By Helen G. Houghton

On Tuesday June 4th, IOC Co-Director Katharine Lusk spoke on a panel co-hosted by the Boston University School of Public Health, Initiative on Cities, AcademyHealth, and de Beaumont Foundation. Titled, “A Conversation About Cities and Health,” the panel, hosted by Sandro Galea, Dean of the School of Public Health, and moderated by Lisa Simpson, the President and CEO of AcademyHealth, was designed around a confluence of conversations around how cities influence health. Dean Galea highlighted that half of the world’s population and 80 percent of Americans live in cities, and cities are uniquely human made entities, and thus provide an immense opportunity to impact the public health of large amounts of people. Cities are becoming our predominant shared experience, shaping the air we breathe, the food we eat, the water we drink, how we behave, think, and feel. Following the publication of Urban Health and Mayors and the Health of Cities, this event seeks to bring together the key information in this field and bring us up to speed on how people and academics think about how cities influence health. Speakers such as Katharine Lusk, Co-Director of the Boston University Initiative on Cities, Julie Morita, Commissioner of the Chicago Department of Public Health, LaQuandra Nesbitt, Director of the DC Department of Health, and Sarah Rosen Wartell, President of the Urban Institute spoke about the direction their organizations were taking to talk about and effect public health.

Lusk specifically focused on the results of the Menino Survey of Mayors‘ health component and what mayors talk about when they talk about health. She provides an overview of the survey’s most interesting and consequential findings. The survey seeks to learn what the attitudes and perceptions of the US mayors are and then ground them in truth using statistics and facts about the cities using a representative sample of US Mayors of cities with populations over 75,000.

Lusk begins her discussion of the findings by discussing what the mayors perceive as their city’s greatest health challenge. Obesity, she says, and its related concerns such as health disease and diabetes, are the most frequently cited concerns, followed closely by opioids and addiction. Following that is access to care, whether that be inadequate services, rates of uninsured, or systemic problems. Lusk highlights the language these mayors use, which is interesting in that it is the familiar public health language of health professionals. Mayors cite concerns like “poverty rates,” “childhood trauma,” “sedimentary lifestyles,” and “access to healthcare” and this is notable, Lusk says, because it shows that mayors have a deep and nuanced understanding of what affects health outcomes.

The discussion then shifts to who cites these challenges, particularly focused on the case of obesity. Thirty-one mayors cited obesity as their city’s biggest health concern, but “this group is heterogeneous,” according to Lusk. Cities in the bottom quarter of obesity rates as well as cities in the top quarter are similarly likely to have mayors who are concerned about obesity. Different types of cities are citing the same concerns. From this, we can see that statistics don’t necessarily drive mayoral concern and action as much as their attitudes do. The unhealthiest cities are not the most likely to take actions to promote public health, the one’s whose mayors care about public health are.

Accountability is the final topic, which is interesting in that most cities do not have direct control over public health because they do not have municipal health agencies. Only about 20 percent of cities do, but the survey finds that having a municipal health agency does not affect perceptions of accountability. Mayors feel accountable for problems such as traffic accidents, gun violence, and lead and other toxins. This would seem to be related to the idea that mayors directly control transportation agencies, municipal laws, and housing agencies and that things they feel least accountable for, obesity and mental health, are seen as individually driven, regardless of whether or not a city can affect these concerns with a municipal health agency. While control does not change perceptions of accountability, both party and gender do. Democratic mayors feel more accountable for gun violence, hunger, and malnourishment than Republican mayors. Female mayors feel an average of 19 percent more accountable for these issues and mental health issues than male mayors. Crisis also appears not to affect perceptions of accountability, except in the case of the opioid crisis.

Lusk summarizes by highlighting again that mayors can and do talk knowledgeably about these issues, and many care about the same things despite differences in their cities. These heterogeneous cities have many homogeneous concerns and this allows for finding unlikely allies and partners in the fight against these problems. Mayors have the tools and interest to affect public health outcomes, they just need the drive to do so. The rest of the panel discussion focused on what mayors are doing to change public health and Lusk’s points about what mayors believe provides a useful context in which to view these actions.