A Foundation-Backed Initiative Looks to Boost Public Health, One City at a Time

Where you live has a major impact on your health: Factors like pollution, poor housing, and lack of access to health care and nutritious food undermine health and lower life expectancy. For a funder like the Robert Wood Johnson Foundation, which seeks to promote a “culture of health,” it is mission critical to tackle factors that influence overall wellbeing.

That’s why the foundation is backing an initiative developed by the National League of Cities, which works with city leaders to address urban problems through the lens of health and healing. Called Cities of Opportunity, the program works with mayors to raise awareness about the many factors that contribute to — or erode — a community’s health.

According to James Hardy, senior program officer on RWJF’s Healthy Communities team, “RWJF’s motivation for funding Cities of Opportunity is about really trying to help cities grapple with significant health and racial disparities within their city limits — in some cases, only miles apart.” The initiative officially launched in 2018, and is solely funded by RWJF, which has backed the program since 2016, when it was still being developed, for a total of $7,436,421 to date.

One of the nation’s largest health philanthropies, RWJF’s four focus areas include Healthy Communities, Health Systems, Healthy Children and Families, and Leadership for Better Health. These programs, and the funder’s support for Cities of Opportunity, reflect RWJF’s commitment to addressing social determinants of health, the many upstream factors that contribute to wellbeing or lead to chronic problems. This effort to head off health issues before they develop, rather than simply responding to immediate needs, has been a national trend in public health philanthropy, and Robert Wood Johnson has been a big player in the shift.

This is also part of RWJF’s effort to bolster the public health field, which took many blows during the COVID pandemic, but will be needed more than ever in coming years, especially as the impacts of climate change worsen. RWJF is a partner in another effort to strengthen public health; it joined the Kresge and de Beaumont Foundations to launch PHEARLESS (Public Health Regenerative Leadership Synergy), which aims to build up leadership and community collaboration in the field, as IP reported last fall.

State of the cities

For its “State of the Cities 2023” report, the National League of Cities (NLC) analyzed speeches by mayors across the country and found that public health was not included in their list of top priorities (those priorities included infrastructure, budget and management, public safety, economic development, and housing). Cities of Opportunities’ goal is to help city leaders understand the many ways that health both impacts and is influenced by all the other priorities on that list.

“A lot of cities take traditional approaches to address health disparities,” said Lourdes Aceves, NLC’s interim director of health and wellness. “They take a narrow view: OK, we're going to put in a clinic. Or there are issues with food access so we'll put in an urban farm — not thinking about or exploring root causes, and not giving enough attention to the impact of the social determinants and broader forces like racism, discrimination and institutionalized inequities. That's why Cities of Opportunity exists: to empower city leaders to see and address all of those interconnected factors that are at play and connect the dots.”

Cities of Opportunity does this through four programs: the Mayor’s Institute, Action Cohort, Learning Labs, and an annual Solutions Forum. Mayors must apply for the Mayor’s Institute and the Action Cohort, which convenes city leaders to learn from experts and to exchange ideas. The Learning Labs and Solutions Forum are open to city leaders, staff and partners in local government.

The Mayor’s Institute is a year-long program that provides city leaders the opportunity to examine a specific area of concern in depth and in the company of peers. Topics have included affordable housing and opioids, for example. The session that ended recently explored community revitalization through infrastructure, the built environment and zoning.

The idea is to encourage city leaders not only to communicate with their counterparts in other areas, but with city officials and community members at home. “Cities of Opportunity helps cities build the voices of community members into their decision making,” said Chloé Nuñez, a program associate on the Health Communities Team at RWJF. “Oftentimes, city departments function in silos and don't understand the implications of how certain decision-making around housing or transit, for example, can impact health and wellbeing. Cities of Opportunity helps create collaboration among departments and elevates the voices in the community that are critical to that decision-making.”

The larger goal is to strengthen the nation’s public health system overall by ensuring that approaches and messaging don’t come from public health departments alone, but are instead amplified widely by city institutions and throughout communities. “Public health has to be coming out of the mouths of your department of public works, your library, your planning department,” Aceves said. “Social determinants should be something that, without using the term, you could make your parent or your child understand.”

Today and tomorrow

Cities of Opportunity isn’t the first effort by philanthropy to zero in on urban issues and challenges, as a recent article on the website Governing pointed out. “Cities of Opportunity is among several long-running cohort-driven initiatives that bring together cities, philanthropies, technical assistance, and often, funding. Each of these separate initiatives has a distinct focus — Bloomberg’s What Works Cities (data), Living Cities (economic and racial equity), Johns Hopkins’ Cities of Service (citizen engagement and civic leadership) and the Global Resilient Cities Network (urban planning).” (See an IP report on Living Cities.)

Cities of Opportunity’s distinct focus is health, of course, and RWJF’s James Hardy believes philanthropy can play a key role in changing the way city and public health leaders view the issue and work within their communities.

“If you think about public health broadly in the U.S., it's a continuum,” he said. “There are a lot of places — I would say the vast majority of places — that are in a health-disparity mindset, meaning that's where they stop. They're really good at quantifying disparities, making them known and convening around them. But moving to a health equity frame is very different, where you're actually looking at those upstream root causes. That is not necessarily typical for public health as a profession — to consider facts like economic opportunity, transportation, access, housing. But you're starting to see more and more of that, and I think philanthropy can be a great help in moving communities along that continuum.”

It’s clear that moving along that continuum will be increasingly urgent as cities across the country face the impacts of climate change in the years to come. Aceves says that climate is a vivid concern for mayors in many Southern cities, where the effects of extreme weather are already evident, and hitting communities with the fewest resources the hardest.

“Cities are challenged to adapt and mitigate the inevitable impact of climate change on their cities,” Aceves said. “They are sounding the alarm to NLC and to Cities of Opportunity. ‘How do we mitigate for this heat? How do we make it so people aren't dying and becoming sick? People can’t even walk outside because it’s so hot, and indoors, it's a hot box.’ What keeps bubbling up is the need for technical assistance and policy support to address the impacts of climate change.”

NLC has a project in the works that will address some of these issues. The Policy Academy, which will launch today, will build on the work of some Cities of Opportunity participants. “We're working with four cities to deepen the work that they did in their respective cohorts on equitable climate resilience,” Aceves said. “And because that space has a lot of technical knowledge needs, we're partnering with our NLC experts to bring some muscle into that space. We're also partnering with the Urban Institute on that effort, again, to bring additional expertise.”

Despite the many challenges cities face, Aceves is optimistic. “We know that it was often city policies made more than 50 years ago that created so many inequities, and that placed a burden on some communities while they've advantaged others. That is the painful part, right? But the flip side is that city leaders also have the power to bring about transformative change. Just as they set a certain path in motion that has resulted in the outcomes that we're dealing with today, they also have the power and they're uniquely positioned to impact the health of their residents today and to make a change in the lives of their residents tomorrow.”

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