By Cassandra Allen
Mayors are leading their cities through an unprecedented time for health policy. At convenings of the U.S. Conference of Mayors, National League of Cities, African American Mayors Association, and others, leaders have come together to share their experiences, outline their priorities, and identify solutions in collaboration with their peers.
In panel discussions, conference sessions, and one-on-one conversations, CityHealth has engaged directly with mayors to discuss their priorities and explore how evidence-informed policy can improve the health of their communities. Their message is clear: when partisan gridlock stalls progress at the state and federal levels, local leaders put in the work to ensure their cities continue to thrive. Amid the wide range of issues facing cities, one issue consistently rises to the top: addressing the housing crisis. Improving transportation and street safety is not far behind, as leaders are leveraging federal funding opportunities to improve street safety, recognizing its vital role in creating healthier, more equitable communities.
Oklahoma City Mayor David Holt addresses reporters at the U.S. Conference of Mayors meeting in Washington, D.C. Photo by Josh Cogan/USCM.
Housing, Housing, and Housing
Cities from coast to coast face similar housing challenges — from affordability and availability to ensuring renters have access to safe and healthy homes. The National Low-Income Housing Coalition estimates that the U.S. faces a shortage of 7.1 million affordable rental homes, contributing to nearly half of all renter households being cost-burdened (spending more than 30% of their income on housing costs). The U.S. Conference of Mayors’ 2025 National Housing Survey found that mayors believe that the housing crisis is “severe, widespread, and worsening,” due to an increasing housing shortfall and rising costs. The survey also found that mayors understand the connection between housing and health — 95% of mayors believe that ensuring housing is safe and residents remain healthy is “extremely important” or “very important.”
While federal support — including low-income tax credits and Community Development Block Grants — is essential to address local housing challenges, increasing uncertainty in today’s political environment underscores the need for local action. Fortunately, cities have an opportunity to develop housing policies that address their communities’ evolving needs, with many working with CityHealth to adopt strong, equitable solutions that benefit all residents.
In CityHealth’s latest assessment, 61% of cities have adopted Affordable Housing Trusts, which provide a community-driven way for cities to invest in building and maintaining affordable housing for everyone. Similarly, to ensure rental units meet basic safety standards, cities like Boston have implemented Healthy Rental Housing policies that can protect renter health by keeping units free from toxins like mold and asbestos. And Legal Support for Renters continues to gain momentum across the country as cities like New Orleans are helping people at risk of eviction remain safe in their homes and avoid homelessness. Most recently, Los Angeles enacted a Legal Support for Renters policy in April, becoming the 26th jurisdiction to provide a tenant right to counsel.
CityHealth’s Akeem Anderson speaks about Complete Streets policies at a meeting of the Community Leaders of America. Photo by Tom Martin/CityHealth.
Acting on Street Safety
While housing remains a top priority for many mayors, local leaders also recognize that healthy communities require safe streets that are accessible for everyone. In CityHealth’s 2024 policy assessment, 40% of cities earned a policy medal in Complete Streets — with four cities (Nashville, Newark, San Antonio, and St. Louis) improving their medals over last year.
At the U.S. Conference of Mayors’ latest convening in January, Smart Growth America’s (SGA) Beth Osborne spoke about the importance of Complete Streets policies so that roadways are designed to reduce pedestrian injuries and fatalities. SGA’s 2024 Dangerous by Design report found that streets in many American cities are becoming deadlier, with 7,522 people being struck and killed in 2022. Pedestrian fatality rates are growing at an alarming rate; in 2009, just eight large metro areas had a pedestrian fatality rate of over 2 per 100,000 people. Today, that number has grown to more than 48 metro areas — a 500% increase.
CityHealth partners with SGA to help cities reverse this trend by adopting Complete Streets policies that help everyone safely get to where they need to go, live, play, and grow. Many mayors have taken advantage of federal programs such as the Bipartisan Infrastructure Law (BIL) to fund projects that improve street safety. More than 1,600 communities have already used BIL funds to improve roadway safety for drivers, cyclists, and pedestrians. Cities can still apply for BIL funding through programs such as the U.S. Department of Transportation’s Safe Streets and Roads for All (SS4A) initiative, but they must act now — the deadline is June 26, 2025.
Wherever funds are sourced, cities looking to adopt or improve a Complete Streets policy can use CityHealth’s Complete Streets Policy Action Guide, which provides a detailed step-by-step process for city leaders and policymakers.
The Opportunity: Cities are Leading the Way
Across the country, mayors are stepping up to meet the moment — proving that cities are continuing to drive innovation for inclusive policies designed to support health and opportunity for all. Now is the time for cities to double down on what works — proven policies with bipartisan appeal that make communities safer, healthier, and more equitable. CityHealth is proud to partner with the nation’s 75 largest cities to advance proven policies — and we invite cities of all sizes and their residents to take advantage of our free tools and resources to create healthier, more equitable communities.
Cassandra Allen is CityHealth’s program officer.
