City News

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.

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.

Too Many Cities Missing Opportunities to Create Lasting Benefits for their Youngest Learners


By Shelley Hearne, President of CityHealth and Ellen Frede, Senior Co-Director at the National Institute for Early Education Research at Rutgers University

Our new national report, Pre-K in American Cities, finds a growing number of large US cities enacting new local funding streams to establish and support Pre-K, yet many programs fail to meet minimum quality standards or serve only a small percentage of eligible children.

Pre-K is a proven policy that every city should employ to ensure all children get a strong and healthy start. High-quality Pre-K provides benefits that go beyond the early years and lays a stronger foundation for later social and economic success and even improved physical health. Most of the large U.S. cities included in the report have a Pre-K program in place, but there is still work to do. To provide children and families the full benefits of Pre-K, city leaders need to design and implement high-quality programs based on research that children and families can readily access.

Based on analysis by NIEER using the same 10 quality standards benchmarks cited in NIEER’s national State of Preschool reports, CityHealth has awarded 5 gold, 8 silver, and 20 bronze medals to cities for Pre-K.

A bronze medal signals that a city meets the criteria for access, a silver represents a city program that mandates quality but provides low accessibility, and a gold medal means that a city earned points for both quality and accessibility in its Pre-K program.

The report is intended to assist localities in determining next steps for providing early learning experiences that improve long-term benefits for children and families. Key findings include:

I. Access is Still Too Low

Access to Pre-K programs is limited in most cities. Only 24 of the 40 largest U.S. cities (60%) offer a Pre-K program that reaches more than 30% of the 4-year-old population.

II. Class Size and Teacher-Student Ratio are Uneven

Just over half of the largest U.S. cities (23 of 40 or 58%) meet quality benchmarks for Pre-K class size, which is one teacher and one teacher assistant for every 20 students.

III. Teacher Preparation is Adequate, but Professional Development and Salary Requirements Are Lacking

Almost two thirds of city programs (25 of 40 or 63%) require Pre-K teachers to have a bachelor’s degree with specialized training in teaching young children, and most programs (34 of 40 or 80%) require at least some specialized training. Only a small fraction of city programs (6 of 40 or 15%) require that all teaching staff receive ongoing professional development. Only 15 (38%) of the rated city programs require that all teachers be paid comparably to those in the K-12 system.

IV. Too Few Cities Conduct Health Screenings

Fewer than a quarter of cities (9 of 40) ensure that children receive vision, hearing, health, and developmental screenings and referrals. The benefits of these screenings are widely recognized by the U.S. Centers for Disease Control and Prevention (CDC), the Institute of Medicine, and the American Academy of Pediatrics.

To see how your city performs in the report, click here.

The report was written in partnership between CityHealth and the National Institute for Early Education Research (NIEER) at the Rutgers University Graduate School of Education. CityHealth, an initiative of the de Beaumont Foundation and Kaiser Permanente, works to advance evidence-based policy solutions with the potential to help millions of people live longer, better lives in vibrant, prosperous communities. One of these policy solutions is access to high-quality Pre-K, which can have significant health benefits for all children, regardless of family income or zip code, when the program’s design adheres to proven practices.

Going for Gold in Texas


By Dave Lofye, CityHealth Texas Director

Everything is bigger in Texas. With a population of 28 million people, Texas is home to six of the 40 largest cities in the country and many of the fastest growing metropolitan areas in the nation. From El Paso to Houston to San Antonio to Fort Worth, every Texas city is unique. Which is why local leaders are taking diverse approaches to adopting public health policies that work for their communities. All eyes were on the Lone Star State last week, as the Texas legislature kicked off its 86th session, and lots of new local leaders took seats at the table across the state. I want to share some of the top developments in Texas that we are watching here at CityHealth.

Local public health leadership is critical. Why? Because Texas communities face big challenges. The state does not perform well on a number of health measures, with some of the highest uninsured rates, obesity rates, and physical inactivity rates nationwide. Since the state is so large and diverse, local governments play an especially crucial role in creating solutions. As Texas cities continue to grow rapidly, building healthy localities where all residents can thrive becomes even more important.

