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Saving Gotham: A Billionaire Mayor, Activist Doctors, and the Fight for Eight Million Lives
The inside story of the most audacious public health campaign of the twenty-first century.
In 2002, a dynamic doctor named Thomas Frieden became health commissioner of New York City. With support from the new mayor, billionaire Michael Bloomberg, Frieden and his health department team prohibited smoking in bars, outlawed trans fats in restaurants, and attempted to cap the size of sodas, among other groundbreaking actions. The initiatives drew heated criticism, but they by 2011, 450,000 people had quit smoking, childhood obesity rates were falling, and life expectancy was growing.
Saving Gotham is the behind-the-scenes story of the most controversial—and successful—public health initiative of our time. Thomas A. Farley, MD, MPH, who succeeded Frieden as health commissioner, introduces a team of doctors who accepted the challenge of public to care for each of New York City’s eight million inhabitants as their own patients. The biggest threats they faced were not cholera or chemical toxins or lack of medical care but instead habits like smoking and unhealthy eating. As these doctors pressed to solve these problems, they found themselves battling those who encouraged those habits, and they reshaped their own agency for a different sort of fight.
Farley shows what happens when science-driven doctors are given the political cover to make society-wide changes to protect people from today’s health risks—and how industries exploit legislatures, the courts, the media, and public opinion to undermine them. With Washington caught in partisan paralysis and New York City’s ideas spreading around the world, Saving Gotham demonstrates how government—local government—can protect its citizens and transform health for everyone.
In 2002, a dynamic doctor named Thomas Frieden became health commissioner of New York City. With support from the new mayor, billionaire Michael Bloomberg, Frieden and his health department team prohibited smoking in bars, outlawed trans fats in restaurants, and attempted to cap the size of sodas, among other groundbreaking actions. The initiatives drew heated criticism, but they by 2011, 450,000 people had quit smoking, childhood obesity rates were falling, and life expectancy was growing.
Saving Gotham is the behind-the-scenes story of the most controversial—and successful—public health initiative of our time. Thomas A. Farley, MD, MPH, who succeeded Frieden as health commissioner, introduces a team of doctors who accepted the challenge of public to care for each of New York City’s eight million inhabitants as their own patients. The biggest threats they faced were not cholera or chemical toxins or lack of medical care but instead habits like smoking and unhealthy eating. As these doctors pressed to solve these problems, they found themselves battling those who encouraged those habits, and they reshaped their own agency for a different sort of fight.
Farley shows what happens when science-driven doctors are given the political cover to make society-wide changes to protect people from today’s health risks—and how industries exploit legislatures, the courts, the media, and public opinion to undermine them. With Washington caught in partisan paralysis and New York City’s ideas spreading around the world, Saving Gotham demonstrates how government—local government—can protect its citizens and transform health for everyone.
319 pages, Kindle Edition
First published October 13, 2015
31 people are currently reading
504 people want to read
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Displaying 1 - 25 of 25 reviews
January 12, 2016
I admit, this was of particular interest to me as someone who's lived in the general NYC area for my entire life, and in NYC itself during many of the years discussed in this book. I remember well when smoking disappeared from bars and restaurants, when calorie counts appeared on menus, and the never-ending media uproar over Mayor Bloomberg's ban on large sodas. I also admit that I lean towards liberal, and I agreed with most of the Bloomberg administration's policies on public health - what I understood of them at the time, anyway. Thanks to this book, I now better understand exactly what was going on behind these policies, what made some succeed and others fail, and what public health means in general.
I wouldn't rank this quite as earth-shatteringly revelatory as The Omnivore's Dilemma, but it's certainly opened my eyes about non-communicable diseases and how much of a role society plays in them. And even more so, about how that social role is shaped by special interests and corporations. I wouldn't be surprised if this ends up filling my "a book that made you angry" reading challenge prompt, because reading about some of the back-room politics and manipulations that big companies (tobacco companies, food and beverage companies, restaurants) resorted to, just to be able to continue marketing and selling toxic goods to us, was infuriating.
