By Matt Leingang
Enquirer staff writer

Sensing a bit of hostility in the room, Malcolm Adcock moves to quell any uprising.

The scene is a recent meeting on a proposed smoking ban for all Cincinnati public places, including bars and restaurants.

Adcock, the city's health commissioner, has some explaining to do.

Tom Ford, co-owner of Murphy's Pub in Clifton Heights, demands to know why the meeting is being held at the American Cancer Society.

Hardly neutral ground, he says. And why, of the 30 people here for this advisory panel, is the deck stacked with mostly health-care professionals?

"We're not starting out with any preconceived notions," the 61-year-old Adcock says, trying to assure Ford that a national movement to ban smoking in the workplace is not necessarily a foregone conclusion in Cincinnati.

As counterintuitive as it seems, Cincinnati's top public health official is not publicly campaigning for clean indoor air legislation.

Instead, he's content to let the advisory panel make a recommendation to City Council in November.

The strategy is vintage Adcock.

Now in his 11th year at the helm of Cincinnati's health department - the city's third-largest department with 540 employees and a budget of $41 million - Adcock has a reputation as a pragmatic, non-confrontational leader.

It's a style that makes him effective, having outlasted two police chiefs and two fire chiefs during his tenure. But it also annoys some critics.

Whether he's making the case for distributing condoms at city health clinics (City Council once moved to end the practice) or fighting to keep medical services intact at the city's six health clinics for the poor (his proudest achievement given Cincinnati's seemingly endless budget crisis), Adcock's approach is more backroom than bully pulpit.

That approach doesn't sit well with Ahron Leichtman, director of the Greater Cincinnati Coalition on Smoking and Health, an outspoken supporter of a smoking ban.

"If the health department can't take on advocacy of this issue, what good is it?" Leichtman asks.

Adcock takes such criticism in stride. Sitting in his Corryville office, near the complex of hospitals that surround the University of Cincinnati, Adcock is circumspect, a manner befitting his bearded, professorial look.

Look, Adcock says, there's no question where he stands on the issue. As a public health official, he supports legislation that would protect workers and patrons from secondhand smoke.

But he's also sensitive to perceived economic threats that a smoking ban might impose on business owners. He's determined to make sure that their fears - real or perceived - get equal time.

"At the end of the day, a smoking ban will require the will of the people, and that's as it should be," Adcock says in his thoughtful, deliberate speaking style.

Turning to nature

Stanbery Park is practically in the back yard of Adcock's Mount Washington home. He walks the park's 2-mile trail at least once a week.

"I come here for peace of mind. It's where I go to get away and to put things in perspective," Adcock says.

Although not much of an outdoorsman (he doesn't fish or hunt), Adcock loves nature. Some of his favorite vacations have been spent hiking in national parks, including Yosemite and Yellowstone.

Walking is also what Adcock does for exercise. Overall, the health commissioner is in good health, save for a few extra pounds around the waist.

Adcock was born and raised in Detroit. He went to school at the University of Michigan's Dearborn campus, where he earned a degree in biology and later a doctorate in microbiology from Wayne State.

A bit of a science wonk, Adcock says he was drawn to a career in public health because of his interest in preventing the spread of infectious disease.

His wife, Noreen, is also a microbiologist, employed as a researcher at the U.S. Environmental Protection Agency in Cincinnati.

The Adcocks, who have two children, moved to Cincinnati in 1982, the year that Malcolm was hired to run the city's public health laboratory. After a brief stint as assistant health commissioner, he was appointed to the top spot in 1993.

When not at work, Adcock says he devotes most of his time to his family. His 25-year-old son, Ryan, is a Cincinnati-based singer-songwriter who tours college campuses nationwide and appears at local music venues such as the York St. Cafe in Newport. The senior Adcock is always in the crowd.

In a way, that helps the health commissioner stay connected to the local bar scene, which has a big stake in the smoking ban debate.

But not too connected.

In 1989, the senior Adcock was diagnosed with a nerve block in his heart. As a result, he wears a pacemaker and avoids subjecting himself to places with lingering secondhand smoke, which can significantly increase the risk of a heart attack, according to medical studies.

