Akst: NYC looks out for health of its own

Cities have long been considered cesspools of ill health. This reflects more than just nostalgia for some imagined pastoral ideal; choked by crowding and pollution and beset by crime, urban life often really has been dangerous.

How strange, then, to find that America's largest city, though still noisy, dirty and crowded, nowadays is healthier than the country as a whole. More specifically, its residents live about 1.5 years longer than the U.S. average.

Dense, walkable communities like New York City are associated with better health. More transit, for instance, means fewer auto fatalities. Nor is this just about affluence; New York City households earn less than the U.S. average.

Many factors are at work, including the kind of people who chose to live in New York. But there's also something extra: Mayor Michael Bloomberg has turned the city into the nation's largest public health lab through a series of unabashed initiatives aimed at discouraging smoking, combating obesity and generally promoting healthy living. Perhaps the most famous -- and derided -- example is the ban on sodas exceeding 16 ounces at places with a food-service license. People can always buy two or three smaller drinks, but changing the default might change behavior.

The big soda ban is only the least of it. New York was the first U.S. city to require fast-food chains to post nutrition information. The city pioneered in banning trans fats, and it subsidizes fruits and vegetables for the poor through its Health Bucks program. The city's Latch On NYC initiative works with hospitals to discourage the use of baby formula in favor of breast-feeding.

New York long ago rid its bars and restaurants of smoking, and its tough anti-smoking ads, coupled with punishing taxes, appear to have helped reduce tobacco use citywide. Bike lanes, despite a lot of grumbling from change-averse New Yorkers, have been expanded, encouraging exercise.

The city has also launched a constellation of efforts to combat childhood obesity, including reduced-calorie school lunches. Over a five-year period, these efforts cut the proportion of obese K-8 students from 21.9 percent to 20.7 percent.

Somewhere along the line, the idea that government should promote public health became derided as nannyism, which is a shame. Corporations don't hesitate to influence our behavior for the sake of profit, and government itself encourages all kinds of behavior, including (by means of tax breaks) the purchase of a home and saving for retirement. In the past Uncle Sam even promoted poor health, by subsidizing suburban sprawl and tobacco growing.

The history of cities suggests that government efforts to improve public health can pay. A century ago, massive spending on urban water systems helped defeat cholera and yellow fever. Economist Edward Glaeser, in his book "Triumph of the City," observes that the fight against urban ills "has never been won by passively accepting the way things are or by mindlessly relying on the free market." On the contrary, he reports, "every battle was won by accountable and empowered public leaders who spent huge amounts of money and enlarged the public sector."

Last week, the Trust for America's Health and the Robert Wood Johnson Foundation predicted that, by 2030, half of Americans will be obese, with commensurate increases in illness and health-care spending. Charting a different path may be beyond the power of most individuals, who would be thinner if they could make themselves so, but collective action on a variety of fronts could do the trick. Fortunately, New York City is showing the way.

Daniel Akst is the author of "We Have Met the Enemy: Self-Control in an Age of Excess."