Annual Popsugar Reading Challenge: a book that made you angry
I wouldn't rank this quite as earth-shatteringly revelatory as The Omnivore's Dilemma, but it's certainly opened my eyes about non-communicable diseases and how much of a role society plays in them. And even more so, about how that social role is shaped by special interests and corporations. I wouldn't be surprised if this ends up filling my "a book that made you angry" reading challenge prompt, because reading about some of the back-room politics and manipulations that big companies (tobacco companies, food and beverage companies, restaurants) resorted to, just to be able to continue marketing and selling toxic goods to us, was infuriating.
Annual Popsugar Reading Challenge: a book that made you angry
December 4, 2015
As someone who works in public health, I have a huge amount of respect for the work that the book details about the efforts of Tom Friedan who was commissioner of health for NYC and who is now the director of the CDC, the author himself who was commissioner following Frieden, and Michael Bloomberg. Bloomberg's tenure as mayor did see what were probably the most aggressive public health campaigns in the country, that the data leaves no doubts to the successes of. Despite the important and potentially fascinating story, the book never really resonated with me. I thought the description of events did not present enough detail beyond we tried to do that, we tried to do this... And the book's tendency to jump between issues and chronology were a little jarring. It might be worth reading if you work in public health, or live in NYC but I don't think it lived up to it's potential.
June 21, 2017
An interesting look at how New York City focused on saving lives by the tens of thousands by attacking the biggest public health menaces. No longer communicable diseases, but smoking, trans fats, portion sizes and sugary drinks. I went in against the "nanny state" provisions, especially the limit on soda sizes. I came away with an appreciation of why those efforts were made.
July 6, 2017
Full disclosure: I read Saving Gotham to prepare for a book discussion that our incoming class of Masters of Public Health students would be having during orientation. From that perspective, the book was a good opening salvo into the world of public health. It serves almost as a primer for the layperson on the major battles of modern day public health, the terminology, and its long-term, big picture possibilities.
The book also reminded me how much the health landscape of the United States has (and hasn't changed). Some of the debates highlighted in the book awoke vague memories that I had from a decade ago: debates about a soda tax, smoking sections in restaurants, the sudden surge in popularity of electronic cigarettes. We live in a world that is the result of the battles fought by public health practitioners like those in the New York City Department of "Health and Mental Hygiene". (Speaking of harking back to earlier years... the title of the department definitely made me cringe). Because of these fights, I would be shocked to walk into a restaurant and have the patrons at the table next to me light a cigarette. I don't remember a world when sodas were perceived as "not that unhealthy". So, I enjoyed the content of the book.
Less enjoyable were the attempts to make the book a human interest piece. Though I enjoyed the politics and discussions of legal battles, brief forays into employee squabbles were jarring, at best. At worst, they seemed like robotic attempts to humanize the bigger picture battles. The book didn't need the extra narratives. Had Farley chosen to stick with his area of expertise - public health practice - the book would have read much smoother over all.
And a final, trivial criticism: the cover and the running head on every single page of the book said "Tom Farley, MD". I found this frustrating, because it reinforced this book as part of an effort by Farley to further his political or academic career. He took over this highly successful health department, and furthered its successes. All of that is excellent. But I couldn't help but enjoy the sections where he was discussing the work of other people more than when he was referring to his own efforts. Perhaps it was his own discomfort in writing about his own struggles. And, when attempting to Google him, I learned why he has to distinguish himself as "Tom Farley, MD" (there are too many other Tom Farleys for him to show up on the first page of the search results).
Overall, it was a compelling book to read as someone who is entering the field of public health. Farley underscored the interdisciplinary nature of public health. Though, I couldn't help but realize that of the people he discussed, very few only had an MPH. The interdisciplinary make up of the Health Department's team was wonderful, but it definitely down played the role of the MPH in influencing public health. As a incoming MPH candidate, I found that somewhat discouraging. Though certainly fascinating.
I would love to read more studies about health in New York City and the extent to which the policy changes begun under Michael Bloomberg's tenure as mayor influenced the long-term health of the city. The implications would be fascinating. As someone who is interested in how to measure the successes of interventions, I would also want to know more about how they measured the "lives saved" counts. The book touched on some of these discussions, but I would be curious to know more.
That I have so many thoughts on this book and so much to say are a testament to how different this book is from other books that I have read about policy, public health and medicine. It feels like a unique piece to add to the conversation about public health. The gripes that I had about it are perhaps what would make the book more accessible to an average reader with less knowledge about the field. I certainly felt strongly about the book, a little bit inspired, a little bit discouraged and curious to learn more about the field, the politics and how to influence health-related changes in the world.
