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New CityHealth Report Shows City Leaders are Putting Policies in Place to Help Residents Thrive

Majority of Large U.S. Cities are Now Leading on Policies that can Improve Residents’ Quality of Life and Well-Being; Others Remain Stagnant

May 22, 2018

New CityHealth Report Shows City Leaders are Putting Policies in Place to Help Residents Thrive

Majority of Large U.S. Cities are Now Leading on Policies that can Improve Residents’ Quality of Life and Well-Being; Others Remain Stagnant

Washington, D.C. – A majority of the largest U.S. cities now are demonstrating leadership when it comes to adopting policies that improve the health and well-being of their residents, according to the CityHealth initiative’s updated city ratings. But others lag when it comes to smart policymaking.

CityHealth, an initiative of the de Beaumont Foundation and Kaiser Permanente, offers a close look at whether the nation’s 40 largest cities have nine key policies in place that experts say help residents lead healthier lives and make communities thrive. CityHealth awarded each city a gold, silver, bronze, or no medal, according to their performance in the assessment. The group also awarded nine policy-specific medals to each city, according to the quality and strength of the laws in place, which address affordable housing, safe streets, and food safety, among other issues.

The report is designed to show which cities are leading the way on policies shown to improve people’s health and quality of life. CityHealth found in just one year, cities earned a total of 24 new medals for implementing proven policies to better the lives of the people who live, play, learn, and work in their jurisdictions. These advances meant that 10 cities—one quarter of the nation’s 40 largest cities —improved their overall medal status.

As a result, for the first time, a majority of the cities—25 cities total—earned a gold, silver, or bronze medal:

Five cities – Boston, Chicago, New York, Los Angeles and San Jose – earned a gold medal overall, demonstrating that those cities’ leaders have used powerful policy tools to enhance their city’s health, well-being, and economic vitality.

Nine cities earned an overall silver medal, and 11 cities earned an overall bronze medal. Last year, only 19 out of 40 of the largest cities medaled. Each city’s medal status is noted below.

“Policy is a powerful lever for boosting health at the city level,” said Dr. Shelley Hearne, CityHealth’s President. “Many cities are demonstrating significant progress across nine pragmatic polices, which have been proven to help millions of people live longer, better lives. Still, too many cities are not getting to gold. We encourage all cities to show their commitment to building a healthier community that truly thrives, by adopting this set of proven policies. Every unearned gold medal represents an opportunity to take action and to improve people’s quality of life.”

While many cities made positive changes, others remain unchanged: Fifteen cities did not earn an overall medal, meaning they were awarded three or fewer medals across each of the nine policies. And four of the nation’s most populous cities (noted below) did not earn a medal for smoke-free indoor air policies, missing a significant opportunity to protect non-smokers from secondhand smoke and reduce smokers’ use of tobacco – the leading cause of preventable death in the U.S.

CityHealth’s nine evidence-based policies address ways that cities can improve the health of their residents in areas of everyday life – from the workplace and school, to housing and public transportation. Each policy is backed by evidence, supported by experts, and has a track record of bipartisan support. In addition to the medal ratings, CityHealth is available to provide technical assistance and support to cities as they advance these policies.

2018 Overall Medal Results:

Overall Gold Medalists – Five Cities (five or more gold medals across each of the nine policies)

Boston, MA
Chicago, IL
Los Angeles, CA
New York, NY
San Jose, CA+

Overall Silver Medalists – Nine Cities (five or more gold or silver medals across each of the nine policies)

Kansas City, MO+
Long Beach, CA+
Philadelphia, PA
Sacramento, CA
San Antonio, TX+
San Diego, CA
San Francisco, CA
Seattle, WA+
Washington, D.C.

