Podcasting Public Health with Former NYC Health Commissioner Tom Farley

Live Taping of the Podcast Person Place Thing at the Mailman School Reveals Lessons in Strategy from Farley’s Decades-Long Career in Public Health

February 5, 2016

Alert to the groundswell of interest in podcasts, the Mailman School last week played host to a live taping of the popular podcast, Person Place Thing. Host Randy Cohen, an Emmy Award-winning writer and former New York Times columnist, interviewed Tom Farley, former New York City Health Commissioner and newly appointed member of the Lerner Center for Public Health Promotion and Sociomedical Sciences faculty. 

As part of the unique show-and-tell format of the event, hosted by the Lerner Center, Farley was asked to talk about a person, place, and thing of significance to him. His choices illustrated some surprising lessons from decades of work helping people make choices to improve their health

Person: Geoffrey Rose

Geoffrey Rose was an epidemiologist at the London School who claimed that rather than focusing on people with high risk, public health researchers and practitioners should shift their attention to people with average risk. Doing this would help a greater portion of the population, he explained in his 1992 book The Strategy of Preventive Medicine. It’s called the Prevention Paradox. When put to the test, Farley came to the same surprising conclusion as Rose. Lowering everyone’s risk—even by a little bit—impacts more lives, since the majority of disease cases come from the average-risk population. Often the most effective interventions go unnoticed by those they target.

“The new approach to public health is to say, ‘let’s build an environment where everybody is naturally going to be just a little bit more physically active’—so little that they won’t even notice it,” Farley said. “We are going to save more lives that way.”

Place: a liquor store in Baton Rouge

In 1993, Farley supported a Louisiana initiative that disseminated 6 million free condoms through health clinics, community centers, bars, nightclubs, liquor stores and other venues across the state. After the program launched, Farley talked to a manager of a liquor store in Baton Rouge which dispensed free condoms in a bowl at the counter. The manager explained that local sex workers would take two or three condoms at a time, leave, and come back for more at a later time. No hoarding, no dumping, no waste. The program worked exactly as intended, reducing the risk of HIV and other STDs for those who needed it most.

People in public health should think hard about how they can make healthy choices easier, said Farley. “How do we make even minor changes just a little easier for someone to do something that will be good for them in the long term? How do we make unhealthy choices just a little bit more difficult? And if we do that, people will naturally behave in a healthy way and they will benefit from it.”

Thing: a three-liter bottle of off-brand soda

For this portion of the interview, Farley pulled out a giant bottle of C&C orange soda. The ingredients listed were “natural flavor,” yellow #6, red #40, soybean oil, and a great deal of high fructose corn syrup. The cost was a mere $2. This cheap, oversized bottle of soda is common in the poorest neighborhoods, and, according to Farley, the epitome of our national struggle with obesity.

“The obesity epidemic was coincident with the invention of the three-liter bottle in the early 1980s,” Farley said. “If you give people a larger container, they will consume more… Portion size is part of a larger marketing pattern. Soda companies are brilliant marketers, and they wanted to drive volume, and get people to consume more.”

In a 2003 study, researchers found people consumed more from a “bottomless bowl” that automatically refilled itself than a normal bowl. The lesson: people rely on visual cues over their stomachs to assess their level of satiation. Therefore, portion size caps—such as mandating soda to be served in smaller cups—can be an effective approach to reducing obesity. However, the beverage industry is powerful. In addition to financing political campaigns and hefty marketing budgets, the industry deeply understands their consumers and the persuasive messaging needed to reach them.

“People often are persuaded by the framing of a question when they first hear about it,” Farley said. Because the policy was first labeled as a “soda ban,” it was already too late to explain its merits. Public health already lost the argument.

“Choice and freedom is such a part of American culture,” Farley said. “It resonates so deeply with us. Once you get anywhere near it, people get their hackles up... If you hear someone make an argument on the fact that they are protecting the freedom of choice, you should get your antenna up about what their real agenda is.”

Listen to the entire podcast here