The book also reminded me how much the health landscape of the United States has (and hasn't changed). Some of the debates highlighted in the book awoke vague memories that I had from a decade ago: debates about a soda tax, smoking sections in restaurants, the sudden surge in popularity of electronic cigarettes. We live in a world that is the result of the battles fought by public health practitioners like those in the New York City Department of "Health and Mental Hygiene". (Speaking of harking back to earlier years... the title of the department definitely made me cringe). Because of these fights, I would be shocked to walk into a restaurant and have the patrons at the table next to me light a cigarette. I don't remember a world when sodas were perceived as "not that unhealthy". So, I enjoyed the content of the book.
Less enjoyable were the attempts to make the book a human interest piece. Though I enjoyed the politics and discussions of legal battles, brief forays into employee squabbles were jarring, at best. At worst, they seemed like robotic attempts to humanize the bigger picture battles. The book didn't need the extra narratives. Had Farley chosen to stick with his area of expertise - public health practice - the book would have read much smoother over all.
And a final, trivial criticism: the cover and the running head on every single page of the book said "Tom Farley, MD". I found this frustrating, because it reinforced this book as part of an effort by Farley to further his political or academic career. He took over this highly successful health department, and furthered its successes. All of that is excellent. But I couldn't help but enjoy the sections where he was discussing the work of other people more than when he was referring to his own efforts. Perhaps it was his own discomfort in writing about his own struggles. And, when attempting to Google him, I learned why he has to distinguish himself as "Tom Farley, MD" (there are too many other Tom Farleys for him to show up on the first page of the search results).
Overall, it was a compelling book to read as someone who is entering the field of public health. Farley underscored the interdisciplinary nature of public health. Though, I couldn't help but realize that of the people he discussed, very few only had an MPH. The interdisciplinary make up of the Health Department's team was wonderful, but it definitely down played the role of the MPH in influencing public health. As a incoming MPH candidate, I found that somewhat discouraging. Though certainly fascinating.
I would love to read more studies about health in New York City and the extent to which the policy changes begun under Michael Bloomberg's tenure as mayor influenced the long-term health of the city. The implications would be fascinating. As someone who is interested in how to measure the successes of interventions, I would also want to know more about how they measured the "lives saved" counts. The book touched on some of these discussions, but I would be curious to know more.
That I have so many thoughts on this book and so much to say are a testament to how different this book is from other books that I have read about policy, public health and medicine. It feels like a unique piece to add to the conversation about public health. The gripes that I had about it are perhaps what would make the book more accessible to an average reader with less knowledge about the field. I certainly felt strongly about the book, a little bit inspired, a little bit discouraged and curious to learn more about the field, the politics and how to influence health-related changes in the world.
September 7, 2017
As a preface, Saving Gotham was the required reading for our interprofessional education for the graduate program in the School of Public Health. Saving Gotham was a captivating selection that served very well in my orientation to public health. Not only did it introduce me to the premise of public health, it also elaborated in detail the problems facing healthcare today. I feel that the small nuances in the text characterizes the profession in a way that is easy to digest and appreciate. I believe that as an introduction to any healthcare program, Saving Gotham should be a read for nearly all public health officials. It shares a sentiment that most can appreciate. An example which spoke out to me the most is regarding the collections of experiences regarding the sugar consumption and the battle with big soda. With family members struggling with chronic conditions, I feel that these comments and sections related best to my own relationships.
Initially, I believed the book to be very roundabout, almost in a "stream-of-consciousness" method. Dr. Farley will jump around discussing several issues and then returning to the second issue. Jumping to the fourth issue. For those who like organization, this will definitely drive you up a wall. However, a point that I want to drive home is that this is HOW IT IS in public health. Often, you are working on several projects for a long duration of time. I think Dr. Farley wrote the book like this to showcase how frustrating things can be in the profession, and that, my friends, is very important.
I do not think that this book changed my perception of public health very drastically. I believe the text really encouraged me to consider the details of the profession. The repeated failures (soda ban) made me reflect on the contributions that have made a difference (like in smoking cessation). One thing may work for a specific issue, but when the same comcept is applied to another problem, the attempt may not necessarily work. It really outlines the struggles that public health faces with not just one antagonist. A common theme seems to be that despite multiple protagonists, it is still an uphill climb with which I can appreciate and challenge myself.
