by Tom Farley
The antitobacco advocates, though, wanted to define e-cigarettes as cigarettes, which would mean that all three of the bills would apply. If we didn’t include e-cigarettes in the pack display ban, they told us, stores would just replace the cigarette-pack power walls with displays for e-cigarettes. As time passed, the advocates only became more insistent. By the end of the summer, the American Heart Association, the American Lung Association, and the American Cancer Society lobbyists stunned us by saying they would now refuse to support the three bills unless they applied to e-cigarettes.
In the middle of that argument, the director for the Campaign for Tobacco-Free Kids inserted an entirely different demand. He believed that, because federal judges were now so expansive in interpreting protected commercial speech, the bill requiring retailers to hide cigarette packs would lose a lawsuit by the tobacco companies. And a federal court ruling like that, if it were broad, might hurt other antismoking policies, like the FDA’s rule requiring that cigarette packs carry pictorial warnings. He didn’t want New York City to pass the pack display ban, with or without e-cigarettes. The pressure of the powerful tobacco companies had split even those of us who agreed that tobacco was the nation’s top public enemy.
These groups mattered because Christine Quinn felt she needed all the antismoking groups standing with her. As she explained later, the bills were confusing, they were “pushing the envelope,” and they weren’t the council’s idea. How could she force the bills through the chamber if even the antismoking people wouldn’t support them? She called the lobbyist for Tobacco-Free Kids and “had a firm conversation with him” in which she threatened to “walk away from everything,” but he didn’t budge. “I couldn’t believe it,” said Quinn. “It was just so insane!”
Hoping to get help out of the morass, I went to Mayor Bloomberg. As we sat at a table in the Bull Pen, I told him that three of the four antismoking groups were insisting that we include e-cigarettes in the tobacco bills and that the fourth wanted to kill the pack display ban because of legal risks. I want to pass all of them without changes, I said, hoping that he could persuade Quinn. If the council were to pass these groundbreaking bills, I believed the advocates would fall in line.
The Bloomberg administration had just been stung by court losses over the sugary drink portion cap and a requirement that taxicabs be gasoline-electric hybrids. We saw these defeats as inevitable turf battles among different arms of a checks-and-balances government, but the public, Howard Wolfson said, saw them as the mayor breaking the law. We couldn’t afford another loss in court, he thought.
Bloomberg listened. If there’s a real risk that we’ll lose the pack display ban in court, he said, pull it back.
That left us with the age-twenty-one bill and the bill that would ban price discounts. We agreed to include e-cigarettes in the age-twenty-one bill. Then we persuaded the antismoking advocates that there was no practical way to prohibit discounting of e-cigarettes when the product was not standardized. And we went back to Christine Quinn with an agreement on the two bills.
In September 2013, Quinn’s long campaign for mayor ended. She had been first in the polls for months but saw her lead disintegrate in the month before the primary, not just to second, which would have given her a chance in a runoff against a surging Bill de Blasio, but to third. Afterward, she was no longer a candidate but still speaker, so she went back to doing what she did best: passing bills. She brought the two antismoking bills up for votes. Few council members spoke in opposition to either, but those who did complained about the age-twenty-one sales restriction. If someone is old enough to go to war, they argued, he should be old enough to buy cigarettes. But as Vicki Grimshaw put it, “I don’t understand why if you can die for your country, you can die for the tobacco industry. I don’t get that parallel.” The age-twenty-one sales limit passed by a vote of 35 to 10. The bill that banned discounts on cigarettes, set a minimum price, required “bundling” of cigars, and gave the city, in the words of the Bloomberg press release, “new tools to crack down on disreputable retailers and black-market bootleggers,” passed by an even larger margin of 36 to 9.
The antismoking advocates and the health department put aside the painful arguments over the now-dead pack display ban and went to a (smoke-free) bar near City Hall to celebrate the success not just of these two bills but of the Bloomberg administration’s twelve years of work against tobacco. “It was great,” said Grimshaw. And then “it was like, Okay, how long will it take before the industry serves us with a lawsuit?”
