The state and local political environment of urban health

Abstract

The state and local political context for addressing urban health problems in the 21st century includes issues of federalism, city-state relations, and policy-making processes within cities and the factors that influence them. The underlying assumption---one with which I agree completely--is that government and politics at these levels will play key roles in developing and carrying out such an agenda.My comments draw on my own professional experience in politics and the press, and, most recently, from the process of helping to develop the Robert Wood Johnson Foundation's Urban Health Initiative, a process that took me to 13 cities around the country, eventually settling on 8 in which we have worked to create a health and safety agenda for children. This paper discusses factors that influence public sector capacity and behavior, including changes in the intergovernmental system, politics, and the press, and the divisions of race, class, and culture. It concludes with observations on what might be some essential elements of an urban health agenda. THE GOVERNMENTAL MILIEU IN REGARD TO URBAN HEALTHThe general environment in which government must work has been changed in recent years by something called devolution, the systematic delegation by the federal government of more and more flexibility and authority to state and local governments. To some in Washington, DC, devolution means cutting taxes and relinquishing many responsibilities that are perceived to be unpleasant, no-win tasks, such as dealing with poor people and big cities. To others in Washington, devolution is a desirable adjustment of the intergovernmental system that recogMr.

The politics of preventable deaths: local spending, income inequality, and premature mortality in US cities

“…12 Furthermore, a focus on behaviour obscures the importance of policies and programmes despite the fact that there is growing evidence that local social policies affect the distribution of health and risks to health. 13 14 With several important exceptions, there are few studies that have examined policies in relation to income inequality.…”