The following questions were asked for our assignment, I thought it would be relevant to share as they do portray a level of significance of the reading.
Q: Which topic from Saving Gotham moved you the most and why?
A: As I mentioned before, the "Big Soda" topic related to my personal experiences the most. Diabetes along with hypertension is a fearful condition to suffer, eventually leading to chronic kidney disease or endstage renal disease on dialysis, diabetic neuropathy, eye disease, and/or strokes. These precursors to fatal disease is an ongoing problem for the United States and thus rings slightly too close to home for comfort. Preventative medicine is what I believe to be one of the facets that need to be addressed more closely to deal with chronic diseases.
Q: Definitely media such as advertisements, played a major role in Saving Gotham.
Did this surprise you at all? In what ways? Do you look at any advertising differently
now? How?
A: Advertisements are designed to promote a cause, whether it be malicious or altruistic. I was intrigued by how the media portrayed and twisted words/intentions into a "catchy" headline. The intention of top media is to sell news under the pretense of telling the truth. The book
didn't really change my views on media, but it definitely surprised on the type of resistance that the public health office had to handle.
Initially, I believed the book to be very roundabout, almost in a "stream-of-consciousness" method. Dr. Farley will jump around discussing several issues and then returning to the second issue. Jumping to the fourth issue. For those who like organization, this will definitely drive you up a wall. However, a point that I want to drive home is that this is HOW IT IS in public health. Often, you are working on several projects for a long duration of time. I think Dr. Farley wrote the book like this to showcase how frustrating things can be in the profession, and that, my friends, is very important.
I do not think that this book changed my perception of public health very drastically. I believe the text really encouraged me to consider the details of the profession. The repeated failures (soda ban) made me reflect on the contributions that have made a difference (like in smoking cessation). One thing may work for a specific issue, but when the same comcept is applied to another problem, the attempt may not necessarily work. It really outlines the struggles that public health faces with not just one antagonist. A common theme seems to be that despite multiple protagonists, it is still an uphill climb with which I can appreciate and challenge myself.
The following questions were asked for our assignment, I thought it would be relevant to share as they do portray a level of significance of the reading.
Q: Which topic from Saving Gotham moved you the most and why?
A: As I mentioned before, the "Big Soda" topic related to my personal experiences the most. Diabetes along with hypertension is a fearful condition to suffer, eventually leading to chronic kidney disease or endstage renal disease on dialysis, diabetic neuropathy, eye disease, and/or strokes. These precursors to fatal disease is an ongoing problem for the United States and thus rings slightly too close to home for comfort. Preventative medicine is what I believe to be one of the facets that need to be addressed more closely to deal with chronic diseases.
Q: Definitely media such as advertisements, played a major role in Saving Gotham.
Did this surprise you at all? In what ways? Do you look at any advertising differently
now? How?
A: Advertisements are designed to promote a cause, whether it be malicious or altruistic. I was intrigued by how the media portrayed and twisted words/intentions into a "catchy" headline. The intention of top media is to sell news under the pretense of telling the truth. The book
didn't really change my views on media, but it definitely surprised on the type of resistance that the public health office had to handle.
This entire review has been hidden because of spoilers.
May 7, 2019
This was a really good book — easy to read, engaging, and to the point. Farley is a good writer who gives enough context to conflicts without spilling into the petty. He also does a good job of describing specifics while also providing a strong overarching narrative of how NYC Dept of Health was redefining public health.
I learned a ton about smoking, trans fat, sugary drinks, portion sizes, etc. in a way that (I hope) will stick. It’s much more engaging and memorable than anything I learned in health class, to be honest. It’s all recent history which is wild — indoor smoking was banned in 2003. 2003! That’s THIS century! This book also helped me contextualize some of the conversations I’ve had/have heard in City Hall related to health. It gives a pretty good 101 on the health department’s culture at least at the very top of the chain. It also is a decent mini 101 on how the FDA is failing us, and a great 101 on how corporate interests (especially in the food industry) impact health outcomes.
