About Our Policies
How We Choose 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 three criteria:
- The evidence-base of policies addressing the key social determinants of health
- Cities’ jurisdictional authority and precedent
- 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.
Our Policy Package
Learn more about the policies in CityHealth’s tried and tested policy package.
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 Update Our 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 2022 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:
- Independent evidence/expert opinion of significant impact on health and equity;
- Policy under city jurisdiction (versus implementation of a state/federal law);
- Evidence of successful implementation and bipartisan support in at least one major U.S. city; and
- 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:
- Active living/transportation
- Mental health/substance abuse
- Public health/emergency preparedness
- Public safety
- Air quality
- Sustainability/climate change
- Tobacco control
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