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Editorial: The crucial role of cities in advancing health equity: A call to action

Local leaders have the greatest ability to affect this positive change for their communities.
Image by Sarah Mai

Kim Norton is the Mayor of Rochester, Minnesota, and Lourdes Aceves is the Health and Wellness Director at the National League of Cities.

Across our nation, deep health disparities persist, rooted in the social, economic and environmental conditions that shape the lives of our communities. The COVID-19 pandemic has laid bare these stark inequities, with communities of color bearing the disproportionate burden of the crisis.

As we work to rebuild and recover, we have a once-in-a-generation opportunity to transform the systems and structures that have perpetuated these disparities for far too long. And it is in our cities where this transformation must begin.

As the level of government closest to the people, cities have a powerful role in creating the conditions for all residents to thrive. Mayors and local leaders are uniquely positioned to drive change, with a deep understanding of their communities’ opportunities and challenges and the ability to work directly with residents to develop solutions that meet local needs.

This is the vision behind the National League of Cities’ Cities of Opportunity initiative. By taking a comprehensive, intersectional approach to advancing health and racial equity, Cities of Opportunity is supporting city leaders to transform systems and policies to create more just and equitable communities. The initiative has grown from a 12-city pilot in 2018-2019 to a seven-city cohort in 2021, spanning cities of diverse sizes and geographies.

The work of cities participating in the initiative illustrates the transformative potential of this approach. From Fremont, California to Plainfield, New Jersey, city leaders are centering equity in their decision-making, leveraging data to address root causes, and aligning resources and partnerships to drive systemic change.

In Rochester, Minnesota, we worked to streamline entrepreneurial services for traditionally underserved populations, including those in the Black, Latino, immigrant, refugee, migrant and justice-involved communities. We also prioritized outreach to women of color, expanding their career pathways to help ensure all residents have the opportunity for economic mobility and improved health outcomes.

In Houston, Texas, the city is developing a risk-based, equitable decision-making framework to prioritize infrastructure investments based on both equity and infrastructure needs. By considering the compounded risks of infrastructure vulnerability and people’s equity vulnerability, the city aims to target investments to the areas of greatest need and impact.

And in South Fulton, Georgia, the city is building wealth in its majority African-American community by dedicating investments in local businesses. Through incentives for developers and trainings for local entrepreneurs, the city is creating pathways for equitable economic development.

These cities are not alone in their efforts. Across the initiative, cities are leveraging existing assets and authority to infuse equity into their work. In Kansas City, Missouri, the city established reducing disparities in life expectancy as the shared result to guide decisions across departments. And in Missoula, Montana, the city adopted both City and County Justice, Equity, Diversity and Inclusion (JEDI) Resolutions, institutionalizing equity as a priority for elected officials and staff.

These examples are just a snapshot of the innovative work happening in cities across the country. But the Cities of Opportunity initiative is about more than just individual programs or policies. It’s about fundamentally shifting how cities approach their work, breaking down silos, building authentic partnerships and centering the voices and needs of those who have been historically excluded.

This work is not easy.

It requires bold leadership, a willingness to confront hard truths, and a commitment to long-term, systemic change. It requires investing time and resources in building trust and partnerships. And it requires persevering in the face of skepticism and resistance.

But as the late Mayor John Engen of Missoula, Montana, a member of the 2021 Action Cohort, reminds us, “What we’re trying to do to get to the root here is eliminating causes of suffering … Wellbeing [is] a right we all deserve rather than the luck of the draw. We need bravery to do this work.”

This is a call to action for all of us. Whether you are a mayor, a community leader, a business owner, or a concerned citizen, we all have a role to play in building more just and equitable communities. We must seize this moment of opportunity and summon the courage to drive transformative change.

The road ahead will not be easy, but cities are lighting the way. With the support of initiatives like Cities of Opportunity, local leaders are demonstrating what’s possible when we put equity at the center of our work. Let us follow their lead and work together to build a future where every person, in every community, has the opportunity to thrive.

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