These days, when the health commissioner retreats to the woods, it's not just the din of the smoking ban debate that consumes him. Nor is it the everyday functions of the health department, which include running the health clinics, monitoring local disease outbreaks and inspecting city restaurants and grocery stores.

Like all public health officials in a post-9/11 world, the threat of bioterrorism has put added pressures on his department.

Adcock's been a key figure in putting together Greater Cincinnati's emergency response plan to incidents involving chemical, nuclear or biological agents. Such threats, while hard to handicap, are tangible.

As recently as March, a "white powder" incident shut down the second floor of the Hamilton County Courthouse. The substance - found in an envelope - turned out to be harmless.

A microbiologist at heart, Adcock began beating the drum for bioterror preparedness in 1998, three years before 9/11. Using federal money, he's beefed up the city's public health lab, purchased new emergency communication equipment and hired an epidemiologist - a "disease investigator" who detects outbreaks.

He concedes that his passion for the issue has produced some internal conflicts. Privately, some health department employees grumble that his focus on bioterrorism has distracted him from other programs.

"When I first started talking about bioterrorism, everybody thought I was nuts," Adcock says. "I had two Board of Health members tell me to stop wasting my time. But how could I stop?"

Adcock answers to the Board of Health and its nine members, but he's also accountable to City Council, the mayor and the city manager.

Looking at the big picture, Adcock argues, ramping up the city's public health infrastructure - even if it's in the name of bioterror - will only strengthen Cincinnati's ability to deal with any crisis, especially in an age of emerging infectious diseases, such as last year's outbreak of severe acute respiratory syndrome.

In front of the camera

Once a month, Adcock ventures to the basement of City Hall, home of CitiCable government-access television, to tape a 30-minute show called Focus on Your Health. The question-answer format allows Adcock to interview people in the health care profession.

Topics can be heavy - bioterrorism, prostate cancer, dental care for the poor.

But he breaks it up with lighter shows on nutrition, fitness and even a demonstration - by Adcock himself - on the martial art of Tai Chi, which Mayor Charlie Luken mercilessly teases Adcock about.

"Kids me every time I see him," Adcock deadpans.

The show is Adcock's only entry into public activism. Much of his other work is behind the scenes.

For example, Adcock sits on the community advisory board of the Hoxworth Blood Center, the main supplier of blood for the region's 25 hospitals. He can't give blood (the heart condition prevents it), but Adcock gives money instead.

Adcock has also played a critical role in lobbying for support of Hamilton County's five-year hospital tax levy. Last approved in 2001, it generates $260 million to help reimburse hospitals for treating the poor. The levy is a frequent target of anti-tax critics.

"He's been enormously influential in helping the county commissioners understand the importance of the hospital levy," says Al Tuchfarber, a professor of political science at the University of Cincinnati and former director of the Institute for Health Policy. "He has extraordinary political skills."

If Adcock chooses to deploy those skills behind closed doors, it's by design. It's where he thinks he's most effective.

So Adcock will sit on the sidelines for the smoking debate and let the public hash it out. His role is to advise City Council.

In all likelihood, Adcock says, the issue will take care of itself, if not this year, then soon.

One of Adcock's favorite books is The Tipping Point by New Yorker writer Malcolm Gladwell. The book explores how major ideas, behaviors and messages reach a critical mass, or tipping point, and take off.

Nationwide, more than 1,700 cities, including Toledo and Lexington, and 10 states have clean indoor air laws, according to the American Nonsmokers' Rights Foundation in Berkeley, Calif.

Advocates in Northern Kentucky are also organizing.

"The culture is moving forward. The trend is clear," Adcock says. "The only question for Cincinnati is, when?"

The Adcock file

Title: Cincinnati health commissioner

Salary: $141,269

Age: 61

Residence: Mount Washington

Personal: Married 31 years to Noreen Adcock, a research microbiologist with the U.S. Environmental Protection Agency in Cincinnati. They have two children: Renee, 29, and Ryan, 25. He also has a 37-year-old daughter, Kimberly, from a previous marriage.

Career highlights: President of Ohio Association of Health Commissioners, 2000-2003; helped implement state and federal plans for bioterror preparedness.

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E-mail mleingang@enquirer.com