• • •
We thought that would be the last word on tobacco. It wasn’t. Council member Jim Gennaro called us after the vote to say he wanted to “ban e-cigarettes.” By that he meant to include them the Smoke-Free Air Act, which would prohibit using e-cigarettes in restaurants, bars, and other workplaces.
Despite her waning days as speaker—or maybe because of them—Christine Quinn was game. “Two things happened,” she explained to me. “One, it was like, what the fuck, let’s give it a shot. You know what I mean. Let’s go out with a bang.” And then “I wanted to allow members the ability to say ‘You know what, I didn’t leave not having gotten X passed.’” And she hated e-cigarettes. “Whether the data show it or not, younger people are going to get them, and it’s going to put you on a life of smoking,” she told me. “You don’t have to be a scientist or doctor to know that. It’s common sense. . . . And there’s nicotine in them! . . . So this is not good! This is bad!”
Mayor Bloomberg, when we spoke about it, reacted even more strongly. “They’re just trying to get young people hooked,” he said, disgusted.
I saw other reasons for banning e-cigarettes indoors. Later I phrased it this way: Imagine a crowded bar filled with people puffing on things that look like cigarettes. If a bartender then smells tobacco smoke, whom would he tap on the shoulder and ask to put the cigarette out? If we allowed e-cigarettes in bars, the Smoke-Free Air Act itself, which depended on enforcement by employees and bystanders, might unravel. And if conventional cigarettes crept back into bars, we would lose Bloomberg’s society-altering achievement of 2002, which was one of the best things anyone had done in the history of smoking prevention.
By the time of the hearing on the e-cigarette bill, the renovations had been completed in City Hall, and we were back in the council’s grand chamber. The majestic room was outfitted with dark wood wainscoting, mahogany desks, deep red carpeting, and life-size portraits of the Marquis de Lafayette and of George Washington beside a white horse. That day dozens of e-cigarette vapers packed the gallery to listen and be heard. Throughout the four-and-a-half-hour hearing, as they murmured and applauded and heckled, they also sucked and puffed on various e-cigarette contraptions, sending out plumes of fruity vapor. And that made our case for us.
Council member Peter Vallone told the crowd, “I’m watching puffs of vapor go up in this room, and it is confusing, number one. And number two, I smell it. It doesn’t bother me. It smells good. But it might bother me if I were in a restaurant and I smelled that.” One of our legislative staff members on the scene found it hilarious. “It smelled almost like bad room deodorizer,” she said. “It was like, what not to do if you want to convince electeds of something.”
Several e-cigarette advocates even puffed away as they testified. “All the Council members were offended,” said another health department employee. Christine Quinn said later, “What a group of freaks! Who the hell knew there was going to be this pack of weirdos who showed up and smoked e-cigarettes in the chambers! Bizarre!”
When the council met two weeks later on December 19, on their last meeting before the new administration took over and before many members were forced out by term limits, the body voted to include electronic cigarettes in the Smoke-Free Air Act by a tally of 43 to 8.
• • •
And there was one last twist before the bill would become law, a coda to the Bloomberg administration’s long war on smoking.
On Decembe
r 26, 2013, five days before Mike Bloomberg ended his twelve-year run as mayor of New York City, he and I met with Sean Parker, the brash tech entrepreneur who cofounded Napster and had been the first president of Facebook. At thirty-four, Parker had already founded or invested in many start-ups, been chased from three companies, and accumulated $2 billion. Another tech entrepreneur called him “the Picasso of business,” but a profile in Forbes had described him as “flighty, manic and unpredictable.” Parker had invested tens of millions in NJOY, the e-cigarette company that proclaims, “Our mission is to obsolete cigarettes.” Wearing jeans and a trim, reddish-brown beard, he arrived in Bloomberg’s Bull Pen to persuade the mayor to veto the bill including e-cigarettes in the Smoke-Free Air Act.
