Even with swine flu in the news, the selection of a new director of the Centers for Disease Control and Prevention (CDC) would not normally be a big story. The appointment has made headlines, however, because President Obama’s choice, New York City health commissioner Thomas Frieden, has already made a name for himself as a vocal critic of fast food, soda, and cigarettes. Dr. Frieden is certainly qualified for the CDC spot: he once logged nearly 12 years at that agency, as well as two years in India studying tuberculosis for the World Health Organization. But his impact in New York has been questionable.
In his tenure as the city’s health commissioner, Frieden transformed the office, generating national attention for his ideas, initiatives, and bombastic comments—he once likened tobacco-company executives to mass murderers. He spearheaded an effort to distribute millions of free condoms (with a snappy-looking New York–themed cover design), successfully pushed a ban on smoking in restaurants, and, more recently, championed the effort to force some eateries to post calorie listings. Whereas health commissioners typically toil in obscurity—quick, name a single memorable initiative of Chicago health commissioner Terry Mason—Frieden is a national figure. Cities across the country are implementing or at least contemplating his proposals. Even before he starts his new job, his influence is being felt in Congress: the Senate Finance Committee is considering using the soda tax that he touts as a way to fund universal health coverage.
But was his seven-year stint in New York successful? We can all agree that Americans are decidedly unhealthy. Obesity rates on this side of the Atlantic are much higher than in Europe, which is one reason why Americans’ life expectancy trails Europeans’. Fully 20 percent of the rise in health-care costs from now until 2020 will be due to obesity and related illnesses. Frieden didn’t simply bemoan the widening of New Yorkers’ waistlines; he sought to do something about it. As Georges Benjamin, the executive director of the American Public Health Association, told the Los Angeles Times, Frieden “has been at the forefront of dealing with cutting-edge issues . . . such as diet, smoking and lack of exercise. Those are exactly the things that are driving up our health costs.”
Frieden favors small, paternalistic measures, and for cash-strapped cities like New York, such measures seem like an inexpensive way to fight the war on obesity. Unfortunately, there is little evidence that they work. Consider the calorie listings at restaurants. In a study of more than 4,000 people published in The American Journal of Public Health, just 0.1 percent of the subjects actually looked at the calorie counts before deciding what to eat. Does anyone order a chocolate shake at McDonald’s and assume that it’s healthful? Undaunted by the results, researchers suggested that perhaps the signage needed to be larger.
Frieden in fact represents the old guard of public health. Awed by the success of the antismoking campaigns of the sixties and seventies, he and his colleagues believe that today’s public health problems can be resolved with yesterday’s tactic: education initiatives. For more promising, forward-looking alternatives, consider North Carolina, where lawmakers enacted several “wellness” initiatives last month for state employees. Among them: higher insurance costs for smokers and the obese. Faced with a budgetary shortfall, the state has realized that those with smoking or weight problems cost roughly $2,000 more per year to insure than those without. North Carolina’s experiment is new, but it represents a return to an old idea: personal responsibility. By reinstilling this value in our public policy, lawmakers will get better results than anything Frieden has dreamed up in New York.