Which Cities are Making Healthy Food an Easy and Accessible Option?

By Shelley Hearne, DrPH, President of CityHealth


We’ve all been there: it’s three o’clock on a Wednesday and the mid-afternoon, post-lunch, energy slump hits. The easiest cure: a snack that will help you get through the rest of the workday. You head down the hall to the vending machine where your choices are...candy, chips, pastries, or more candy. Wanting something healthy, you head downstairs to the office cafeteria, only to find that the same unhealthy foods are available.

In an environment where the unhealthy choice is consistently the cheapest, easiest, and most available option—where does one go? How can we increase access to healthy food and offer healthy food choices?


CityHealth’s newest research looks at which cities are trying to change the fact that residents often have few options while trying to find healthy food on city property. In our latest report, Healthy Food Procurement in American Cities, we looked at these policies in the nation’s 40 largest U.S. cities. We assessed whether the city has nutrition standards in place, what percentage of foods and beverages sold on city property abide by those standards, and whether all types of city food and beverage contracts are covered.

We found that across the country, cities are making great progress on this policy. Nine cities—Boston, Long Beach, Los Angeles, New York, Philadelphia, San Antonio, San Francisco, Seattle, and Washington, D.C.—earned a gold medal, our highest rating. Four cities improved their status since 2018: San Antonio moved from no medal to achieving gold, Seattle moved from bronze to gold, Denver from no medal to silver, and Austin from no medal to bronze. 

Cities across the country are giving residents new choices, thanks to healthy food procurement policies. These policies help ensure that healthy food options are available in city-owned or controlled places so that when the mid-day snack craving hits, healthy options like fruits, veggies, and nuts are easy picks. These healthier selections—whether they’re available in a vending machine or on a menu—also help us achieve and maintain a healthy weight, which helps reduce obesity and related conditions, like heart disease and type 2 diabetes.

At CityHealth, healthy food procurement is one of our nine recommended policy solutions that cities can adopt to help their communities thrive. Healthy food procurement alone won’t beat the obesity epidemic, but it’s a great start for city leaders who want to make their city a healthier place. This is a policy that changes the way public officials spend dollars that are directly under their control. The truth is, when they do, it’s a win-win for residents and businesses. Experts found that when cities leverage their purchasing power to offer healthier food choices in city-owned and controlled places, everyone benefits—businesses’ profits go up, and residents see their weight go down. The Automatic Merchandising State of the Industry report found that offering healthy food attributed as much as a 25% upswing in sales and the Snack Food Association reports that sales growth of healthier snacks is outpacing traditional snack foods by a ratio of 4 to 1. 

Explore your city’s rating and learn more about how this evidence-based policy helps cities thrive in our new report: Healthy Food Procurement in American Cities.

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For the cities themselves, it’s a policy that’s sorely needed to rein in sky-high health care spending. One-third of adults are obese, and an additional third is overweight. Every year, cities with the highest obesity rates pay an estimated $50 million in costs associated with obesity and related chronic conditions. Even cities with comparatively low obesity rates incur millions of dollars in preventable health care bills. By adopting healthy purchasing or procurement policies, so that foods served or sold on city property include healthy options and meet basic nutrition standards, cities can help reduce obesity rates and curb these costs. 

Running a city isn’t easy, and policy change can be complex. City leaders are often presented with tough choices that present few good options. Whether or not to offer healthy food isn’t one of them. We encourage cities to adopt this proven policy and provide their residents the opportunity to grab a healthy snack or lunch when they are on city property. Show your residents that your city is doing all it can, where it can, to create healthy spaces and give residents the chance to thrive - even during that afternoon snack break.

Back-to-School for Our Youngest Learners – How Pre-K Roots Our Kids in a Healthy Start

By Mark Del Monte, CEO/Executive Vice President of the American Academy of Pediatrics

The start of Pre-Kindergarten is a milestone. For the child, it is their first experience entering school, and  for their caregivers it is an emotional moment seeing their child grow up and go to “big kids” school, and for communities it brings new opportunities to support the education and health of its youngest residents.

Researchers have long shown that children benefit enormously from high quality Pre-K. Kids enter school better prepared, ready to learn, and are less likely to repeat a grade later on. Pre-K also accounts for increased high school graduation rates and increased years of education completed.

