Boston’s Tom Menino walks the walk on health policy

INTRO TEXT

When John Auerbach was in charge of the state Department of Public Health’s AIDS program in the 1980s, Larry Kessler, the director of the nonprofit AIDS Action Committee, came to him all excited about an unlikely ally he’d found for an early, and controversial, effort to combat the spread of HIV.”There’s this great city councilor from Hyde Park, of all places, who’s taking the lead on supporting needle exchange programs,” Kessler told Auerbach, who is now the executive director of the Boston Public Health Commission.

If Tom Menino defied the expectations of those who pegged him as a middle-of-the-road district city councilor from a middle-class Boston neighborhood who would never stray far from conventional sensibilities, as the city’s mayor for the last decade he has done nothing less than blaze a trail as one of the nation’s most forward-looking leaders on municipal health.

Menino nourishes a reputation as the “urban mechanic,” but he may go down in Boston history as the public health mayor. From his early championing of controlled distribution of syringes to intravenous drug users to enacting a citywide ban on workplace smoking, a man not known for grand plans has distinguished himself by pushing the envelope on health.

Boston is “probably the leading city in the nation and I think he’s probably the leading mayor in the nation in terms of making public health a city issue,” says Judith Kurland, who was director of the city’s Health and Hospitals Department under Menino’s predecessor, Raymond Flynn.

“This guy is legitimately an unsung hero,” says Geoff Wilkinson, executive director of the Massachusetts Public Health Association, a statewide nonprofit advocacy group. In April, the association recognized Menino with its highest honor, the Paul Revere Award, named for the patriot leader whose credits include serving as Boston’s first public health officer.

While Boston boasts the oldest public health department of any US city, it can also lay claim to one of the newest. The 1996 merger of Boston City Hospital and Boston University Medical Center to form Boston Medical Center forced a reorganization of the city’s health services. With the 132-year-old public hospital spun off as part of a new private, not-for-profit hospital, the city had a fresh slate for public health programming, one focused more on community-based initiatives. In 1998, Menino tapped Auerbach to direct the newly organized public health commission, and he told him to follow his best instincts.

“He said, ‘I want to have the best health department in the country, so you can make whatever recommendations you want to make from a public health perspective, and I’ll be supportive,'” Auerbach says.

And supportive Menino has been. Shortly after Auerbach came on board, the public health commission approved regulations that banned smoking in restaurants. “It was risky for the mayor to take that on,” says Auerbach.”He heard from a lot of angry restaurants that thought they would all go out of business.” A year ago, Boston extended the smoking ban to include bars and all other workplaces.

Under Menino, the city has taken its expanded view of public health to everything from a 1999 lawsuit against gun manufacturers to asthma control initiatives, not to mention heart disease and cancer prevention programs. Responding in part to findings of high air particulate pollution counts in some city neighborhoods, the public health commission imposed strict new controls on the operation of waste transfer stations, junkyards, and recycling facilities, many of which are centered in low-income areas of Roxbury and Dorchester.

‘If it makes sense,’ Menino says, ‘We’re going to do it.’

With the running room and support he’s been given, Auerbach says he is the envy of other city public health directors. “People think I’ve died and gone to heaven,” he says.

For his part, Menino calls himself nothing more than a “cheerleader” for the efforts of Auerbach and his staff. “I told him I would back him up. I’d be the front guy,” says Menino. “Give me the reason to do it, and if it makes sense, we’re going to do it.”

Last fall, Boston was one of 12 cities nationwide awarded funding from the federal Department of Health and Human Services to establish programs to combat diabetes, obesity, and asthma. Among the projects the city is funding with the $1.2 million award is the expansion of a three-year-old program for neighborhood-based walking clubs. The city has awarded grants of up to $2,000 to 60 different groups of walkers. The clubs include Somalian women who bought sneakers for their walks in traditional dress on the outdoor track at English High School, senior citizens in Chinatown who hired a tai chi instructor to lead warm-up exercises, and a South Boston contingent who take their exercise while they take in the salt air at Castle Island.

“All they need is a pair of sneakers,” says Menino. “They don’t need to join any fancy health club.”

When it comes to pounding the pavement for good health, Boston’s mayor doesn’t just talk the talk. He often heads out of his Hyde Park home at 5 a.m. for a brisk stroll. “I did 55 minutes this morning,” says the city’s perambulator-in-chief. “It’s my private time. It’s time for me to clear the webs out of whatever brains I might have.”

And it’s paid off for the mayoral waistline. “I honestly don’t go on a scale,” says the slimmed down mayor, claiming he can’t put a number on the weight he’s walked off, aided by a new food consciousness. (The best guess of those who see him regularly is that he’s shed 40 to 50 pounds.)

“It’s not Atkins or South Beach,” says the mayor, scoffing at the faddish programs that America’s flabby class has flocked to. “It’s the Menino diet,” he says. “It’s push back”–a reference, apparently, to his chair in relation to the dining table. “It’s food in moderation.”