A peek into Bloomberg's new public health initiative

For the next 18 months, Bloomberg Philanthropies, in partnership with the World Health Organization and Vital Strategies, will be working with cities across the globe to tackle the different factors contributing to noncommunicable diseases.

A total of 46 out of a goal of 50 cities have signed up to date to be part of “Partnership for Healthy Cities,” the foundation’s latest initiative launched just last month, just before the 70th World Health Assembly. The program will see Bloomberg Philanthropies investing up to $100,000 per partner city to help them in their efforts to implement one of 10 proven interventions in NCD and injury prevention. These range from anything from creating a smoke-free city, to reducing the consumption of sugary beverages, to interventions aimed at road safety. Cities taking part in the initiative will also receive support to better communicate their policies and intentions to the public, and will become part of a network of cities sharing knowledge and best practices in promoting healthier cities.

The program will be very much city-driven; local governments will have leeway on what intervention to prioritize and work on. WHO and Vital Strategies, meanwhile, will provide assistance and help them make use of data to guide their decisions as well as in developing their work plans, said Dr. Kelly Henning, who leads the public health program at Bloomberg Philanthropies.

The foundation’s emphasis on locally-driven decision making is to ensure the project’s sustainability even after the initiative closes at the end of 2018. The partnership grew out of Michael Bloomberg’s discussions with WHO on how he can “elevate” and move forward the agenda of NCDs prevention as WHO global ambassador for NCDs. The United Nations health body appointed the three-time mayor of New York City and founder of Bloomberg Philanthropies to the role in 2016. Bloomberg committed to the role for two years.

“We do recognize that the timing is very short, at least for this phase of work that we’re engaged with them on,” Henning told Devex. “But you know it’s a trajectory. So for example, if your city would like to ban tobacco advertising, perhaps what you can do in 18 months — if you’re starting with no ban — [is] start developing the policy and start that policy on a pathway to being passed and implemented.”

But if the city has already taken the steps to develop a policy, the focus for the next 18 months could be getting legislative approval and a kickstart to implementation.

“It varies per city. It’s not a one-size-fits-all,” Henning said.

Data meanwhile is crucial for helping mayors identify which issue is causing the most problems in their cities, allowing them to choose the right intervention that would enable them to have the highest possible impact. A city found to have very low smoking rates, for example, would be better off choosing an initiative other than tobacco control.

Bloomberg Philanthropies’ public health focus

The initiative reflects Bloomberg Philanthropies’ focus under its public health program, one of the foundation’s five core priority areas alongside education, environmental protection, government innovation and arts promotion.

The foundation keeps an eye out for “underappreciated” and “underfunded” health issues, said Henning. Until of late, NCDs, known to be the leading causes of death across the world, including in low- and middle-income countries, have received insufficient political attention and donor support. But NCDs have been at the core of Bloomberg Philanthropies’ priorities.

Michael Bloomberg, its founder, has been a huge advocate and supporter of policies controlling tobacco use, a key risk factor in a number of NCDs such as cardiovascular disease and cancer. His foundation is touted as the biggest donor to tobacco-control efforts worldwide, contributing close to $1 billion since 2007 to help countries put in place strong tobacco-control policies that would help educate the public on the negative impact of tobacco use on people’s health and lower tobacco’s global demand.

But being under the radar isn’t the only criteria the foundation applies when choosing which causes to support. It looks at burden of disease or, as Henning put it, “leading killers of people around the world,” particularly in low- and middle-income countries, their largest focus areas. Obesity and road accidents are high up on that list and so are included in the foundation’s priorities, she said.

The foundation also puts particular importance on evidence, that’s why among the leading killers list, it identifies which ones have already commanded proven interventions or nearly proven interventions and those where they can harness the use of data to inform decisions.

“We tend to try to take prevention interventions to scale. If you look at our tobacco program for example, we work in many, many countries and our data suggest that we’ve already averted 30 million tobacco-related deaths in our first 10 years of funding,” Henning said. “These are large programs that we would like to take to scale, with the hope that we’re proving to other donors and to country bilateral donors that noncommunicable diseases and injury prevention can be done through assistance to low- and middle-income countries, and can produce amazing outcomes.”

The foundation does most of its work at the national level, said Henning, but they do support city-level work from time to time, sometimes depending on the context on the ground. In Indonesia, seeing the slow pace of work on tobacco control at the national level, for example, the foundation opted to support a mayor’s group working “very actively” on tobacco control.

The Partnership for Health Cities is the foundation’s first “overtly dedicated program just for cities,” said Henning.

Asked why the foundation is focusing on cities and not remote areas often out of reach of government services, Henning said half of the world’s population now live in urban settings. Cities can influence state and national governments, as the foundation has seen in its public health work, serving then as catalysts for initiatives to progress in other larger areas of a country.

“And cities are quite uniquely placed to lead the way on some of these evidence-based policies. They have mayors in place, they have local governance structures in place, and so they are good beginning points for a lot of these [NCD and injury prevention] strategies,” she said, adding Michael Bloomberg’s experience as mayor of New York City has given him lessons to share with other mayors around the world.

The philanthropist, known for his interest in public health policies, successfully put in place a smoking ban in New York City when he was still mayor. He was also able to get restaurants there to eliminate the use of trans fat and post calorie information for each food item, for example, as part of his wider agenda to get New Yorkers to live healthier and longer lives. But some of his efforts faced widespread and tougher opposition, such as his failed attempt to ban the sale of large sugary drinks in restaurants and delis in the metropolis.

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