Making Health Policy Consumer Friendly with Restaurant Grading

The Only Secret Should Be the Sauce

Guest post featured on National League of Cities’ Cities Speak blog, authored by CityHealth Policy Advisory Committee Member Dr. Jonathan Fielding

Americans don’t just love to eat; we love to know about the foods we’re eating. Labels in restaurants increasingly inform the consumer about ingredients, calories, and even how animals have been raised.

But good luck trying to find out if your restaurant choice fares well in food safety inspections – it’s one of the last best kept secrets, despite the fact that these checks are supported with tax dollars. Only a few cities and states tell consumers before they walk in the door of a food establishment how well the business stores, handles, and prepares food, or whether they follow best practices to prevent you from being exposed to Salmonella, E.coli, Hepatitis A, or toxins that can lay low for days before wreaking havoc.

That shouldn’t be a secret.

Not only do consumers have a right to know, but growing evidence shows that when municipalities publicly grade restaurants, overall restaurant hygiene improves.

Read the rest of Dr. Fielding’s blog —>

City Health through Pre-K – Learning from Our Peers and Building Relationships Across Sectors is Key to the Success of Our Cities’ Young Children

CityHealth and the National Institute of Early Education Research (NIEER) recently convened Pre-Kindergarten policy leaders from cities across the country to exchange ideas and best practices on how to establish high quality, accessible early childhood education programs in localities. This blog presents a read-out of that session.

By Tim Burgess, Former Mayor of Seattle and City Councilmember

I have spent much of my political career working to expand access to high-quality, affordable Pre-K for Seattle’s young children, and I am proud of the Seattle Preschool Program that came out of that work. I also recognize that our work is far from over, as thousands of children – many of them low-income or children of color – enter kindergarten unprepared to succeed. When the opportunity arose to participate in the CityHealth through Pre-K Summit, and spend 2 ½ days in Detroit learning about evidence-based strategies to develop a quality Pre-K program and engage with early childhood leaders from around the country - I jumped at the chance to do so.

That’s a Wrap: Texas Legislative Session Produced Progress in the Lone Star State

As the dust settles after the 2019 Texas legislative session, we are reflecting on the significant strides that Texas policymakers made in advancing public health policies. CityHealth congratulates state and city officials for their continued leadership in improving people’s lives and helping communities thrive. This post highlights just a few updates from this year’s legislative session on Tobacco 21, access to high-quality Pre-K, and earned sick leave and shares where to catch CityHealth next in the Lone Star State.

Tobacco 21 is on the Move Across America

On this year’s World No Tobacco Day, I am excited to acknowledge the momentum of policy change in the country right now. There is a movement with real power to pass laws to protect people, especially children, from tobacco and its harms. Tobacco 21 laws, which raise the minimum legal age of sale for tobacco from 18 to 21, are passing in cities and towns all over America. This is something to be proud of – this stunning groundswell of support was simply unthinkable only a few years ago.

How More of Us Can Bike to Work Safely – Today and Everyday

Emiko Atherton

Emiko Atherton

By Emiko Atherton, Vice President, Thriving Communities, Director, National Complete Streets Coalition, Smart Growth America

May 17 is Bike to Work Day--a day celebrated as part of National Bike Month. Here in the Washington, D.C. area, local bike enthusiasts will encourage their fellow residents to join their ranks, fill the streets, and pedal their way to work. Biking to work has several different benefits and allows us all to interact with our communities in new and different ways but it all starts when cities implement comprehensive Complete Streets policies.

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Complete Streets is one of the nine policies our partner, CityHealth, advocates for, as a powerful policy that local leaders can put in place that can transform health for their residents. It helps those who live in cities walk, bike, ride, drive or take public transit safely.

A strong complete streets policy includes street lighting to illuminate the path home from after school activities in the winter, or crosswalks for mothers and fathers to use with strollers and toddlers on the way to the community park, or bike lanes to provide commuting options for those throughout the community.

Additionally, these policies:

· Promote healthy living by helping to reduce the risk of obesity and healthy problems such as diabetes, heart disease and high blood pressure.

· Provide an economic boon to a cities, helping them to avoid a total of $18.1 million in collision and injury costs in one year alone.

· Improve public safety by reducing traffic speed and the risk of injury for pedestrians and cyclists.  

· Enhance a sense of community, improve greenspace and help reduce crime and stress.

