Public Health and the New York Primary

With the presidential campaign now focused squarely on New York State's April 19 primary, there may well be an opportunity for substantive discussion that many New Yorkers, in my experience, would like to hear. That substance would focus on a range of pressing issues including public health, which have not yet received sufficient attention in the ongoing give-and-take of political debate.

On April 14th, all of the Republican and Democratic candidates for President will be in New York City - the Democrats for a debate in Brooklyn; the Republicans for a gala in Manhattan. And what better place to discuss public health than New York City?

An older city, New York faces all of the challenges of maintaining longstanding infrastructure. A coastal city, New York is subject to rising winds and water and to the damages of more severe storms. A global city, New York's airports must be on alert for travel-borne illnesses. And of course, as an innovative city, New York has long been in the vanguard of planning for our future.

Public health, after all, refers to the actions we take collectively to create health and address particular vulnerabilities. It is dependent on all of the factors that affect how we live and how well we pursue options for healthy living. Does our public infrastructure provide safe water, clean air, essential sanitation, and easy access to healthy food, affordable housing, fundamental healthcare, social services, and opportunities for exercise and recreation? Are appropriate preparations being made for the health impacts of climate change - arguably the greatest risk facing the planet? Are systems in place to prevent, detect, and control the spread of disease? Are we preparing for good health across our now-longer lives? Are we sufficiently forward-looking in anticipating needs that go far beyond this single election season?

When it comes to addressing future needs, New York City has been especially forward-looking. Its PlaNYC, originally released in 2007 by Mayor Michael Bloomberg, has evolved into Mayor Bill de Blasio's One New York: The Plan for a Strong and Just City (OneNYC) , a groundbreaking effort to address New York City's long-term challenges: the forecast growth to 9 million residents by 2040, changing climate conditions, an evolving economy, and aging infrastructure. As the plan states, "OneNYC represents a unified vision for a sustainable, resilient, and equitable city, and charts the path for collectively achieving this goal."

New York City has also been a leader in ensuring an age-friendly city, a crucial priority given that life expectancy in the United States has grown by 30 years in the last century. Age-FriendlyNYC , a commission led by the Mayor and on which I serve, has created more than 60 low-cost, high-impact interventions designed to enhance successful aging. It offers a model for the nation, whose population aged 65 and over is projected by the U.S. Census Bureau to be nearly 84 million in 2050, more than double the population of 40 million in 2010. Our city's good health extends to rich and poor alike. Just this week, the Journal of the American Medical Association published a study that ranked the New York metropolitan area first in the nation for life expectancy among the poor.

In addition, New York City has created a comprehensive mental health plan called ThriveNYC , with the leadership of Mayor de Blasio and First Lady Chirlane McCray. It is focused on six principles: "change the culture" to have an open conversation about mental health; "act early" by investing in prevention and early intervention; "close treatment gaps" by addressing disparities in care; "partner with communities" to create effective and culturally competent solutions; "use better data" to produce better treatment, policies, and interventions; and, "strengthen government's ability to lead" in fulfilling its responsibility to support mental health.

How America solves--and leads--in the creation of public health solutions is a crucial issue that demands attention and discussion from the presidential candidates. The question is: Can the focus on the New York primary serve as more than just another stop on the long road to the White House? Can it inject New York's passion for public health leadership and illuminate the topic in a way that frames these crucial issues for the remaining months of the campaign? Can we, at long last, bring an investment mentality to health?