It’s a pretty glowing overview of what the Department of Health & Mental Hygiene was able to accomplish under Bloomberg’s 3 terms, though I did feel like he could’ve been more critical of certain policies. Farley does a fair job to describing the roles everyone played and who contributed on the city side, though I do wish I got to know some of the people he mentions a little more outside of brief introductions for each. Outside of bureaucrats, he only really talks about Christine Quinn. I think he could’ve taken a more genuine approach to understanding people’s critiques of using SNAP to achieve what the City Council chose not to. Besides that, I liked the book.
I’d recommend to anyone interested in public health, NYC, and legislation/government/bureaucracies.
I learned a ton about smoking, trans fat, sugary drinks, portion sizes, etc. in a way that (I hope) will stick. It’s much more engaging and memorable than anything I learned in health class, to be honest. It’s all recent history which is wild — indoor smoking was banned in 2003. 2003! That’s THIS century! This book also helped me contextualize some of the conversations I’ve had/have heard in City Hall related to health. It gives a pretty good 101 on the health department’s culture at least at the very top of the chain. It also is a decent mini 101 on how the FDA is failing us, and a great 101 on how corporate interests (especially in the food industry) impact health outcomes.
It’s a pretty glowing overview of what the Department of Health & Mental Hygiene was able to accomplish under Bloomberg’s 3 terms, though I did feel like he could’ve been more critical of certain policies. Farley does a fair job to describing the roles everyone played and who contributed on the city side, though I do wish I got to know some of the people he mentions a little more outside of brief introductions for each. Outside of bureaucrats, he only really talks about Christine Quinn. I think he could’ve taken a more genuine approach to understanding people’s critiques of using SNAP to achieve what the City Council chose not to. Besides that, I liked the book.
I’d recommend to anyone interested in public health, NYC, and legislation/government/bureaucracies.
March 12, 2021
A very timely read as we debate the role of the intersection of public health and government. Tom Farley recaps the role of NYC's public health department during the Bloomberg administration. He give a first-person account of the public programs they developed, launched, and fought for all in the name of making NYC healthier.
I enjoyed reading about the public smoking ban, soda tax, and other initiatives we heard about in the news. The book gives the reader a peek into how much effort it takes to get one of these initiatives done and the forces working against public health.
Saving Gotham made me think about many different things - what is the government's role in public health, when does something that's good on it's face go to far because it infringes on personal freedom, and how do we get things done when there are so many stakeholders with different agendas.
I recommend picking up this book because if you're interested in any of these topics.
I enjoyed reading about the public smoking ban, soda tax, and other initiatives we heard about in the news. The book gives the reader a peek into how much effort it takes to get one of these initiatives done and the forces working against public health.
Saving Gotham made me think about many different things - what is the government's role in public health, when does something that's good on it's face go to far because it infringes on personal freedom, and how do we get things done when there are so many stakeholders with different agendas.
I recommend picking up this book because if you're interested in any of these topics.
June 28, 2021
An inside look at individual voices in politics taking long hours to make changes that are often lost in the bureaucracy or refused because of the problem with politics. The government's involvement in public health is redefined by this team in New York City in the 2000's and changed forever. Non-communicable diseases are given attention for the first time by a public health commissioner. And Michael Bloomberg did some really great things despite all the opposition he met from his colleagues -- he is definitely my favorite of these voices.
May 22, 2025
New York, known for crime, is also known for health--thanks to Mayor Bloomberg and a team of dedicated doctors and politicians. This is an interesting look at what went into the cigarette ban that started an international movement (it will never work people said). The author also talks about efforts to limit soda consumption (don't mess with Coca Cola) and what's involved in trying to get new legislation done.
June 16, 2021
Informative, but the writing lacks flow. Dr. Farley jumps from topic to topic and event to event, making things a little hard to follow. Otherwise this is an insightful read about the public health policies the NYC health commissioner's office was able to pass under Bloomberg's mayoral administration.
August 23, 2019
Sparked my interest for public policy! Explained and shared the city/state/federal approach to changing human health behavior on the individual by implementing soda tax, nutrition labels, no smoking indoors, etc. Taking a macro approach to health policy.
July 23, 2018
Loved this book! Really great insights into the Bloomberg administration's fights to improve New York City's health and contains lots of teachable moments for those in the field of public health.
July 19, 2019
I just................
that’s the review. I just.
that’s the review. I just.
May 27, 2020
Insightful and helpful
January 28, 2021
Interesting read but tends to be dry.