The package of local policies that support Complete Streets helps to make communities accessible to all for work and play. As we all dust off our helmets and map our route to work this Bike to Work Day, I hope that all cities stand committed to traveling all of the routes we can to create the healthiest cities possible. 

Find out whether your city has a solid complete streets policy here.

About Smart Growth America and the National Complete Streets Coalition

The National Complete Streets Coalition, a program of Smart Growth America, is a non-profit, non-partisan alliance of public interest organizations and transportation professionals committed to the development and implementation of Complete Streets policies and practices. A nationwide movement launched by the Coalition in 2004, Complete Streets is the integration of people and place in the planning, design, construction, operation, and maintenance of transportation networks. To date, over 700 agencies have adopted Complete Streets policies.

Smart Growth America is the only national organization dedicated to researching, advocating for, and leading coalitions to bring better development to more communities nationwide. From providing more sidewalks to ensuring more homes are built near public transportation or that productive farms remain a part of our communities, smart growth helps make sure people across the nation can live in great neighborhoods.

In the Zone: Women, Alcohol and Violence

By David Jernigan, PhD, CityHealth Senior Policy Advisor

David Jernigan, PhD

David Jernigan, PhD

Study after study has found that concentrations of alcohol outlets – particularly those that sell for consumption off-site – are associated with greater violence and other problems in the neighborhoods around them. Homicides, assaults, robberies and other crimes go up when the number of alcohol outlets in a neighborhood increases.

 Included in this list are intimate partner violence, sexual assault and rape. One study even found that the advertising sexualizing women that often covers the exterior of such establishments was associated with increased assaults on women in those neighborhoods.

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Women are already at a significant disadvantage to men when it comes to drinking. Because of differences in the way male and female bodies metabolize alcohol, the same amount of alcohol will have greater effects on a woman than a man, when drunk at the same pace and by persons of similar body size and drinking history. 

Other consequences of drinking specific to women include higher risk of breast cancer – 15% of U.S. breast cancer cases and deaths from breast cancer are considered attributable to alcohol use. There is no safe level of consumption for alcohol-attributable breast cancer – one study found that a third of the cases happened at levels of consumption of one and a half drinks per day or less.

Drinking among women has been rising in recent years. The amount and frequency of drinking and high-risk drinking by women increased between 2002 and 2012, at the same time that men’s frequency fell. Binge drinking (four or more drinks within two hours for women) rose more than three times as fast among women as among men.

These differences are showing up in local emergency rooms, where visits involving alcohol consumption have risen significantly faster for females than for males in recent years. Between 2002 and 2012, alcohol dependence (addiction) rates fell among men, but not among women. Alcohol causes an estimated 25,693 deaths per year among women nationwide.

Studies have repeatedly connected alcohol outlet density with violence against women. In Bloomington, Indiana, higher off-premise outlet density in a block group was associated with greater intimate partner violence in that block group. In Milwaukee, density of both on- and off-premise alcohol outlets was associated with greater non-intimate partner-related violence against women.

Bars and restaurants, selling for on-premise consumption, have smaller effects on public safety than off-premise outlets, but the effects can still be there. Atlanta found that a three percent drop in on-premise alcohol outlet density in one popular neighborhood was associated with twice as large a drop in exposure to violent crime than two comparable neighborhoods where the number of alcohol outlets increased.

Off-premise outlets, however, seem consistently to have a higher impact on the neighborhood around them, possibly because they increase the supply of alcohol without providing any kind of supervision for the drinking that ensues.

Beginning in the early 1990s, cities across California began to use local zoning tolls to reduce the proliferation of alcohol outlets in their neighborhoods. While licensing of alcohol outlets is often the responsibility of state agencies, zoning in many states is a local power. The best practice has involved setting new, local zoning-based standards for all alcohol outlets, and using a fee on those outlets to fund enforcement of those standards. 

Among the nation’s 40 largest cities, CityHealth has found that just 8 have explicitly taken the kinds of local zoning authority that permit them to control the number of alcohol outlets in a neighborhood. This authority ideally gives local communities the right to a say in the number of outlets that sell for on- or off-premise consumption, and to exercise that right both going forward, for new outlets, and over the number of outlets currently in place.

Taking and exercising cities’ right to a voice in the number, placement and sales and service practices of alcohol outlets within their borders could play a significant role in helping to win that battle.