Commentary: Mayor Menino, Out-Front Leader On Public Health

In the early 1990’s, at the height of the AIDS epidemic, there was a shortage of courage among many political leaders. That was why I was surprised when I heard that a little-known city councilor from Hyde Park was taking a public stance that needle exchange should be considered as a way to slow the spread of HIV. Needle exchange was (and still is in many circles) too controversial for most elected officials to support, in spite of the substantial body of evidence that it was effective. When I heard he was from Hyde Park, not a neighborhood that had felt the full impact of the epidemic, I wondered, “Who is this guy?”

That guy, it turned out, was Tom Menino. And in classic Menino style, he wasn’t taking the position he took because it was politically popular to do so. It wasn’t. He was taking the position because he thought it was the right thing to do.

It was several more years before I actually met him. I heard he was looking for someone to head up the newly created Boston Public Health Commission. I wasn’t interested in the job. I thought that the task was too overwhelming – pulling together 50 or more relatively small programs into a single department at a time when resources were limited and most of the attention was focused on supporting the success of the nascent Boston Medical Center. But I remembered the story of his courage in the AIDS epidemic, and I wanted to thank him.

I was immediately impressed. The Mayor knew a lot about public health. But what really sold me was his passionate vision. He made it clear that he cared deeply about the health of the city’s residents, particularly those who were poor, frail, or vulnerable. He wanted someone to head the city’s health department who was going to shake things up, get in front of the issues, and work in partnership with him to promote good health. He said he wouldn’t be afraid to take on difficult issues. I left the meeting thinking I wanted to work for him in any position that was available.

Within a month of taking the job of Executive Director of the Boston Public Health Commission, I found out that he wasn’t kidding in anything he’d told me. He wanted to announce a proposal to require all restaurants in the city to either go smoke-free or to have designated smoke-free sections. This may not seem controversial now, but in 1998 this was front-page news, and the Mayor met a lot of angry resistance. When we held a hearing on the proposed regulation, hundreds of opponents turned out. Many called this idea un-American.

The Mayor didn’t care. He knew it was the right thing to do. Reflecting both his political acumen and his wry humor, the Mayor decided to hold a press conference to affirm his support in Doyle’s in Jamaica Plain, the restaurant and bar where everybody goes — including people who wouldn’t much like the idea. I wasn’t sure what we were in for. But I should have known better. Typically, the Mayor had spoken with the owners of Doyle’s and secured their support.

He somehow made this pretty revolutionary idea seem like the natural thing to do, consistent with our history and traditions. The regulations passed and were implemented without resistance. Within a few years, he was leading the charge again — proposing that all workplaces within the city, even bars and clubs, go smoke-free. Boston’s current relatively low smoking rates are a tribute to his leadership .

It didn’t take long for me to realize that the Mayor really cared, cared deeply, about certain principles — and you wouldn’t be able to work for him very long unless you did, too. One of those principles was that everyone in the city needed to be treated with fairness and dignity. If the Mayor felt that certain neighborhoods or individuals were being discriminated against because of, say, poverty or racism – watch out.

For example, when he learned of the much higher rates of infant mortality among Black and Latino residents of the city, he wanted a campaign to address it. This led to a number of programs, including home visits to new mothers by nurses and educators, and school-based educational classes on health for teenagers.

But the Mayor was not content with isolated efforts. He wanted a full-scale mobilization of the city against racial and ethnic disparities in health. He established a blue-ribbon committee with participation from virtually all of the city’s hospitals. He held press conferences to announce the latest statistical finds of inequity. He prioritized funding for the city’s community health centers and agencies of color to increase outreach and accessibility of services. He later hired the brilliant and tireless Barbara Ferrer to lead the Boston Public Health Commission, not only because she is brilliant and tireless but because he knew her proven track record in spearheading efforts to combat inequalities in health, and her unique expertise at working with the city’s children and young adults.

It was pretty edgy for a big city mayor to be giving speeches about combating racial and ethnic inequities in health. Just as it had been pretty edgy to take public and risky stands on needle exchange and cigarette bans. You just don’t see that very often—that leadership, that courage, that principle. Year after year, issue after issue, the Mayor really did get in front of the issues—and led not just the city but the state and, as President Obama noted yesterday, the country too. Even if they didn’t understand or support every one of the issues he raised at the beginning, the people of Boston understood that the Mayor was taking the issues on out of principle, not for political gain. For them, not for himself. And because the people of Boston always knew, he got more done in 20 years than most leaders could get done in a lifetime.

John Auerbach is a Professor of Practice in Health Sciences and the Director of the Institute on Urban Health Research at Northeastern University. From 2007 to 2012 he was the Massachusetts’s Commissioner of Public Health.