CityHealth is here to help. As Texas Director, I support local leaders who want to adopt a pragmatic and achievable, yet aspirational, package of policies that align with their priorities and needs.  Our nine evidence-based policies help residents lead healthier lives, make communities thrive, and should be among the tools that mayors, city councils, health directors, and city managers use in the pursuit of healthy communities. 

At the 86th Annual Meeting of the U.S. Conference of Mayors in Boston, CityHealth held a medal ceremony to celebrate the cities that show the greatest commitment to policymaking that supports the health and quality of life of their residents over the past year. Mayor Ron Nirenberg of San Antonio was honored by by President of CityHealth, Shelley Hearne, CEO of the de Beaumont Foundation, Brian Castrucci, and Senior Vice President and Community Health Officer of Kaiser Permanente, Bechara Choucair.

At the 86th Annual Meeting of the U.S. Conference of Mayors in Boston, CityHealth held a medal ceremony to celebrate the cities that show the greatest commitment to policymaking that supports the health and quality of life of their residents over the past year. Mayor Ron Nirenberg of San Antonio was honored by by President of CityHealth, Shelley Hearne, CEO of the de Beaumont Foundation, Brian Castrucci, and Senior Vice President and Community Health Officer of Kaiser Permanente, Bechara Choucair.

In 2018, three of the six CityHealth cities in Texas earned an overall CityHealth medal. Austin and Houston earned bronze medals while San Antonio earned a silver medal. Austin and San Antonio have earned an overall medal since 2017, showing that Texas cities are on the move when it comes to adopting the CityHealth package. The remaining three cities—Dallas, Fort Worth, and El Paso—have not yet earned an overall CityHealth medal but are well positioned to do so in the future. As we enter 2019, we reflect back on some of the biggest accomplishments in Texas on CityHealth-aligned policies and take a look at what to expect in the next year.

To see which medal your city earned, click here.

New Developments in Texas Cities. San Antonio remains the first city in Texas to adopt a Tobacco 21 ordinance, meaning someone must be age 21 to purchase tobacco products in San Antonio. This new law went into effect in October 2018 and is providing significant momentum for adoption of a statewide Tobacco 21 law during the 2019 legislative session. (To learn more about the Tobacco 21 ordinance in San Antonio, check out our Policymaker Webinar with Dr. Colleen Bridger, the Health Director of the San Antonio Metropolitan Health District.)

In Dallas, residents approved a ballot measure in November to increase funding for schools, including Pre-Kindergarten programs. The funding will go to the Dallas Independent School District, which previously released data showing that students who attended pre-kindergarten programs outperformed their peers on third grade standardized tests. Dallas currently earns a bronze medal for its pre-kindergarten program; the program meets enrollment standards but only five of CityHealth’s 10 quality benchmarks identified by the National Institute for Early Education Research.

Over the past year, the city councils of Austin and San Antonio approved earned sick leave ordinances. These laws require employers to allow employees to take paid time off for illnesses or injuries for themselves or their family members. These measures have been controversial, resulting in legal challenges in both cities and the threat of preemption by the state legislature. CityHealth will continue tracking these developments as they occur.

Other Texas cities continue to promote public health-focused policies that are aligned with CityHealth. Fort Worth recently received certification as a Blue Zones Community—which was the culmination of a five-year initiative to improve the well-being of city residents—and additional honors for Mayor Betsy Price’s FitWorth initiative. El Paso’s Department of Public Health was recently awarded for its leadership in addressing chronic disease and promoting healthy lifestyles. The Houston Health Department was also recognized last year for efforts to help residents improve the health and well-being of their communities through advocacy.

What’s Next in Texas? Over the past year, CityHealth is proud to have worked with local leaders, community partners, and other key stakeholders—from MD Anderson to the American Heart Association to local chambers of commerce to elected officials. We were honored to cosponsor a Texas Tribune health care panel in El Paso that featured members of the El Paso delegation to the state legislature and thrilled to see CityHealth highlighted at the Healthier Texas Summit by Dr. Karen DeSalvo when discussing her vision for “public health 3.0.”

Over the next year, CityHealth will continue to build partnerships, support local leaders, and help advance evidence-based public health policies that Texas cities need. We’ll keep an eye on the state legislature and keep you posted on the progress being made as Texas’ largest cities move to adopt CityHealth policies that give residents an equal opportunity to live full and healthy lives.