 Overall Bronze Medalists – Eleven Cities (four or more gold, silver or bronze medals across each of the nine policies)
Albuquerque, NM+
Atlanta, GA*
Austin, TX+
Baltimore, MD
Charlotte, NC
Denver, CO
Fresno, CA
Houston, TX
Louisville, KY+
Milwaukee, WI+
Portland, OR+

 No Overall Medal – Fifteen Cities (for cities receiving three or fewer medals across each of the nine policies)

Columbus, OH
Dallas, TX
Detroit, MI
El Paso, TX
Fort Worth, TX
Indianapolis, IN
Jacksonville, FL
Las Vegas, NV
Memphis, TN*
Mesa, AZ
Nashville, TN*
Oklahoma City, OK
Phoenix, AZ
Tucson, AZ
Virginia Beach, VA*

+ These cities increased their overall medal status since last year.

* These cities are the only ones included in this study without smoke-free indoor air laws.

How cities performed on the nine CityHealth policies:

Affordable Housing

Affordable housing promotes diverse, inclusive neighborhoods and positive mental health, reduces crowding and exposure to environmental hazards, and frees up household resources to pay for health care and healthy food.

Thirteen out of 40 cities received a medal for their affordable housing policies.

Alcohol Sales Control

Neighborhoods with high concentrations of alcohol outlets are linked to more drinking and higher rates of violence and driving under the influence. Policies that address a high density of alcohol outlets can reduce crime, increase safety and may reduce spending on health care and criminal justice costs.

Fifteen out of 40 cities received a medal for alcohol sales control policies.

Complete Streets

Complete streets policies safely combine all forms of transportation, such as walking, biking, driving or taking the bus. These policies can expand economic growth, improve individuals’ health, and save lives.

Thirty-two out of 40 cities received a medal for complete streets policies, up from 31 in 2017. New medalist for 2018: Kansas City. Five cities increased their medal status to gold:  Fresno, Sacramento, San Diego, San Francisco, and San Jose.

Earned Sick Leave

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

Nineteen out of 40 cities received a medal for earned sick leave laws, which are two more cities (Austin and Baltimore) than one year ago.

Food Safety

Policies that require food establishments to publicly post food safety inspection grades empower consumers, promote transparency, and reduce foodborne illness.

Fifteen out of 40 cities received a medal for restaurant inspection ratings policies. Three more cities (Milwaukee, San Antonio, and Seattle) received a medal since the last assessment.

Healthy Food Procurement

Policies that ensure food sold and served in city buildings meets basic nutritional standards provide more residents with affordable and healthy food choices and can reduce some of the high medical costs associated with obesity.

Sixteen out of 40 cities received a medal for their healthy food procurement, with one city (Louisville) joining the ranks of cities that received this medal since the last assessment.

High-Quality, Universal Pre-Kindergarten

Access to high-quality Pre-K benefits children and their communities throughout the course of their entire lives – it raises children’s lifetime wages, high-school graduation rates and years of education completed, reduces crime and teen pregnancy, and improves health outcomes.

33 out of 40 cities received a medal for high-quality Pre-K, which are two more cities (Albuquerque and Seattle) than in 2017.

Smoke-Free Indoor Air

These policies protect non-smokers from the harmful effects of tobacco – which is the largest preventable cause of death – and they reduce smokers’ consumption of tobacco at the same time.

36 out of 40 cities received a medal for clean indoor air policies, adding two more cities (Fort Worth and Louisville) to the list of cities with smoke-free policies.

Tobacco 21

Policies that raise the minimum legal age for the sale of tobacco products to 21 reduce the number of young people using these products, which greatly decreases their risk for addiction and disease.

Fifteen out of 40 cities received a gold medal for their Tobacco 21 policies, which is two more cities (Portland and San Antonio) than in the first assessment.

CityHealth will update its ratings again next year. For more details on how each of the 40 cities stack up, go to

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 will regularly evaluate cities on the number and strength of their policies.

The de Beaumont Foundation is dedicated to improving the capacity and performance of the U.S. public health system, and equipping public health agencies to thrive in a transforming health landscape. In so doing, we aspire to improve the health of the populations of the communities they serve across the U.S.

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 more than 12.2 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:


Contact: Liz Voyles, 202-297-9641