After making small talk with Bloomberg about where they were investing their billions and the foolishly high stock price of Twitter, Parker began to make his case. Before he got rolling, though, the mayor told him calmly that “we’re too far into this” to back out now.
Parker went on anyway. He wasn’t investing in e-cigarettes to make money. He was only in NJOY to make people healthier. The tobacco industry was a typical, traditional, “fucked-up market.” Government regulation of tobacco hadn’t achieved much and—as always when government tried to interfere with markets—was bound to fail. But e-cigarettes were going to disrupt that market. They were already winning market share from combustion cigarettes, and they were still in version 1.0. Future versions were bound to outcompete Marlboro. When they did, they would do more to end smoking and promote health than anything government would ever do. Given their potential, Bloomberg shouldn’t do anything to interfere with e-cigarettes, especially prohibit people from using them indoors.
The mayor looked bored and distracted and mostly left it up to me to respond. It would be one thing if NJOY were trying to help smokers quit, I jumped in. If NJOY wanted to end smoking, the company should do the studies that showed that e-cigarettes were safe and effective for quitting and then get licensed by the FDA for that. If NJOY did that, public health people like me would be the company’s loudest cheerleaders. But NJOY was behaving like a pure for-profit company, and the profit in e-cigarettes was in getting nonsmokers addicted. The company’s marketing—like sending hunky bare-chested men to pass out free samples in Union Square—seemed to be all about capturing young nonsmokers.
Parker wasn’t impressed. It dawned on me that he and I saw the world entirely differently. He believed in the limitless potential of technological innovation and free markets to make the world better. I believed government needed to protect citizens from profit-driven corporations selling products that hurt people. We weren’t going to agree.
The more Parker pressed his case, the more distracted Bloomberg looked. The mayor glanced around the Bull Pen and commented on other things he was working on. But he came back to e-cigarettes just enough to confirm, calmly, that he couldn’t possibly veto a bill that his administration had pushed.
With just five days left, Parker shot back, Bloomberg could do whatever he wanted.
Bloomberg’s attention was wandering further afield, so the conversation became one between Parker and me. He became increasingly agitated as he kept arguing, as if he were a kettle about to boil. Eventually the mayor, looking more bored than ever, stood up and walked back into the sea of desks. And then Parker left, red-faced.
• • •
On December 30, 2013, with less than forty-eight hours left in his mayoralty, Mike Bloomberg held a bill-signing ceremony in the Blue Room, the last of hundreds. Christine Quinn’s last-minute flurry of legislating had given him twenty-two to sign. It was a bookend of sorts. One of his earliest bills had banned smoking in bars and restaurants. One of the last would prohibit using a high-tech cigarette substitute in the same places.
The Blue Room was packed with reporters and curious onlookers. Jim Gennaro was there, proud of himself and full of praise for the mayor. Bloomberg, standing behind the podium with the mayoral seal and beside the portrait of Alexander Hamilton, was a touch nostalgic. When he opened up the floor for comments, several doctors and health advocates who had traveled to City Hall for the moment came to the mike to extol not just the e-cigarette bill but Bloomberg’s dozen years protecting New Yorkers’ health. They were followed by two angry smokers who, with comments like “good people disobey bad laws,” lit up cigarettes in front of the news cameras. “Okay,” Bloomberg said to them calmly, “I think it’s time to leave.”
20
“That is, ultimately, government’s highest duty.”
On September 20, 2011, I entered the General Assembly Hall at the United Nations with a small group of city officials. The UN was holding a high-level meeting to “launch an all-out attack on non-communicable diseases (NCDs)”—including heart disease, stroke, cancer, diabetes, and chronic lung disease—“the often preventable scourge that causes 63 per cent of all deaths.” It was only the second such meeting in the organization’s history on a health topic; the other had been held ten years earlier on HIV/AIDS. The General Assembly Hall is an oval cavern trimmed in green and gold. The ceiling was lost several stories above us, and the floor below was filled with desks bearing labels like Paraguay and Estonia. Balcony seats ring three-quarters of the oval, and behind them are glass-windowed booths for interpreters. At the front, beneath a giant wooden backdrop holding the UN logo, is a green-marbled desk for the UN leaders, in front of which stands a speaker’s lectern.