See How Your City Scores: Celebrating Child Health Everyday with High Quality, Accessible Pre-K

By Shelley Hearne, DrPH, President of CityHealth

Welcome to the CityHealth blog!

CityHealth, an initiative of the de Beaumont Foundation and Kaiser Permanente, provides leaders with 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.

We awarded each of the cities either a gold, silver, bronze or no medal designation based on that assessment.  Our goal is that all city leaders use our assessment as a tool to work together and move toward the gold standard in each policy area by adapting evidence-based policies shown to improve the well-being and quality of life for their residents.  This is also about accountability - so our nation’s citizens have the data they need to hold their elected officials accountable for taking the steps necessary to make their city thrive.

Visit us here to find out more about policymaking at the city level that supports healthy communities, and meet local leaders and experts who are finding innovative ways to help cities thrive. To receive new blog entries in your inbox, sign up here.


Today, to celebrate Child Health Day, CityHealth recognizes a great way city leaders can enhance every child’s opportunity to be healthy and thrive: by creating high-quality, accessible early education programs for kids.  Pre-Kindergarten (Pre-K)’s educational benefits to three- and four-year-olds are well established, but here’s the significant added benefit: done right, Pre-K can provide an important, life-lasting health boost for our youngest citizens.  Because of these health benefits, CityHealth targets and assesses Pre-K as one of its nine top recommended policies for city leaders to improve quality of life for urban residents (see scores below.) 

There is no question that there are numerous health benefits associated with attending high quality Pre-K programs – both in the short-term and long-term.  Ninety percent of children’s adult brain volume is developed by age six, and we know that experiences during early childhood fundamentally affect the structural development and neurobiological pathways in the brain.  On a more practical level, when children are in high quality Pre-K programs, the odds improve that children who need treatment for vision, hearing, or chronic issues, like asthma, get the help they need.  Preschool participants are more likely to go to a doctor, receive appropriate immunizations and screenings, and get dental care.

In fact, the U.S. Centers for Disease Control and Prevention (CDC) recognizes Early Childhood Education programs, such as Pre-K, as one of the most important and effective policies available to improve population health.   The nation’s leading health agency cited the strong evidence demonstrating that early childhood education fosters socio-emotional, cognitive, and motor skill development, in addition to academic achievement.  Early Childhood Education also leads to longer-term benefits such as reductions in obesity, child abuse and neglect, youth violence, teen birth rates and emergency room visits.

CityHealth recognizes that in order for cities and their children to fully reap the benefits, Pre-K programs must be of high quality and widely accessible. To help catalyze widespread adoption of this important health intervention, CityHealth awards medals – gold, silver, bronze, or no medal--based on the National Institute for Early Education Research’s 10 research-based quality standards benchmarks and an assessment of the level of enrollment in the city’s largest Pre-K program. Thirty-three out of 40 cities received a medal for offering, accessible, high-quality Pre-K, including five gold, eight silver, and 20 bronze. Incredible progress was made in recent years to open access and increase quality of Pre-K programs around the country. However, our goal is for every child to live in a gold medal city, and clearly in order to meet this standard, there is much more work for us to do.

We invite you to see how your city performs when it comes to Pre-K policy and learn more about how our medals were awarded and what they mean for children and families.

            As we celebrate Child Health Day, it is also a great time to recognize cities that are going beyond traditional Pre-K programs to ensure that the children being served get the health services they need.  For example, Seattle built on an already strong system by coordinating health and mental health services on-site at Pre-K provider locations in consultation with teachers.  Another highlight is the Cincinnati Preschool Promise public school sites, which provide access to school-based health centers, school nurses and other school-based support groups.  Recognizing the importance of wrap-around services for children and families is crucial to keep a city’s residents healthy and provide them the tools they need to succeed.

CityHealth is working with urban leaders who want to increase access and quality of Pre-K programs in their cities.  If you are interested in how cities are making high Pre-K available to kids, and want to know more about how city leaders are leveraging policy to create stronger communities that support healthy families and kids,  sign up here to keep in touch with CityHealth.