they could have a lasting effect.