Bloomberg's Health Legacy: Urban Innovator or Meddling Nanny?

Michael Bloomberg assumed office as the 108th mayor of New York City on January 1, 2002. As he leaves the mayoraltyhaving won reelection twice-his public health legacy is bitterly contested. The public health community views him as an urban innovatora rare political and business leader willing to fight for a built environment conducive to healthier, safer lifestyles. To his detractors, Bloomberg epitomizes a meddling nannyan elitist dictating to largely poor and workingclass people about how they ought to lead their lives. His policies have sparked intense public, corporate, and political irecritical 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. Even though the courts have blocked some of his boldest initiatives, he has offered a paradigm for the new public healthreaching 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, along with the overarching charge of unjustified paternalism.