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:
- 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.
Looking for CityHealth’s 2.0 policies? Learn more about the 2.0 Policy Package that CityHealth will use to assess cities starting in December 2022.

Earned Sick Leave
Earned sick leave laws reduce the spread of contagious illnesses, increase employment and income stability, and save cities money in health care costs.

High-quality, Accessible Pre-Kindergarten
Children who attend high-quality pre-k are more likely to succeed in school, go on to stable jobs and earn more as adults—all of which are linked to better health and stronger communities.

Affordable Housing/Inclusionary Zoning
As cities grow, it’s important that residents of all income levels have access to affordable housing that sets them up for good health.

Complete Streets
Complete streets policies unlock opportunities by allowing city residents to safely walk, bike, drive and take public transit around their community.

Tobacco 21
Curbing tobacco use among young adults has been shown to decrease the number of people who start – and continue – smoking.

Smoke Free Indoor Air Policies
Comprehensive smoke-free air laws protect non-smokers from secondhand smoke and reduce smokers’ consumption of tobacco – the leading cause of preventable death in the U.S.

Safer Alcohol Sales
Safer Alcohol Sales policies put cities in charge of the location and practices of alcohol retailers. Neighborhoods with high concentrations of alcohol sales are linked to more drinking and higher rates of violence and driving under the influence.

Food Safety and Restaurant Inspection Ratings
Policies requiring food establishments to publicly post safety inspection “grades” empower consumers, reduce foodborne illiness rates and cut down on health care costs.

Healthy Food Procurement
Policies that make sure healthy food options are available on public property aid city residents in making smart decisions that will help them achieve and maintain a healthy weight.