Many U.S. Cities Are Making Progress to Advance Health-Promoting Policy Solutions; Greenspace and High-Quality Pre-K Among Top Policies in 2024

47 of 75 largest cities earn overall medals in CityHealth’s 2024 policy assessment

BETHESDA, MARYLAND — DECEMBER 3, 2024 — CityHealth’s latest policy assessment of the 75 largest U.S. cities found that in 2024, city leaders, state legislatures, and voters adopted or strengthened evidence-based policy solutions to improve health. This year, CityHealth awarded 47 cities (63%) with overall gold, silver, or bronze medals, with eight cities moving from bronze to silver and one city earning a bronze for the first time. Conducted since 2017, CityHealth’s annual assessment found that Greenspace and High-Quality, Accessible Pre-K rose to the top as the most-adopted solutions, while policies like Eco-Friendly Purchasing and Legal Support for Renters saw slower uptake, representing prime opportunities for policy adoption in 2025. CityHealth is an initiative of the de Beaumont Foundation and Kaiser Permanente.

“From coast to coast, cities have demonstrated remarkable resilience and innovation, proving that progress is possible amidst a shifting landscape,” said CityHealth Executive Director Katrina Forrest, JD.  “We celebrate cities and their visionary leaders who have worked to transform bold aspirations into equitable policy solutions that can improve the health and well-being of all members of a community. Looking forward, CityHealth stands committed to partnering with local leaders to create healthier, more vibrant communities that will benefit residents for generations to come.”

Seven exemplary cities rose to the top by earning overall gold medals: Boston, Denver, Minneapolis, New Orleans, Portland, San Antonio, and St. Louis — each of which also earned an overall gold medal in 2023.

Nine cities showed progress by improving their medals in 2024, including eight that moved from overall bronze medals to overall silver medals — Albuquerque, Aurora, Baltimore, Lincoln, Long Beach, Sacramento, San Diego, and Santa Ana. One city, Omaha, earned its first overall medal, a bronze.

“The progress achieved in 2024 highlights the critical role of local governments in advancing health and equity through evidence-informed policymaking,” said de Beaumont Foundation President & CEO Brian C. Castrucci, DrPH. “By forming deep partnerships with city leaders, CityHealth has helped to establish a strong basis for cities to meet emerging health challenges and create the conditions where everyone can live healthier lives. This approach shows the power of ‘policy as medicine’ by proactively addressing the root causes of poor health.”

Cities can earn individual gold, silver, or bronze medals in CityHealth’s 12 policy areas, with overall medals awarded to cities earning five or more individual policy medals. The medals are awarded for city laws that meet CityHealth’s policy criteria, which provide an evidence-backed framework that cities can use to help promote health equity and address key public health concerns such as affordable housing, paid sick leave, greenspace access, and more.

“Most people spend a few hours a year in the doctor’s office. For the rest of the year, people are in the care of their community,” said Bechara Choucair, MD, executive vice president and chief health officer at Kaiser Permanente. “CityHealth policies are practical, effective solutions that improve health by reaching people where they live, learn, work, and play.”

2024 ASSESSMENT: KEY FINDINGS

CityHealth, in partnership with the Center for Public Health Law Research at Temple University’s Beasley School of Law and other evaluation partners, rated America’s 75 largest cities based on the criteria established for each of the 12 policy solutions (listed below) using gold, silver and bronze medals. For complete results, including individual medals by policy area, go to www.cityhealth.org/2024-assessment/.

OVERALL RESULTS*

Gold

1. Boston
2. Denver
3. Minneapolis
4. New Orleans
5. Portland
6. San Antonio
7. St. Louis

Silver

1. Albuquerque*
2. Atlanta
3. Aurora*
4. Baltimore*
5. Chicago
6. Kansas City
7. Lincoln*
8. Los Angeles
9. Long Beach*
10. Milwaukee
11. New York
12. Newark
13. Philadelphia
14. Pittsburgh
15. Sacramento*
16. San Diego*
17. San Francisco
18. San Jose
19. Santa Ana*
20. Seattle
21. St. Paul
22. Washington, DC

Bronze

1. Anaheim
2. Cleveland
3. Colorado Springs
4. Columbus
5. Dallas
6. Detroit
7. Fort Worth
8. Fresno
9. Henderson
10. Houston
11. Indianapolis
12. Louisville
13. Nashville
14. Oakland
15. Omaha*
16. Riverside
17. Stockton
18. Tucson

*Indicates medal advancement from 2023

POLICY SOLUTIONS

CityHealth’s tried and tested policies help all people in our nation’s largest cities have access to a safe place to live, a healthy body and mind, and a thriving environment. In 2024, America’s 75 largest cities earned 422 individual policy medals across all 12 policies, including 161 gold medals, 113 silver medals, and 148 bronze medals.

• Affordable Housing Trusts
• Complete Streets
• Earned Sick Leave
• Eco-Friendly Purchasing
• Flavored Tobacco Restrictions
• Greenspace
• Healthy Food Purchasing
• Healthy Rental Housing
• High-Quality, Accessible Pre-K
• Legal Support for Renters
• Safer Alcohol Sales
• Smoke-Free Indoor Air

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CityHealth, an initiative of the de Beaumont Foundation and Kaiser Permanente, works to advance a package of proven 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. Find out more at cityhealth.org.

The de Beaumont Foundation advances policy, builds partnerships, and strengthens public health to create communities where people can achieve their best possible health. Learn more at www.debeaumont.org.

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve nearly 12.5 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.