US Mayors’ and Health Commissioners’ Opinions About Health Disparities in Their Cities

Purtle, Jonathan; Henson, Rosie Mae; Carroll‐Scott, Amy; Kolker, Jennifer; Joshi, Rennie; Roux, Ana V. Diez

doi:10.2105/ajph.2017.304298

Cited by 30 publications

(55 citation statements)

References 27 publications

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“…Awareness about specific areas with higher health needs might improve resource reallocation or other sorts of place-based public policies. Previous research has shown that a lack of data on health inequalities, and subsequent lack of awareness of their existence, is a barrier on the design and implementation of policies to reduce them 29 . Future research should expand this effort to more cities with a large number of subcity units, or collect and analyse data at smaller units of analysis (eg, census tracts) where available, allowing for a better and finer characterisation of the segregation patterns in life expectancy at birth across Latin American cities.…”

Section: Discussionmentioning

confidence: 99%

Inequalities in life expectancy in six large Latin American cities from the SALURBAL study: an ecological analysis

Bilal¹,

Alazraqui

Caiaffa

et al. 2019

The Lancet Planetary Health

105

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SummaryBackgroundLatin America is one of the most unequal regions in the world, but evidence is lacking on the magnitude of health inequalities in urban areas of the region. Our objective was to examine inequalities in life expectancy in six large Latin American cities and its association with a measure of area-level socioeconomic status.MethodsIn this ecological analysis, we used data from the Salud Urbana en America Latina (SALURBAL) study on six large cities in Latin America (Buenos Aires, Argentina; Belo Horizonte, Brazil; Santiago, Chile; San José, Costa Rica; Mexico City, Mexico; and Panama City, Panama), comprising 266 subcity units, for the period 2011–15 (expect for Panama city, which was for 2012–16). We calculated average life expectancy at birth by sex and subcity unit with life tables using age-specific mortality rates estimated from a Bayesian model, and calculated the difference between the ninth and first decile of life expectancy at birth (P90–P10 gap) across subcity units in cities. We also analysed the association between life expectancy at birth and socioeconomic status at the subcity-unit level, using education as a proxy for socioeconomic status, and whether any geographical patterns existed in cities between subcity units.FindingsWe found large spatial differences in average life expectancy at birth in Latin American cities, with the largest P90–P10 gaps observed in Panama City (15·0 years for men and 14·7 years for women), Santiago (8·9 years for men and 17·7 years for women), and Mexico City (10·9 years for men and 9·4 years for women), and the narrowest in Buenos Aires (4·4 years for men and 5·8 years for women), Belo Horizonte (4·0 years for men and 6·5 years for women), and San José (3·9 years for men and 3·0 years for women). Higher area-level socioeconomic status was associated with higher life expectancy, especially in Santiago (change in life expectancy per P90–P10 change unit-level of educational attainment 8·0 years [95% CI 5·8–10·3] for men and 11·8 years [7·1–16·4] for women) and Panama City (7·3 years [2·6–12·1] for men and 9·0 years [2·4–15·5] for women). We saw an increase in life expectancy at birth from east to west in Panama City and from north to south in core Mexico City, and a core-periphery divide in Buenos Aires and Santiago. Whereas for San José the central part of the city had the lowest life expectancy and in Belo Horizonte the central part of the city had the highest life expectancy.InterpretationLarge spatial differences in life expectancy in Latin American cities and their association with social factors highlight the importance of area-based approaches and policies that address social inequalities in improving health in cities of the region.FundingWellcome Trust.

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Section: Discussionmentioning

confidence: 99%

Inequalities in life expectancy in six large Latin American cities from the SALURBAL study: an ecological analysis

Bilal¹,

Alazraqui

Caiaffa

et al. 2019

The Lancet Planetary Health

105

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“…19 Although mayors may recognize the importance of public health concerns, including the social determinants of health and health disparities, they may perceive little to no power over these concerns at the community or city level. 21 Research suggests that changing the narrative on accountability is imperative, particularly given that many top health challenges, such as obesity and opioid abuse, are complex, multifaceted conditions that require a set of multisectoral and multilevel solutions. Mayors have a critical role in leveraging assets, resources, and initiatives to catalyze change at the local level.…”

Section: Discussionmentioning

confidence: 99%

“…This study aimed to assess mayors’ perceptions of the top health challenges facing their cities, examine mayors’ perceptions of their own accountability for a set of public health challenges, and explore characteristics associated with perceived accountability. Because previous studies demonstrated that Republican and Democratic officials and constituents tend to hold distinct public health policy views, 21 -26 we hypothesized that mayoral political affiliation and city-level prevalence of a health concern would predict patterns in perceptions of accountability for public health issues.…”

mentioning

confidence: 99%

Perceptions of Public Health Priorities and Accountability Among US Mayors

et al. 2020

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Objective Mayors have considerable and often direct influence over health policy in their cities, yet little is known about mayors’ general perceptions of current public health challenges. The objective of this study was to assess perceptions, attitudes, and priorities related to public health among US mayors. Methods We collected survey data from a nationally representative sample of US mayors (N = 110) in 2018 and matched survey responses with city-level health surveillance data. We conducted descriptive analyses and multivariable regression modeling to estimate associations of interest. Results Mayors in our sample most frequently cited obesity/chronic diseases (23.6%; 26 of 110), opioid abuse/drug addiction (22.7%; 25 of 110), and health care access (13.6%; 15 of 110) as the top health challenges facing their cities. However, mayors identified a different set of health issues for which they believed constituents hold them accountable. With the exception of opioid-related deaths, prevalence of a health concern was not associated with perceived accountability for that particular issue, whereas partisanship and sex predicted patterns in perceived accountability. Conclusions Mayors recognized critical health challenges at the city level but varied widely in their perceived accountability for such challenges. Findings can inform strategies to engage local policy makers in cross-sector collaborations to improve the health and overall well-being of people in cities across the United States.

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“…Counties are usually larger than their cities, are mostly administered by different governmental entities, and contain overlapping, but distinct, populations, with different sociodemographic composition, health behaviors, and health conditions ( 1 ). As such, use of information from county-level data sources may skew data-driven efforts to allocate resources and target interventions ( 2 , 3 ).…”

Section: Objectivementioning

confidence: 99%

Health and Health Determinant Metrics for Cities: A Comparison of County and City-Level Data

et al. 2020

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What is already known on this topic? Many local health departments develop city-level public health policies but lack city-level health data. This lack causes reliance on county-level data, which may misrepresent city populations. What is added by this report? We found substantial and highly variable city-county differences within and across 4 public health metrics, suggesting use of county-level data may mischaracterize health metrics in cities. What are the implications for public health practice? Use of county data to proxy city measures could hamper municipal public health policymaking. Public health officials concerned with cities should use city-level data whenever possible.

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US Mayors’ and Health Commissioners’ Opinions About Health Disparities in Their Cities

Cited by 30 publications

References 27 publications

Inequalities in life expectancy in six large Latin American cities from the SALURBAL study: an ecological analysis

Inequalities in life expectancy in six large Latin American cities from the SALURBAL study: an ecological analysis

Perceptions of Public Health Priorities and Accountability Among US Mayors

Health and Health Determinant Metrics for Cities: A Comparison of County and City-Level Data

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