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Unpacking the 2023 CityHealth Policy Assessment

byCharles HollowayonDecember 18, 2023

Unpacking the 2023 CityHealth Policy Assessment: A Guide for ECE Professionals

Before diving into the report, it’s essential to understand the organization behind it. CityHealth, an initiative of the de Beaumont Foundation and Kaiser Permanente, focuses on advancing a set of evidence-based policy solutions aimed at improving public health in the largest U.S. cities. Their approach emphasizes addressing key social determinants of health through policies under city jurisdiction, identified through rigorous analysis and expert consultation. This strategic focus on upstream policies aligns well with the goals of early childhood education professionals, who play a critical role in shaping the environments that influence lifelong health and well-being.

2023 Policy Assessment Overview

The 2023 CityHealth Policy Assessment provides an invaluable look at how cities are faring in adopting these vital health policies. Notably, 61% of the 75 largest U.S. cities earned an overall medal for their health policies in 2023, which is a testament to the growing importance cities place on public health and its impact on early childhood settings.

Gold Standard Cities and Their Policies

The report highlights seven cities that achieved gold medals, indicating they are leading in health policy implementation:

  1. Boston
  2. Denver
  3. Minneapolis
  4. New Orleans
  5. Portland
  6. San Antonio
  7. St. Louis

These cities set benchmarks in areas crucial for early childhood education, such as Affordable Housing Trusts, Complete Streets, and High-Quality Accessible Pre-K.

Notably, 22 cities received gold medals for their pre-K programs, signaling a strong commitment to early education – a critical determinant of long-term health outcomes. To see the 22 cities, go to page four of the report.

Policy Areas with Direct Impact on Early Childhood

The assessment evaluates policies across diverse areas, many of which bear relevance to early childhood professionals, including:

  • High-Quality Accessible Pre-K: Directly linked to our area of focus, this category assesses the quality and accessibility of early education programs.
  • Affordable Housing Trusts: Recognizing the fundamental role stable, affordable housing plays in child development.
  • Complete Streets: Ensuring safe, accessible transportation options for families, which is a key aspect of creating child-friendly urban environments.
  • Greenspace: Highlighting the importance of accessible public spaces for physical and mental well-being of children and families.

Challenges and Future Prospects

Despite the progress, challenges such as state preemption remain, potentially limiting cities' ability to implement child-focused health policies. State preemption refers to a legal doctrine where laws or regulations made at the state level supersede or override laws made at the local level, such as by city or county governments. In the context of public health policy, this can mean that even if a city or local government wants to implement certain health policies, they may be restricted or prohibited from doing so if the state government has passed a law that either explicitly or implicitly prevents local governments from enacting such policies.

Fortunately, however, CityHealth’s framework provides a roadmap for future policy enhancements, allowing early childhood educators to align their advocacy and program development with broader health policy initiatives.


The 2023 CityHealth Policy Assessment, underpinned by CityHealth's thorough policy selection and evaluation process, offers valuable insights for those of us in early childhood education and care. By understanding and engaging with these policy areas, we can contribute more effectively to building healthier, more supportive communities for our young learners.

Our collective efforts in utilizing these insights can lead to transformative changes in the lives of children across our cities.


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