America’s largest cities have reached a new milestone in public health: 37 out of the 40 largest U.S. cities (92.5%) received top marks for adopting policies that improve people’s health, according to new data released today by CityHealth.

This is the highest percentage of cities to earn an overall CityHealth medal since the initiative began its annual ratings in 2017, with the results coming in slightly ahead of 2020 (90%) and nearly double the number from the 2017 assessment (47.5%). Today, more than 44 million people live in a city that has earned an overall CityHealth medal. Overall medals are awarded based on the combined strength and number of health policies that cities have in place.

Among the nation’s 40 largest cities, there are:

• 10 gold medal cities
• 11 silver medal cities
• 16 bronze medal cities
• 3 cities that did not earn a medal

For the first time, Albuquerque earned an overall gold medal and Oklahoma City earned an overall bronze medal.

• Albuquerque earned an overall gold medal for earning individual gold medals in Complete Streets, earned sick leave, high-quality, accessible pre-K, smoke-free indoor air, and Tobacco 21. The city also earned a silver medal in healthy food procurement.
• Oklahoma City earned an overall bronze medal for earning individual medals in Complete Streets high-quality, accessible pre-K, smoke-free indoor air, and Tobacco 21.

Cities earned three new individual medals in 2021, with gains in Complete Streets, earned sick leave, and affordable housing/inclusionary zoning.

CityHealth, which is an initiative of the de Beaumont Foundation and Kaiser Permanente, currently rates cities in nine policy domains based on data produced using policy surveillance conducted by the Center for Public Health Law Research with the National Institute of Early Education Research (NIEER) (the data on Universal Pre-K) and David Jernigan, PhD, and Ryan D. Treffers, JD (the data on Safer Alcohol Sales). All the data are displayed on CityHealth.org using the Center’s MonQcle software ranking technology, and may be downloaded on each policy page.

The 2021 assessment is the final time CityHealth will rate cities on its inaugural package of nine policy solutions. Over the past five years, CityHealth has worked with city leaders to redefine what health means for their cities and adopt the upstream policies that can improve people’s access to healthy choices and resolve critical health disparities in their communities. Several CityHealth policies, such as Complete Streets and smoke-free indoor air, have seen a remarkable rate of adoption. Tobacco 21 stands out as an exemplar story of policy success — growing from just 13 cities earning medals in 2017 to all 40 cities earning medals in 2019. This remarkable achievement was the result of locally driven innovation that ultimately became the law of the land. A retrospective look at the first chapter of CityHealth’s work was also published today as a compendium to the 2021 policy assessment.

Starting in 2022, CityHealth will assess cities on a new package of 12 policy solutions. CityHealth selected its new policy package following feedback from city leaders and after a comprehensive review of the latest data and evidence on effective policy solutions that are shown to improve people’s health. This expanded policy package sets a new gold standard for cities to aspire to and is designed to be responsive to the evolving challenges cities face today. CityHealth is also growing its footprint in 2022 by including the nation’s largest 75 cities in its annual policy assessment. A complete list of the new policies and cities may be found here.

See complete results, including individual medals by policy area, at cityhealth.org/our-policy-package/. The annual assessment may be accessed here.