In Brief:
The country is still climbing out of the economic and social wreckage caused by an infectious virus. Some think the pandemic may have changed cities forever. Yet “public health” was not among the top five priorities the National League of Cities (NLC) found in its 2023 analysis of speeches by U.S. mayors. Any course correction may depend on raising awareness that there are public health dimensions in every “priority” issue.
The life expectancy of Americans varies considerably from state to state (see map). Differences in health status are rooted in the policies, practices and structures that exist in them, says Lourdes Aceves, director of health and wellness at NLC.
Through its “Cities of Opportunity” initiative, NLC helps city leaders recognize all the factors that contribute to the health of a community, for good or for bad. “We want them to understand that to address health inequity, they have to connect the dots and approach the problem comprehensively.”
A list of “social determinants” of health could just as easily be a catalog of urban challenges. They include housing and food security, transportation, employment, education, wealth inequality and racial equity, as well as things such as drug abuse, health-care access, water and air quality, and green space.
Cities of Opportunity is among several long running cohort-driven initiatives that bring together cities, philanthropies, technical assistance and, often, funding. Each of these separate initiatives has a distinct focus — Bloomberg’s What Works Cities (data), Living Cities (economic and racial equity), Johns Hopkins’ Cities of Service (citizen engagement and civic leadership) and the Global Resilient Cities Network (urban planning).
Unsurprisingly, “good health” correlates with good quality of life. NLC has developed a “Theory of Change” that details how cities can make the most of their unique power to advance health and well-being.
These high-level concepts come with intensive programs and expert assistance to help mayors develop and enact comprehensive plans.
From Roadblocks to Road Maps
NLC’s Cities of Opportunity initiative has four components: an Action Cohort, a Mayors’ Institute, quarterly peer-to-peer Learning Labs facilitated by Cities of Opportunity alumni and annual half-day Solutions Forums.
The most intensive work takes place in the Action Cohort and the Mayors’ Institute. Participation in these is limited, with participants selected through a competitive application process. The learning labs and forums are open to all.
The Action Cohorts program began with a 12-city pilot in 2018, followed by smaller groups in 2019 and 2021. The current group of five cities began its 15-month process in February 2023.
(NLC)
The 2023 Mayors’ Institute schedule included a three-day convening in Houston for mayors and their team members. “We brought a small army of subject matter experts to help them brainstorm, poke holes and refine their plans, to get them to a good place for implementation,” says Aceves.
NLC support includes operational expertise, helping mayors move from “conflict to collaboration” and “roadblocks to road maps.” At the end of the 12- to 15-month work period, participants have a multiyear work plan.
The plans aren’t “cookie cutter,” Aceves says. “They are ‘bespoke’,” that is, designed specially according to the needs of an individual city. We work to customize them to fit a city’s needs, capacity and resources, both in staffing and in funding.”
Mayors in the Action Cohort work to identify health equity issues in their communities and develop action plans to address them. Dearborn, Mich., is one of the cities in the class of 2023, and its mayor brings a valuable skill set to this work.
(City of Dearborn)
Health in All Policies
Abdullah Hammoud was elected mayor of Dearborn in 2022, following three terms representing the city in the Michigan House of Representatives. In addition to a master’s degree in business administration, he holds a master's of public health in epidemiology and genetics.
“You don’t see many epidemiologists who abandon ship and run for office,” he says. In fact, the change was set in motion by a research job he took soon after earning his public health degree.
His boss pointed out that it could take 10 years for a paper published in a medical journal to lead to a policy decision. She preferred short policy briefs that could be easily understood by policymakers and have immediate impact. Hammoud believes this led him to the public service path he was meant to be on.
One of his first moves as mayor was to create a city public health department and hire a scientist from the National Institutes of Health as director. “We don’t provide medical services,” Hammoud says. “Our public health department is piloting what we call ‘health in all policies.’ That means that every decision across the whole city has to pass a public health litmus test, from rezoning and water policy to policing.”
Cities of Opportunity is working with the mayor to develop an advocacy plan to foster the collaboration that will be needed to implement “health in all policies” across all city departments, Aceves says. Hammoud is glad to have support from NLC’s “extremely powerful” network and a diverse coalition of mayors.
“When I struggle to come up with thoughtful solutions, rather than trying to reinvent the wheel, we've come into the habit of searching for examples of what other cities have done,” says the mayor. “Can we tailor that solution to the city of Dearborn in some way? The conversation goes from there.”
Peeling Back the Layers
Mount Vernon, N.Y., Mayor Shawyn Patterson-Howard, in office since 2019, is in the 2023 Mayors’ Institute cohort. Its focus on infrastructure has great importance to her city.
The city’s hundred-year-old stormwater and wastewater systems pose immediate threats to health and the environment. Sewage leaks into decaying clay stormwater pipes that sit below wastewater pipes, causing toxic discharges in local rivers.
(City of Mount Vernon Communcations Department)
Heavy rain can cause stormwater to back up in the sewage system and bring wastewater up into homes. “People are losing utility infrastructure — heating and air conditioning, electrical boxes and washers and dryers, all of those things in the bottom level of their houses or in their basements,” says Patterson-Howard. Structural damage comes with mold and degraded air quality.
These infrastructure problems catalyzed a lawsuit from federal and state government over Clean Water Act violations in 2018. In 2020, a District Court ordered the city to take steps to come into compliance with the act. Court orders and financial sanctions followed when deadlines were missed. In September 2023, the litigation was resolved with a consent decree.
Mount Vernon received $160 million from the state and another $3 million from the federal government to set things right. Participation in the Mayors’ Institute is enabling the city to develop a more holistic approach to the work ahead than it would have otherwise.
Streets that will be torn up so new systems can be put in place are being reimagined to make them “walkable, bikeable, skateable and drivable all at the same time.”
A comprehensive plan for the city — its first since 1968 — encompasses standards for green infrastructure, lighting for public streets and spaces, EV charging stations, green buildings, and retaining pervious surfaces in development projects. “We want there to be some type of urban farming, rooftop gardens and more use of solar power,” says Patterson-Howard.
The NLC process has allowed the city to “peel back the layers,” she says, and get input from technical experts as well as sister cities facing similar problems. “When you’re building those relationships, it takes you out of ‘woe is us,’ normalizing the challenges governments large and small face,” says Patterson Howard.
“Sometimes pulling yourself out of the drain you think you’re circling is really important. Running for office is much easier than governing.”
