CityHealth, an initiative of the de Beaumont Foundation and Kaiser Permanente, advances a package of evidence-based policy solutions that will help millions of people live longer, better lives in vibrant, prosperous communities. CityHealth regularly evaluates cities on the number and strength of their policies.
Choosing Our Policies
CityHealth rates the nation’s 40 largest cities based on their progress in adopting an evidence-based policy package. This policy package was derived using a three-part process that considered 1) the evidence-base of policies addressing the key social determinants of health; 2) cities’ jurisdictional authority and precedent; and 3) analysis by a policy advisory committee representing key partners, influencers, and community representatives. The goal was to provide city leaders with a pragmatic, achievable, yet aspirational, package of policies that could align with their city priorities and needs.
Similar to the Center for Disease Control and Prevention’s (CDC) HI-5 initiative, CityHealth started with all policies that leading authorities, such as the Robert Wood Johnson Foundation’s County Health Rankings, the National Academy of Medicine, and the CDC’s Community Guide, determined as having sufficient evidence/expert opinion to provide important health benefits. Policies were sorted into key categories related to how they addressed social determinants of health along with key preventable causes of death and disability: education, environment, financial security, housing, nutrition, public safety, tobacco control and transportation.
The focus was exclusively on upstream policies that prevent health problems, not on medical treatment and care. CityHealth also determined that at least one policy should be under the direct authority of the local public health agency (rather than a city council, zoning board, or other decision maker). Policies were further filtered by jurisdictional authority–only policies that could potentially be actionable at the city level. CityHealth conducted a feasibility assessment, drawing from national subject matter experts and a policy advisory committee representing influential parties in a local policymaking process, which included a mayor, a chamber of commerce representative, a public health dean, and community leaders.
The CityHealth package is not intended to be an exhaustive list; instead, nine policies were selected that met specific criteria of being largely under city jurisdiction, being backed by evidence, and showing a track record of bipartisan support. The project team also looked for those policies that were ready to be adopted in the most places with the greatest potential to improve people’s lives.
How We Assess Cities
Following this assessment, CityHealth created a public accountability tool to convey the status of the nine policies in each of the nation’s largest cities. Working with leading subject matter experts, CityHealth developed criteria for scoring individual policies as gold, silver, bronze, or no medal.
See our 2018 Report Methodology for descriptions of how we scored cities on each policy.
Cities were awarded an overall city-wide medal based on how many policy medals it had earned: gold is awarded for five or more gold medal policies; silver is awarded for five or more silver or gold; and bronze is awarded for four of any combination of medals. Recognizing that cities have different needs, priorities, and realities, CityHealth does not weight policies and only requires a plurality of policies winning top marks in order to medal.
To see where your city landed, check out our Find a City page.
Modifications to CityHealth Policy Package and Medal Criteria
Recognizing that passing new policies is a lengthy process and best practices will inevitably evolve, CityHealth will revisit its recommended policy package and scoring system every five years. We aim to have an updated set of policies and medaling criteria for the 2021 assessment.
Like the original process, policies will be selected by the de Beaumont Foundation and Kaiser Permanente based on findings from a multi-tier assessment:
1) Independent evidence/expert opinion of significant impact on health and equity;
2) policy under city jurisdiction (versus implementation of a state/federal law);
3) evidence of successful implementation and bipartisan support in at least one major U.S. city; and
4) recommended by the CityHealth Policy Advisory Committee, which represents a diverse yet pragmatic set of urban interests, ranging from business to community leaders.
We are evaluating enforceable laws, rules, executive orders that fall in the following categories:
Mental health/substance abuse
Public health/emergency preparedness