Local leaders in cities around the country are navigating tight budgets, shifting politics and growing community needs — but they're still delivering real results for residents, according to a new report from CityHealth.

• CityHealth's 2025 Policy Assessment shows how cities are implementing practical, proven policies — from green space to renter protection — to build healthier, stronger communities where people can thrive.

Why it's important: 80% of Americans live in cities — which means the decisions made in city halls around the country shape how most American families live, work and stay healthy every day. From cleaner air to childcare access, health and wellness begin where the people are.

The story: CityHealth worked with the Temple law school Center for Public Health Law Research and other evaluation partners to rate the 75 largest cities in the country on each of CityHealth's 12 smart policy solutions using gold, silver and bronze medals.

• Each policy solution, from flavored tobacco restrictions to smoke-free indoor air to increased green spaces, addresses individual- and population-level health.
• These are tried and tested policies that help people have access to a safe place to live, a healthy body and mind, and a thriving environment.

The impact: In 2025, 51 cities surveyed earned an overall medal — representing nearly 48 million people living in cities with strong health policies.

• Eight cities earned an overall gold — including Chicago, which reached the top tier for the first time.
• Eleven cities improved their overall status, showing nationwide momentum.
• Five cities earned their first-ever overall medal, and another six moved up to a higher tier.

Some examples: These policies and medals aren't just for show: they actually improve real lives.

• Affordable Housing Trusts help families stay housed and allow cities to build and preserve affordable homes. 10 cities improved in this policy area.
• Greenspace policies expanded access to healthier outdoor spaces, with 58 cities earning medals — a 5% year-over-year increase.
• Legal support for renters gained meaningful ground as cities confronted rising eviction rates, including by making new investments in legal support programs.
• Complete Streets programs earned 32 cities medals, demonstrating balanced priorities for safety during all kinds of transportation.

An expert's take:

• "The policy momentum we're seeing across the country is a powerful reminder that real progress starts locally," CityHealth Executive Director Katrina Forrest said.

The results: After a comprehensive survey, here's the overall leaderboard:

• 🥇 Gold tier cities include Boston, Denver, Chicago, Minneapolis, New Orleans, Portland, San Antonio and St. Louis.
• 🥈 Silver tier cities include Albuquerque, Atlanta, Aurora, Baltimore, Cleveland, Columbus, Kansas City, Lincoln, Los Angeles, Long Beach, Louisville, Milwaukee, Nashville, New York, Newark, Oakland, Philadelphia, Pittsburgh, Sacramento, San Diego, San Francisco, San Jose, Santa Ana, Seattle, St. Paul and Washington, D.C.
• 🥉 Bronze tier cities include Anaheim, Austin, Cincinnati, Dallas, Detroit, Fort Worth, Fresno, Henderson, Houston, Indianapolis, Irvine, Omaha, Phoenix, Riverside, Stockton, Tucson and Tulsa.

Looking ahead: Housing will likely remain a top priority in 2026, and CityHealth's policy package offers cities a roadmap to strengthen stability for families.

• Healthy food purchasing policies also offer an opportunity for cities to lead by example by ensuring nutritious food options in public buildings.

CityHealth will continue partnering with cities, offering tools, technical assistance and best practices that help leaders meet the moment — and help residents feel the impact.

The takeaway: CityHealth's findings reaffirm what communities experience every day: cities deliver.

• Local policy choices shape health outcomes, strengthen neighborhoods and ensure residents have access to opportunities that help them live longer, better lives.
• With continued investment and support, cities can continue to lead the way.

See the full report.