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New Report: Mayors and the Health of Cities

Boston University has released the Mayors and the Health of Cities report. See what US mayors’ thoughts are on the health of their cities.


Earlier this month, the Boston University Initiative on Cities, with support from Citi and The Rockefeller Foundation, launched Mayors and the Health of Cities, a new report that sheds light on how US mayors perceive and prioritize the health of their cities in the context of existing urban health data. The report also highlights promising city-led initiatives targeting four priority health areas: the obesity epidemic, the opioid crisis, traffic fatalities, and gun violence.

Key takeaways include:


  • Many believe they play a vital role in promoting community health and well-being at the local level.
  • They listed obesity and chronic diseases, and the health of vulnerable populations as the top health challenges of their cities.
  • A substantial number mentioned that social determinants of health were underlying drivers of population health.
  • Many believe their constituents hold them most accountable for traffic deaths and least accountable for obesity. One potential reason is that health issues are predominantly seen as individual risk factors outside of mayoral control.
  • Partisanship stood out as the strongest predictor of mayoral perceptions of accountability, with Democratic mayors significantly more likely to believe they are held accountable for obesity than their Republican peers.


  • 25% of the mayors surveyed listed obesity as the leading public health challenge in their community. They perceived lack of physical activity and poor diet as two challenges that lead to higher weights. 
  • Mayors perceive availability and affordability of healthy foods as major challenges to eating healthy among lower-income residents.
  • Mayors mentioned the ways they are tackling obesity in their cities. Many of the solutions fell within one of these three categories: making it easier to buy, cook, or grow healthy food; making unhealthy foods and beverages less desirable and accessible; or making physical activity more attainable.
  • Mayors believed health improvements could be attained via sugary drink regulations and taxes, financial incentives (SNAP incentives) to purchase healthier foods, increasing healthy food access, increasing green spaces and making cities more walkable and bikeable.

Traffic Deaths

  • Mayors said constituents held them accountable for traffic deaths (pedestrian, cyclist and car).
  • While the improved design of motor vehicles has contributed to reduced vehicle fatalities, pedestrian and cyclist crashes continue to increase in many communities.
  • Nationally, pedestrian deaths have increased by 35% over the last 10 years.
  • Using data from the Insurance Institute for Highway Safety, researchers found there were 848 fatal cyclist crashes involving motor vehicles in 2016, the most since 1990. Additionally, 770 cyclists died in 2017, which still represents a 25% increase since fatalities fell to their lowest point in 2010. 
  • Mayoral solutions included promoting walkable, bikeable cities, which could also promote population health, reduce car dependency and lower emissions.

The full report can be accessed here.