June 30, 2022
read this book for one of my public health classes. a good read and insightful but many of the same themes and stories were reiterated throughout, making it a bit boring to read at times
April 23, 2025
Definitely recommend! If you are into public health ☺️
October 31, 2022
Not the easiest or most entertaining read, but a fascinating insight into health policy and the corporate, media and social factors that influence it.
August 12, 2016
This is an excellent book which I read in preparation for graduate school in public health. I had definitely heard about Mayor Bloomberg's law restricting the sizes of soda; however it was interesting reading about the work behind the scenes which pulled it off. I enjoyed that in New York City that public health initiatives were so successful due to the partnership between health agencies/departments on the local, state, and federal level with city council members and others. This success was also dependent upon the mayor's support of such laws allowing New Yorkers to make healthier options reducing health problems like smoking, obesity, diabetes, high blood pressure, and improving nutrition (i.e. giving New Yorkers the option of knowing the calories of their food through calorie labeling laws). I also commend the department of public health officials on taking inequities into account for minority New Yorkers as well as their unique vulnerabilities, for example vulnerabilities to soda companies, food companies, fast food chains, and city council members in agreement with lobbyists and the lack of grocery stores. This book underscores what when a group of like minded people can accomplish in improving health of a population with access to beneficial resources - like a billionaire mayor - to successfully manifest the various ideas they have thought up. Even if your not in public health , or slightly intrigued about what public health constitutes, do yourself a favor and read this book!
A spoiler, the writing could have been clearer and more coherent. Part one is full of ancedotes of what Tom Frieden's health department officials did to pass laws on smoking ban, nutrition food calorie labels, the soda tax, and removing trans fats from restaurant foods. Since the second part is built upon the work of Frieden's health team from the health department it is much more coherent and understandable. Just a heads up.
A spoiler, the writing could have been clearer and more coherent. Part one is full of ancedotes of what Tom Frieden's health department officials did to pass laws on smoking ban, nutrition food calorie labels, the soda tax, and removing trans fats from restaurant foods. Since the second part is built upon the work of Frieden's health team from the health department it is much more coherent and understandable. Just a heads up.
July 9, 2016
This was an ultimately a disappointing book. It covers NYC Mayor Bloomberg's public health drives to reduce salt, cut smoking, reduce calorie counts, and other efforts. The conversational style was interesting but trivialized some important points. On the other hand, it was quite readable. Most of Bloomberg's successes came early under Thomas Frieden. Later attempts by Frieden's successor overreached any electoral mandate. Still it was mostly a noble effort. It is thanks to those early successes that so few restaurants and bars around the country allow indoor smoking. We're all more aware of the dangers of too much salt and overlarge portions.
June 14, 2016
Nice overview (and actually a pretty detailed description) of the health policies that mayor bloomberg and his staff made in nyc. these include reduction in sodium in canned foods, no smoking in bars, soda laws.
this book also enlightened me to the intense advocacy efforts of corporate food/beverage companies - like coca cola, malboro, etc, and how much of a pull they have in congress. congressmen/women are often basically bought off to not agree to policies because the organizations fund their campaigns.
this book also enlightened me to the intense advocacy efforts of corporate food/beverage companies - like coca cola, malboro, etc, and how much of a pull they have in congress. congressmen/women are often basically bought off to not agree to policies because the organizations fund their campaigns.
August 20, 2016
I really thought this was going to be an interesting book. It has a grabbing title, and I have a vested interest in the subject matter. I couldn't have been more wrong. I struggled through this book and couldn't wait to be done. Much more about the red tape than the issues themselves. It seemed disorganized as well.
September 18, 2016
An interesting account of how Mayor Bloomberg, Tom Frieden, and Tom Farley worked together in NYC to make their mark on public health. Proof that public-private collaboration is key to success, and controversy should be expected with any meaningful proposals.
A great read for Philadelphians as Dr. Farley leads the city as Public Health Commissioner and our soda tax kicks off in January.
A great read for Philadelphians as Dr. Farley leads the city as Public Health Commissioner and our soda tax kicks off in January.
January 23, 2016
Great subject matter, but a bit verbose and repetitive.
February 12, 2016
Very interesting book about Mayor Bloomburg and his health initiatives!
Displaying 1 - 25 of 25 reviews