Ed Hunter, president and CEO of the de Beaumont Foundation. Photo courtesy de Beaumont Foundation.

The de Beaumont Foundation recently announced the launch of its CityHealth initiative. APHA chatted with Ed Hunter, president and CEO of the foundation, to learn more about the program and its impact on public health:

Q: Congratulations on the launch of the CityHealth initiative! What can you tell us about the project?

CityHealth is a project of the de Beaumont Foundation that aims to help cities thrive through policies that improve people’s day-to-day lives.

We worked with a wide variety of experts to get the benefit of the best evidence on how to use policy to improve health and vitality of cities, and we selected nine policies that are backed by strong evidence, are supported by multiple sectors and across the political spectrum, and are within the jurisdiction of cities. These policies are:

  • Paid Sick Days,
  • Universal, High-Quality Pre-Kindergarten,
  • Affordable Housing and Inclusionary Zoning,
  • Complete Streets,
  • Alcohol Sales Control,
  • Tobacco 21,
  • Clean Indoor Air,
  • Food Safety and Restaurant Inspection Ratings, and
  • Healthy Food Procurement.

We then rated how the 40 largest U.S. cities fared across these nine policies; in effect, we took a look at whether cities were taking advantage of these critical tools to improve the health and vitality of their residents. We did an extensive review of the laws and regulations in place across the 40 largest cities — the first time this has ever been done — and awarded medals based on what we found.

CityHealth awarded overall five gold medals, five silver medals and nine bronze medals to cities. In assessing whether policies in place met our criteria, we also found that 21 did not warrant a medal. This shows us that while there are opportunities across the U.S. to implement these policies, there is also a long way to go to take full advantage of tools that we know work to improve health.

Q: Why is this initiative so important now?

Our national dialogue has been dominated by health care and health insurance coverage, but, as any APHA member knows, good health and a high quality of life are the summation of many things that affect our everyday lives, such as education, safe streets and access to healthy food. It’s critical that we also focus on these “upstream” factors that affect our health.

It’s important to address these issues now, so that we can get to work preventing costly disease and disruption that inevitably flow from these social and economic factors. Our nine policies tackle these factors across multiple sectors, and give us a chance to get ahead of the health care cost curve. The sooner we start addressing these upstream policy solutions, the sooner we will reap the benefits.

APHA has set a bold goal of making America the healthiest nation in one generation. With this initiative, we hope to focus new energy on policy as an important tool to achieve that goal, and spark action in cities across the U.S.

Q: Can you talk about the significance of using policy as a lever for affecting healthy change?

Policy involves the use of laws and regulations to set conditions that affect health. It is one of the most important tools available to local and state governments to improve the lives of those living in their communities. Policy is the lever that can affect tremendous positive change for the greatest number of people, and can apply across the full spectrum of residents in a city. Many of our greatest public health achievements have involved policy, including removing lead from paint; mandating safer automobiles; and limiting exposure to second-hand smoke. And once policies are enacted, they don’t need to be revisited each budget cycle; though they need to be implemented effectively and enforced, unlike programs funded from annual appropriations they typically don’t have an expiration date.

CityHealth is part of our efforts to help public health agencies catalyze change, lead action and engage partners so they can save lives and make communities healthier. CityHealth provides information that empowers city leaders — who are closest to their communities — have a deeper understanding of the community’s needs and priorities, and know which policies will have the biggest impact while best fitting with local priorities. We don’t want to simply assess where they are today — we want to help cities advance these nine policy priorities and move toward the established gold standard.

Q: I love the focus on cities as incubators of innovation. Why is that, and is there a success story or two that has helped serve as inspiration for the foundation?

CityHealth is focused on cities because this is where innovative solutions are born, tested and proven. City-level changes also have the biggest impact on the most people because municipalities are the closest government to their residents, and, thus, are best able to assess and respond to their needs. Cities have pioneered many of the nine policies we have assessed, providing the evidence base that reassures us that these work.

We systematically reviewed the evidence of success, and also identified some specific success stories across the U.S. A few examples:

  • A year and a half after implementation of Connecticut’s paid sick days law, three-quarters of surveyed employers expressed support for the policy, and most reported a modest impact or no impact their costs and business operations.
  • In an evaluation of the benefits of high quality pre-K in Tulsa, researchers found children gained nearly a year’s worth of early literacy skills, and five months’ worth of early math skills.
  • Just one month after Minnesota’s Freedom to Breathe law went into effect, exposure to a carcinogen from tobacco in a group of nonsmoking hospitality workers fell by 85 percent, and nicotine exposure by 83 percent.
  • Following passage of public grading systems, Los Angeles and New York City saw as much as a 20 percent reduction in foodborne illness hospitalizations — a decrease sustained in subsequent years.
  • Atlanta’s Complete Streets investments include upgrading curbs, sidewalks, bike lanes, crossing signals and ramps for the disabled — all to decrease congestion, improve mobility and provide transportation options. On Ponce de Leon Avenue, one of the most visible examples of a reconfigured Complete Street, there have been 25 percent fewer crashes and 5,000 more vehicles accommodated since its transformation.

Q: How can public health professionals and other local leaders use CityHealth to improve the health of their communities?

Everyone has a part to play in taking action, and the de Beaumont Foundation’s CityHealth initiative will be there to help.

  • City leaders can use CityHealth tools to assess the current status of their community and evaluate how policies align with local efforts to improve health and vitality. CityHealth has compiled a set of evidence-based choices for cities to adopt along with information on the experience of other cities that have already moved forward.
  • Public health officials in cities bring a lot to the table. Health agencies have strong ties to the community and work effectively across sectors. They can help city leaders interpret the evidence in light of local conditions and strategize about the range of policies that can improve their city. Health agencies can also focus on building stronger policy capacity in their workforce, as our Public Health Workforce Interests and Needs Survey found that influencing policy development was the top training need.
  • Residents know for themselves what’s wrong or right in their neighborhoods. They can help city leaders and health officials identify important needs and participate in the design and implementation of local initiatives.
  • Local foundations and civic groups can join CityHealth in this effort. For example, providing support to bring together local coalitions, building on existing efforts to adopt these approaches, or helping to build capacity for analysis and advocacy.

To aid city leaders and health officials in these efforts, the de Beaumont Foundation’s CityHealth program is committed to helping cities that choose a path forward. We are committed to supporting technical assistance, helping cities adapt research findings to local contexts and facilitating the sharing of information across cities.