Methodology

For the report, CityHealth evaluated 75 of the largest U.S. cities on 12 upstream, prevention-oriented policies that aim to improve people's access to healthy choices and address health disparities in their communities. The policies include:

• Affordable housing trusts
• Complete streets
• Earned sick leave
• Eco-friendly purchasing
• Flavored tobacco restrictions
• Greenspace
• Healthy food purchasing
• Healthy rental housing
• High-quality, accessible Pre-K
• Legal support for renters
• Safer alcohol sales
• Smoke-free indoor air

Each policy category had its own evaluation metrics, and awarded bronze, silver, and gold medals based on which metrics they met. Cities were also awarded an overall medal status based on the number and type of medals they earned across all 12 policy categories.

• Gold: Cities must earn five or more gold medals across all policy categories.
• Silver: Cities must earn five or more gold or silver medals across all policy categories.
• Bronze: Cities must earn five or more gold, silver, or bronze medals across all policy categories.
• No medal: Cities that received fewer than five medals were not awarded an overall medal. 

Commentary

According to CityHealth, housing will likely remain a top priority for city leaders in 2026, especially since housing costs continue to increase. Healthy food purchasing policies could also help cities ensure people have access to nutritious food options in public buildings.

"Cities are catalysts for change. They accelerate new policy ideas, test and refine solutions, and drive progress because residents rely on them to meet their unique needs," CityHealth wrote in the report. "As the level of government closest to the people, cities often move quickly to turn strategies into sustained solutions."

"The policy momentum we're seeing across the country is a powerful reminder that real progress starts locally," said Katrina Forrest, executive director of CityHealth.