It was my first time at the UN. Although I had been warned, I found it even more chaotic than advertised. When we arrived, speaking behind the lectern was the president of Hungary, who was followed by the prime minister of St. Kitts and Nevis. As the heads of state spoke, delegates at their tables chatted with one another, tapped on their cell phones, or milled around. But when these speakers finished and the next one rose to the podium, the delegates sat up, lifted their cell phones, and began snapping pictures, their flashes flickering across the floor. They were seeing New York City’s mayor, Michael Bloomberg.
For more than 150 years, most governments had assumed that the only diseases worth preventing were caused by infections that passed from one person to another. And even in 2012, the communicable diseases of HIV, tuberculosis, and malaria persisted. But as the twentieth century became the twenty-first, the diseases that killed most humans had changed drastically. With sanitation, vaccination, and nutrition subduing infectious diseases, NCDs had come to the fore. This “epidemiologic transition” hit countries at different times, but the change reached every corner of the world. In the United States, fewer than 5 percent of deaths were from communicable diseases, and 88 percent were from NCDs. Between 1990 and 2010, Mexico had begun to look like the United States, as deaths from communicable diseases dropped from 19 to 7 percent and those from NCDs rose from 56 to 77 percent. India of 2010 looked like Mexico of 1990 and was changing quickly. It seems inevitable that sub-Saharan Africa, the last holdout for the scourge of infectious diseases, will follow India within the life spans of most people living there today. Globally, for every person killed by natural disasters in 2010, NCDs killed 175 people. For every one killed by war, NCDs killed 1,950.
NCDs aren’t just signs of old age. In fact, many of them are easy to prevent. “Knowing how to reduce such diseases is not the problem,” a report of the secretary-general read. “The problem is lack of action.” The report went on, “The greatest reductions in non-communicable diseases will come from population-wide interventions to address the risk factors of tobacco use, unhealthy diet, lack of physical activity, and harmful use of alcohol.” Mike Bloomberg was now at the podium to tell the world’s leaders how he had done that.
Improving public health has long been one of my passions, and it’s why I’m devoted to enhancing one of the world’s preeminent schools of public health at my alma mater, the Johns Hopkins University, which is dedicated to saving lives, millions at a time.
In the early 1990s, according to Al Sommer, “public health was a bac
kwater.” Even the term felt outdated and distasteful; to many, public health meant “washing your hands, flushing the toilet, and poor docs for poor people.” But with his donation to Johns Hopkins, Bloomberg had made public health “a legitimate enterprise, gotten students excited about doing it, gotten donors excited about investing in it, and created a global movement.” Between 2000 and 2014, graduate schools of public health in the United States more than doubled in number, from 28 to 60. Other schools of public health acquired the names of new-economy philanthropists, from Michael Milken at George Washington University to T. H. Chan at Harvard. And Johns Hopkins and other leading universities had established undergraduate programs in public health that students flocked to.
We have made reducing noncommunicable disease the focus of public health policy here in New York City, a city of about 8.4 million people. And I’m happy to report that we have had considerable success as a result. It’s fundamental to why for New Yorkers today, life expectancy has increased faster and remains higher than for Americans overall.
Mike Bloomberg often quipped, “If you want your friends and relatives to live long, healthy lives, tell them to move to New York City.” His audience usually laughed, but it wasn’t a joke. Between 2001 and 2010, life expectancy at birth in New York City increased 3.0 years to 80.9 years. In the United States as a whole during that decade, life expectancy rose only 1.8 years, to 78.7. For most of the twentieth century, New York City residents had had a shorter life expectancy than other Americans. The gap the city opened up in 2010 was the largest in history. The renaissance in health wasn’t just an urban trend, because New York City had a faster rise in life expectancy in the twenty-first century than every other major city in the United States
