Michael Bloomberg leaves the mayoralty of New York City, with his health legacy is bitterly contested. The public health community views him as an urban innovator—a rare political and business leader willing to fight for a built environment conducive to healthier, safer lifestyles. To his distractors, however, Bloomberg epitomizes a meddling nanny—an elitist dictating to largely poor and working class people about how they ought to lead their lives. His policies have sparked intense public, corporate, and political ire—critical of sweeping mayoral power to socially engineer the city and its inhabitants. Here, I seek to show how Bloomberg has fundamentally changed public health policy and discourse. He has used the engine of government to make New York City a laboratory for innovation—raising the visibility of public health, testing policy effectiveness, and probing the boundaries of state power. The courts have blocked some of his boldest initiatives, but he offered a paradigm for the “new public health”—reaching beyond infectious diseases to upstream risk factors in everyday life and the human habitat. I also critically probe various arguments designed to derail his policies (e.g., questions of policy consistency, scientific evidence, First Amendment claims, and civil liberties) along with the overarching charge of unjustified paternalism. The article discusses key Bloomberg policies, including those in the areas of diet and nutrition (e.g., menu labeling, trans fat ban, and the soda portion limit); physical activity (e.g., bike and walking paths, safe school routes, parks); and tobacco control (smoke free laws, cigarette taxes, and advertising restrictions). A graphic categorizing his major health policies appears at http://www.law.georgetown.edu/oneillinstitute/gostin_hcr_bloombergshealthlegacy.html
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