"Most people spend a few hours a year in the doctor’s office. The other 364 days out of the year, people are in the care of their city."

That's according to Loel Solomon, vice president of community health at Kaiser Permanente. Together with the de Beaumont Foundation as part of the CityHealth initiative, his organization examined the 40 largest cities to see how well they're helping residents live their healthiest lives. They looked at things like paid sick leave policies and whether people can bike or walk to work.

"Your mayor, city council and city manager has just as much of an impact on your health as your doctor," he says.

On Friday, during the opening night of the U.S. Conference of Mayors' annual meeting in Boston, 24 cities will be awarded for their work in population health. The gold medalists are Boston, Chicago, Los Angeles, New York and San Jose, Calif. Nine cities earned a silver medal, and 11 earned a bronze.

The cities were each judged on nine policy areas: affordable housing, alcohol regulations, walkability, paid sick leave, food safety, healthy food options, universal pre-K, smoke-free places and the smoking age.

To get a gold medal, cities had to show that they have implemented several policies addressing each of those issues. A silver medal went to cities that made strides in five of the policy areas, and a bronze went to cities that had made strides in four. For example, in order to earn a gold medal for earned sick leave, a city must mandate that all businesses allow employees at least two days a year for sick time or to care for a family member.

While some of the policies seem obvious as influential on health, others -- like universal pre-K and affordable housing -- are less explicitly so. But according to Solomon, access to both is foundational to a healthy community.

“These policies aren’t just nice things to do. They are powerful and necessary prevention,” he says.

Even though just five of the 40 cities earned gold medals, Brian Castrucci, CEO of the de Beaumont Foundation, stresses that several have made significant changes in the past year to make their communities healthier. San Antonio, Texas, a silver medalist, raised the legal age for buying tobacco to 21 earlier this year -- the first city in Texas to do so.

"There are thousands of young people in San Antonio who won’t pick up smoking now as a result of the city passing a tobacco 21 law," says Castrucci.

At a time when the Trump administration is taking steps to roll back provisions of the Affordable Care Act (ACA), the landmark health care law signed by President Obama, and Congressional Republicans are reportedly gearing up to introduce another ACA repeal bill this year, Castrucci says he hopes these rankings will remind mayors how they can impact their residents' health.

“This is an opportunity to show there are so many things we can do besides health care," he says. "Many of our diseases have origins in the community; we need to go where the problems are. Our health leaders of the future are going to be city councils and mayors."