The New York City Department of Health was created in 1866, in part in response to a cholera outbreak in the city. From its beginning, the department focused especially on the health problems of children and the poor. In November 1866, Dr. Elisha Harris, of what was then the Metropolitan Board of Health, wrote:

We cannot fail to note the marked increase in the death rate, year by year, for nearly 20 years past… There is reason to believe that all this increase of the death rate is caused in particular classes of inhabitants. It is found to be mainly in those classes from which the paupers are derived, viz the ignorant and poor classes… Already we know that, as regards periods of life, the excess of mortality is in children under five years of age. ^[6]

To stop the spread of cholera, the new department stepped up efforts to improve sanitation, even going so far as to send workers to clean floors, fumigate rooms and burn the clothes of suspected cholera victims. Partly due to these efforts, New York in 1866 suffered one-tenth the number of cholera deaths that it had in an 1849 outbreak.

The department stayed consistently ahead of the public health curve. In the early 1900s, it opened the first public health laboratory using new discoveries about bacteria to prevent and control disease. By the 1950s, it had adopted strategies to control the spread of most infectious diseases. Antibiotics were used to treat and stop the spread of tuberculosis and sexually transmitted diseases and, by 1955, polio vaccination was a regular part of the New York City schools’ health program; by 1960, the city was virtually polio free. The department then turned its attention to diabetes, cancer and other chronic diseases, establishing in 1958 the Health Research Council with a $7 million budget to study chronic and infectious diseases. Chronic diseases, including hearts disease, cancer, chronic lower respiratory diseases and diabetes are the top causes of death in New York City.

In 2002, the Department of Health merged with the Department of Mental Health, Mental Retardation and Alcoholism Services to form the Department of Health and Mental Hygiene. The new department continued to focus on preventative health measures as well as policy changes to create healthy environments. With an annual budget of $1.5 billion, the department's 6,000 employees dealt with issues as varied as monitoring the temperature of water in hot dog vendors’ carts to battling avian flu. In 2003, Health Commissioner Frieden(who was a medical doctor) convinced Mayor Bloomberg to take the politically risky move of passing the Smoke Free Air Act, which banned smoking in most indoor places, including bars and restaurants.

“The mayor says he was warned that tourists from Ireland and Italy would never come to New York if we did it,” Commissioner Frieden later said. ^[7] “Now those countries have banned smoking too. It doesn't happen until it’s happened in New York.” Frieden took some innovative approaches to combating infectious and chronic diseases in the city because he believed that public health was essentially about social justice. “When anyone dies at an early age from a preventable cause in New York City, it’s my fault,” he noted.

The department was unusual among city health authorities. Thanks to New York City’s sizeable population of 8.4 million, it could combine the resources and regulatory power of a state-level public health agency with direct implementation capacity and access to a large population. ^[8] It also had a well-developed infrastructure, expertise in communications using modern media, the critical regulatory authority of a technical and independent Board of Health, and, most importantly, political support. ^[9] “In New York City, we tend to be on the cutting edge—taking more aggressive actions than other cities,” says Gail Goldstein, then-deputy director of the Cardiovascular Disease Prevention and Control Program. ^[10] She adds:

I think certainly the reason we were able to implement all the cutting edge initiatives of the past 10 years was because we have a public health mayor [Bloomberg]. He has a very strong commitment to public health and was willing to fight those fights, from tobacco to … calorie labeling to salt. And when you have that kind of political will, you can do more aggressive things than you can elsewhere.

Trans fat/heart disease . As of the 21 ^st century, heart disease had emerged as the leading cause of death in New York City, regardless of race, ethnicity or gender. The Centers for Disease Control (CDC) reported that for 2005, heart-related death rates in the boroughs of Brooklyn, the Bronx, Staten Island and Queens exceeded 300 per 100,000, compared with a national average of 253 (Manhattan rates were about average). ^[11] Dr. Lorna Thorpe, then-New York City deputy commissioner of health, said heart-related death rates were high due in part to high levels of poverty. “The national poverty level is 12 percent, and citywide we’re a lot higher than that,” she said in August 2005. ^[12]

Heart disease was caused by a range of factors, including genetics, obesity, tobacco use, diet and high blood cholesterol levels. While heart disease affected all New Yorkers, those in low-income areas were at special risk when it came to diet and cholesterol levels. Studies showed that with more fast food restaurants in lower-income and minority neighborhoods, as well as fewer supermarkets selling healthy foods, residents of low-income neighborhoods were more likely to consume high levels of trans fat, putting them at greater risk of developing heart disease. ^[13]