Cities Are Key Drivers in Promoting Health

“Cities are engines of ingenuity and incubators of change,” said Michael A. Nutter, emphasizing the significant potential of cities to safeguard and advance the well-being of their citizens.

The SIPA professor and former Philadelphia mayor was speaking at the December 5 program “Cities Matter: The Role of Cities in Promoting Health.” His remarks kicked off discussion about the role of cities in pioneering innovative policy mechanisms that prioritize and promote healthcare included severa.

Also participating was SIPA’s Ester Fuchs, who joined scholars and experts including Charles Branas, Diana Hernández, Malo Hutson, Vincent Schiraldi, Rose Cuison-Villazor, and Jane Waldfogel. The event was sponsored by the Columbia Population Research Center of the School of Social Work and Mailman School of Public Health in partnership with the Urban and Social Policy,

In his keynote, Nutter highlighting the challenges he faced—and the victories he achieved—as a big-city mayor working to improve the health of residents. When Philadelphia sought to ban smoking in most restaurants and bars, for example, Nutter said he was determined to overcome those who predicated a negative impact. In the end, the law resulted in increased patronage at businesseses subject to the smoking ban and an improved health environment for their employees.

“We just have to fight some of these misnomers that people put out there when people fight health challenges,” Nutter said.

While Nutter commended aspects of American health care, he observed that the United States was far from being a leader in population health and health equity—highlighting the fact that African-American males had the lowest life expectancy in any study and across any array of indicators.

“Health disparities are not only ethically problematic, they also come at a heavy cost,” he said.

Nutter also spoke about the urgency for cities to take on a larger role given the current political climate, with an administration that is not as committed to sustainable and progressive narratives of change.

“Particularly in today’s political context, cities will have to step up to the plate and do more,” he said.

The former mayor emphasized the need for determined leadership in cities to offset the inadequacies on the federal level.

“At a moment where federal action may not be possible and in some cases, be counterintuitive, the cities and mayors will lead the way in improving health and reducing these disparities,” he said. “Action at the city level is more important now than ever.”

Building on Nutter’s observations, Fuchs, who is the director of the Urban and Social Policy Program at Columbia SIPA, urged cities to strengthen their resistance against any backlash from the administration.

“Federalism, and what used to be called state rights—which were considered to be negative by most of us who consider ourselves to be liberal or progressive—now create the legal opportunity for cities to step in and do the work of the federal government,” she said.

Fuchs also pointed to problems in the “language of entitlement” that cast cities in an unfavorable light.

“Cities are not dependent on the federal government,” she said. “They are entitled to get this tax revenue back.”

Fuchs emphasized the political need to “keep the pressure on Washington.” She said it was crucial “to not completely roll back on entitlement and programs that are essentially redistributive in nature and which will help poor people.”

The Trump administration’s tax bill is set to impact cities, and not for the better, in Fuchs’s view.

“The loss of federal funding that is being threatened by the current administration to cities is devastating and will really have a terrible impact on cities abilities in social services and public health” she said. “The tax cuts present a huge difficulty for the entitlement program,” she said.

This would also have negative repercussions on the Medicaid and Medicare programs that are tied to the city’s healthcare. Fuchs identified this as an emergent challenge that cities will need to find ways to combat while also pushing for change at the federal level.

— Neha Sharma MPA ’18