51 of 75 largest cities earn overall medals in CityHealth’s 2025 policy assessment, with 35 medal improvements across 12 policies
Amid shifting policy landscapes, constrained resources, and evolving community needs, CityHealth’s 2025 Policy Assessment shows that U.S. cities are continuing to drive meaningful health progress through local policy action. This year, 51 of the nation’s 75 largest cities earned an overall medal for the strength and number of evidence-based health policies they have in place, with 11 cities improving their overall medal status. Chicago joined the ranks of CityHealth’s top echelon of cities by earning its first overall gold medal under the current policy package — becoming the eighth city to achieve the initiative’s highest honor. CityHealth is an initiative of the de Beaumont Foundation and Kaiser Permanente.
Key results: CityHealth awarded 51 cities (68%) with overall gold, silver, or bronze medals, with one city moving from silver to gold, five cities moving from bronze to silver, and five cities earning an overall bronze medal for the first time. Approximately 47.6 million people live in a city that has earned an overall medal — an increase of nearly 4 million people compared to 2024.
“From expanding affordable housing to improving access to greenspace, the policy momentum we’re seeing across the country is a powerful reminder that real progress starts locally,” said CityHealth Executive Director Katrina Forrest, JD. “Even amid competing priorities and unprecedented demands, local leaders continue to demonstrate what it means to lead with health — advancing policies that create safer, healthier conditions for everyone. With more than 80 percent of Americans living in cities, policy has the power to shape the future of health for millions, and CityHealth is proud to support the leaders driving this progress.”
Eight exemplary cities rose to the top by earning overall gold medals: Boston, Chicago, Denver, Minneapolis, New Orleans, Portland, San Antonio, and St. Louis — with Chicago earning its first overall gold under the current policy package, having previously earned an overall silver.
In addition to Chicago, ten other cities showed progress by improving their medals in 2025, including five that moved from overall bronze medals to overall silver medals — Cleveland, Columbus, Louisville, Nashville, and Oakland. Five cities earned an overall bronze medal for the first time: Austin, Cincinnati, Irvine, Phoenix, and Tulsa.
“Across the country, cities are proving that the policies they choose can be as powerful as any prescription,” said de Beaumont Foundation President & CEO Brian C. Castrucci, DrPH. “This assessment shows the impact local leaders can have when they choose policies that strengthen the foundations of health. City officials from both sides of the aisle are recognizing that policy is medicine — it’s how we build safer neighborhoods, healthier housing, and stronger futures for all.”
Cities can earn individual gold, silver, or bronze medals in CityHealth’s 12 policy areas, with overall medals awarded to cities earning five or more individual policy medals. The medals are awarded for city laws that meet CityHealth’s policy criteria, which provide an evidence-backed framework that cities can use to help promote health equity and address key public health concerns such as affordable housing, paid sick leave, greenspace access, and more.
“Health doesn’t start in the clinic — it starts in the communities where people live, learn, work, and play,” said BecharaChoucair, MD, Executive Vice President and Chief Health Officer at Kaiser Permanente. “By looking beyond the four walls of care and investing in policies that make cities healthier, local leaders are improving conditions for 47.6 million people. That kind of progress shows how local action can shape the health of a nation.”
2025 ASSESSMENT: KEY FINDINGS
CityHealth, in partnership with the Center for Public Health Law Research at Temple University’s Beasley School of Law and other evaluation partners, rated America’s 75 largest cities based on the criteria established for each of the 12 policy solutions (listed below) using gold, silver, and bronze medals. For complete results, including individual medals by policy area, go to https://www.cityhealth.org/2025-assessment/.
