Cities as Platforms for Population Health: Past, Present, and Future

Abstract

Policy Points Cities have long driven innovation in public health in response to shifting trends in the burden of disease for populations. Today, the challenges facing municipal health departments include the persistent prevalence of chronic disease and deeply entrenched health inequities, as well as the evolving threats posed by climate change, political gridlock, and surging behavioral health needs. Surmounting these challenges will require generational investment in local public health infrastructure, drawn both from new governmental allocation and from innovative financing mechanisms that allow public health agencies to capture more of the value they create for society. Additional funding must be paired with the local development of public health data systems and the implementation of evidence-based strategies, including community health workers and the co-localization of clinical services and social resources as part of broader efforts to bridge the gap between public health and health care. Above all, advancing urban health demands transformational public policy to tackle inequality and reduce poverty, to address racism as a public health crisis, and to decarbonize infrastructure. One strategy to help achieve these ambitious goals is for cities to organize into coalitions that harness their collective power as a force to improve population health globally.

Keywords: climate change; health inequity; municipal health departments; population health; public health; public health workforce; systemic racism; urban health.

Figure 1

Vital Conditions for Health and Well‐Being [Colour figure can be viewed at wileyonlinelibrary.com] Reprinted from Milstein B, Payne B, Kelleher C, Homer J, Norris T, Roulier M, Saha S. Organizing around vital conditions moves the social determinants agenda into wider action. Health Affairs Forefront. https://www.healthaffairs.org/content/forefront/organizing‐around‐vital‐conditions‐moves‐social‐determinants‐agenda‐into‐wider‐action. Source: Rippel Foundation.

Figure 2

A Well‐Being Portfolio Balances Vital Conditions and Urgent Services. [Colour figure can be viewed at wileyonlinelibrary.com] Reprinted from Milstein B, Payne B, Kelleher C, Homer J, Norris T, Roulier M, Saha S. Organizing around vital conditions moves the social determinants agenda into wider action. Health Affairs Forefront. https://www.healthaffairs.org/content/forefront/organizing‐around‐vital‐conditions‐moves‐social‐determinants‐agenda‐into‐wider‐action. Source: Rippel Foundation.