On September 11, 2001, I was deep in the rural areas of India, after five years of publication to help control tuberculosis. In the lobby of a small hotel, I watched on a backward TV with a decrease in the second tower of the World Trade Center. She was born in New York City, was trained as a doctor there, and ran the tuberculosis program. When watching my hometown under the attack, I knew that it was time to return. Three months later, as the rubble continues, the elected mayor, Mike Bloomberg, called to ask me to become a health commissioner.
Before I started, I visited my father in the elderly care house. He was the cardiologist. Quiet, cute, and a man from a few words. Parkinson’s disease was almost completely heard. I sat on the side of his bed, grabbed his hand, and told him about my new role. I said, “Dad, I want to be the best health commissioner.”
He looked at me and spoke quietly the last words that will talk to me: “How do you know?”
It was a simple, devastating question. How do you know if you are doing a good work in public health? Being the best does not mean delivering the best speech, pushing the bolder policy, or even working in the longest hours. This means saving most of the souls. But how can we measure that? At that time, tobacco was more than New York residents than anything else. However, we did not know even the number of people who smoke. No one was counting.
This has changed when my colleague, Dr. Farzad Mustashri, launched a simple but strong survey. We started contacting 10,000 New York residents every year, and we asked if they smoked cigarettes. The results were realistic: 22 % of adults smoke, without progress in a decade. If nothing changes, Tobacco will kill 400,000 New York population and disrupt a million others with heart attacks, strokes, lung diseases and cancer. Now we can see the crisis clearly. The next step was to act.
Tobacco tax was the most effective way to reduce smoking. It was a political battle of bruises, but with the leadership of mayor Bloomberg, the tax rose $ 1.42. The following year poll showed a significant decrease in smoking. Soon after, we passed a law that makes all restaurants and bars free of smoking. After that, the following year poll showed another decrease.
I thought we had a break. But the following year, the poll showed something worrying: progress stopped. He was terrifying. We may fail in our top priority.
Data forced us to rethink. We tried to raise the tax again, but the state legislative council refused. Then came the option of risky: spending $ 10 million, and the money that can finance clinics and employee salaries, on Tobacco control ads. I was not convinced. But the data gave us the courage to gambling.
Next year survey revealed the results: ads worked. Smoking decreased again, especially in the societies that we targeted more than others. Our gambling resulted in fewer smokers, a longer life, and the healthiest future contracts.
This is how I can answer my father’s question. Monitoring – measuring what matters in particular – invisible visual progress. Without this, we had blinded blindly, not sure whether we were providing lives or wasting time and money. With her, we knew. Public health usually does not issue headlines. The life that is saved by dramatic medical care is celebrated as a miracle, but millions preserved with prevention are often invisible. The lighting of light illuminates that unknown life, proving that prevention works.
Today, smoking at the lowest levels. Less than 4 % of the United States high school students smoke, which is the lowest rate of ever. I continued this work in subsequent years, when President Obama appointed me the director of the Centers for Disease Control and Prevention (CDC), where I served for eight years. Most people who smoke in the past have already resigned. Real progress and measurable. The last words that my father spoke to me, How do you know, My guidance question remains. They remind me that good intentions are not enough. We need evidence that our actions lead to real results.
This same approach, which I revealed in my next book, The formula for better health: How to save millions of lives – including It is to know what is already happening, believing in the possibility of progress, and working systematically to create a better future. This is important not only for public health but also to personal health and any institution trying to make a change. For your own health, you may ask yourself a copy of the same question: How do I know if what I do is doing? Do the medications you take control blood pressure? Do you get physical activity that you can adhere to for years? Does your efforts lead to a longer and healthier life? My father’s question prompted me to see progress and failure clearly. It is a question that can all guide us towards a longer and healthier life and our organizations to make faster progress and more progress.
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