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New Report on Mayors and Health, From Boston University Initiative on Cities, Reveals Obesity, Opioids, Guns, and Traffic Crashes as Key Priorities

Report authored by Boston University and supported by Citi and The Rockefeller Foundation, offers new perspective on how US mayors think and talk about health, provides insight into the state of urban health, and features cases of several city-led initiatives dedicated to health and well-being.

Washington, DC – Today 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.

Report findings show that one-fourth (25%) of the 110 surveyed mayors identified obesity and related chronic diseases as their city’s greatest health challenge—beating out the opioid epidemic and other addiction-related issues (24%), as well as concerns over health care access or cost (14%). Currently, nearly two out of five US adults (39.8%) are obese, with 57.3% of today’s children projected to be obese by 2050.

However, when asked about their political accountability, mayors identified an entirely different set of health issues: they believe constituents hold them most accountable for traffic accidents (70%), gun violence (56%), and lead and other toxicants (52%). Although obesity was identified as the top health challenge facing their cities, fewer than 10% of mayors believe constituents hold them accountable for this issue. Other priority health concerns, including opioids and mental health, were also ranked relatively low by mayors in terms of perceived accountability.

“Our report is the first to examine a representative sample of mayors across the U.S. and analyze their perceptions and priorities related to major public health concerns in the context of city-level health data. As our top health concerns have shifted over time, so too should our collective responsibility to address them,” said Dr. Monica Wang, Assistant Professor of Community Health Sciences at the Boston University School of Public Health. “No one sector alone can shoulder the burden of solving today’s complex health challenges. What is most exciting to me is the rich variety of cross-sectoral, multidisciplinary collaborations that cities are pursuing to target such challenges. Whether through legislation, community programs, city-wide initiatives and campaigns, or changing the built environment, mayors are often a key catalyst or advocate for such efforts.”

Partisanship emerged as a strong predictor of mayoral perceptions of accountability, with Democratic mayors more likely than their Republican peers to believe they are held accountable for gun violence (72% Democrats vs. 23% Republicans), hunger or malnourishment (55% vs. 32%), asthma (17% vs. 8%), and obesity (13% vs. 4%).

Findings included in the report are based on analyses from several datasets and sources, including a nationally representative survey of American mayors, the City Health Dashboard 500 Cities, and supplemental information from federal sources.

“A complex set of economic, social, environmental and political factors shape the health of Americans, making it one of the most challenging policy areas for any city leader to address,” said Jamie Alderslade, U.S. Markets Director for Citi Community Development and member of Initiative on Cities’ Advisory Board. “The Mayors and the Health of Cities Report provides essential new insights for anyone interested in advancing a meaningful national conversation, and ultimately action, on how we make enduring progress toward improving the health of our country.”

“This report showcases how data can play a crucial role in revealing the scope of the health challenges cities face today,” said Dr. Naveen Rao, Managing Director of Health at The Rockefeller Foundation. “With a better understanding of how mayors view the overall health of their cities, communities can better focus resources and develop partnerships to address these challenges and improve the wellbeing of their residents.”

The report was released at the National Press Club today (Tuesday, June 4, 2019), as part of a panel discussion on cities and health featuring health commissioners from Chicago and Washington, DC.

“When it comes to the health and well-being of their city, mayors care deeply and know their constituents are looking to them for solutions. Yet, just one out of five has a municipal health agency to lean on” said Katharine Lusk, report co-author and Co-Director of the Boston University Initiative on Cities. “But mayors actually have many in-house allies to tackle urgent health challenges. Transportation, Public Works, Police, Parks – these departments are all being enlisted as partners in addressing public health concerns.”

Despite variation in priorities and perceptions of accountability related to health challenges, one pattern emerged clearly: mayors understood that investing in the health of their cities and communities translates into overall well-being and prosperity. Additional key findings of the report—which can be read in full at—are below. Follow the conversation on social media using the hashtag #UrbanHealth.

Health Resources:

  • Just one in five cities has a municipal level health authority, meaning most mayors are reliant on county or regional level agencies to coordinate local health
  • However, the solutions to the health concerns mayors elevate—including obesity, opioids, traffic crashes, and gun violence—necessitate strong multi-agency cooperation. Municipal police, transportation, public works, and school departments are critical allies, alongside health authorities and residents, in tackling these

Obesity, Diabetes, and Heart Disease

  • 25% of mayors identified obesity as the leading public health challenge in their Lack of physical activity, poor diet, and diabetes were frequently referenced in relation to obesity.
  • However, an overwhelming majority of mayors (90%) believe that obesity is not a health issue for which they are held accountable by constituents, suggesting a need for more urgency or political
  • Several mayors cited social determinants of health as key contributors to obesity, such as poverty and lack of healthy food access. Nearly two-thirds of urban residents have limited access to healthy food, meaning they live more than a half mile from a major supermarket or grocery


  • Nearly 24% of mayors believed addiction—specifically opioids—was the top health challenge facing their cities, frequently identifying it as a “crisis” or an “epidemic”.
  • 65% of mayors believe their constituents hold them accountable for the opioid
  • Addiction/opioids was the only health outcome cited by mayors where prevalence drives priority. Mayors confronting higher rates of overdose deaths in their cities are more likely than their peers to believe that constituents look to them for

Traffic Accidents

  • A majority of mayors (70%) cited traffics accidents as the leading health issue for which they are held accountable by their
  • However, only two out of 110 mayors identified this as the top health concern facing their
  • Of the mayors surveyed, every city represented in our sample experienced at least one traffic-related fatality in 2018, with three cities experiencing over 100 traffic-related

Gun Violence

  • Gun violence was cited by mayors as the second leading health issue for which they are held accountable by constituents; however, only four out of the 110 surveyed mayors identified gun violence as their city’s leading health
  • Democratic mayors were significantly more likely than their Republican peers to believe constituents hold them accountable for gun violence (72% vs. 23%, respectively).


About the Initiative on Cities

The Boston University Initiative on Cities researches, promotes, and advances the adaptive urban leadership strategies and policies necessary to support cities as dynamic centers of inclusive economic growth and sustainable development in the 21st century. Founded by a proven urban leader, the late Mayor of Boston Thomas Menino, and a highly regarded academic, Professor Graham Wilson, the Initiative serves as a bridge between academic research and the real-life practice of city governance. Additional information may be found at and at

About Citi

Citi, the leading global bank, has approximately 200 million customer accounts and does business in more than 160 countries and jurisdictions. Citi provides consumers, corporations, governments and institutions with a broad range of financial products and services, including consumer banking and credit, corporate and investment banking, securities brokerage, transaction services, and wealth management.

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About The Rockefeller Foundation

The Rockefeller Foundation advances new frontiers of science, data, policy, and innovation to solve global challenges related to health, food, power, and economic mobility. As a science-driven philanthropy focused on building collaborative relationships with partners and grantees, The Rockefeller Foundation seeks to inspire and foster large-scale human impact that promotes the well-being of humanity throughout the world by identifying and accelerating breakthrough solutions, ideas and conversations. For more information, sign up for our newsletter at and follow us on Twitter @RockefellerFdn

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