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Wednesday, 20 November 2013

New York City does it again - the role of the city-state in improving the public's health

In passing an ordinance that prohibits the sale of tobacco to those under age 21, and setting minimum prices for a pack of cigarettes at just over 10, New York City continues to demonstrate innovation in respect to addressing health issues for its residents. New York ban on tobacco sales under 21

Okay, New York has roughly the same population as the province of Quebec and with size comes capacity and resource.
The point is that the city is taking control over its own public health issues.  It is not depending on, or demanding that the state take action. It has acknowledged the need to address its own health concerns and find its own solutions.   New York’s attack on the fundamental problems of community violence have expanded over the years in its attempts to address obesity and now tobacco. With evidence of success    NYC dept of health and mental hygiene. It helps to have a mayor that is brave and caring enough to address such issues (something both Toronto and Montreal have lacked in recent years).
The re-emergence of the city-state should not be dismissed.  While some local governments mock the radical efforts and legal barriers that New York has experienced, their efforts are turning heads in the municipal ranks.
Vancouver’s mayor declaring a public health crisis over the issues over mental illness,  Toronto’s work on housing and more recently on racialization and health inequalities, Montreal’s work on Transportation and health are all examples of local city-state efforts to address community health issues without allowing the federal-provincial divide to become an impediment.
The obstacle is Canada has about 3700 local/municipal governments, each one needs to be addressed in person and uniquely.  As such, it is not surprising that the focus of policy efforts is aimed at the 13 provincial/territorial governments, or when possible the single federal body.  It seems increasingly though that the decision power is moving from pan-Canadian to provincial/territorial and now to local government/First Nations communities.

Public health professionals have long been associated with local governments and their efforts. Paraphrasing a quote that isn’t readily at hand ‘The greatest gains in the health of the people has been made, not through the efforts of doctors and hospitals, but through the efforts of local government’.  A statement that was made over fifty years ago and remains just as true today.

Kudos to New York City and those local governments that take “governance for the good of the people” to heart and apply a broad interpretation. 

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