Exploring Health and Equity: What’s your City Type?

Health disparities are pervasive in America’s cities. America’s small and midsize cities face similar health challenges to our biggest cities and they are home to far more people, yet their health challenges receive far less attention. Smaller cities also typically have fewer resources and less infrastructure with which to respond to health challenges than their large city counterparts.

With 1 out of 4 people in the U.S. calling small and midsize cities home, we set out to explore this.

At the Dashboard we have been busy creating new analysis and resources to help small and midsize cities including:

• New City Types health framework

• Interactive City Types Data Explorer

• Adding new small and midsize cities to the Dashboard

New typology for health

In our new report, City Types for Improving Health and Equity:  Understanding America’s Small and Midsize Cities, we categorized over 700 small and midsize cities—those with populations of 50,000 to 500,000—into ten discrete City Types, based on a typology of sociodemographic and population characteristics, from Emerging Cities and Regional Hubs to Working Towns and Big City Exurbs. Our team produced the first health-focused typology for small and midsize U.S. cities to better understand wide variations in health between these cities and explore how factors like poverty, housing, and inequality are driving these differences.

What did we find?

In addition to categorizing these places, we used the typology to examine the social drivers of health in these City Types over time and uncovered sizable changes in measures of health, equity, and well-being across each one. Here are some key findings:

• Cities are divided by economic and racial/ethnic measures, and wealth tends to be concentrated in cities that are predominantly White.

• Poverty, rent burden, and income inequality grew across all City Types between 2000 and 2017.

• Regional history and proximity to bigger cities contribute to local socioeconomic disparities.

• As we see in other research, health outcomes track closely with socioeconomic disparities most of the time.

To learn more about these findings, explore the report.

Diving into the City Types – Introducing the Data Explorer

We transformed our analysis of City Types into an applied, hands-on tool for users to engage with all of the powerful information inside the report. Available on the City Health Dashboard City Types landing page, the new Data Explorer can help cities explore their data by City Type. The Data Explorer allows you to dive into measures from the report including poverty, life expectancy, ratio of Black-to-White median household income, and more, giving you a snapshot of the data by City Type. You can also search for a city of interest to compare within and across Types.

How It Works

Let’s focus on Utica, NY. Utica, with a population of 60,675, is in the Regional Hubs City Type. Regional Hubs are midsize cities that serve as hubs within smaller metro areas, with high inequality and large Black populations, where residents mostly work locally. Selecting Renters with Excessive Housing Cost reveals that almost 60% of Utica’s renters are paying 30% or more of their incomes on rent, compared to an average of about 54% for all Regional Hub cities. But, what if we zoomed out further? Compared to the average rent burden of 51.4% for all 719 of the small and midsize cities, a lot more of Utica’s residents are experiencing rent burden, leaving less for doctors’ visits or buying healthy foods.

A leader in Utica can also use the Data Explorer to identify high performing cities within their City Type, and explore and adapt successful policies and interventions from those peers to improve their own local outcomes. In this case, Kansas City, MO has the lowest rate of housing cost burden among renters for all Regional Hub cities at 46.8%.

Since 2013, the Kansas City Council has made investment in underdeveloped neighborhoods a key priority in their strategic plan, increasing accessible, safe, and affordable housing options. In 2019, to advance their housing-specific goals the city council passed a sweeping 5-year housing policy that called for further development of new affordable housing options, removed barriers for accessing affordable opportunities, and created a $75 million public-private trust fund to renovate existing homes. Given that Kansas City and Utica share a number of important characteristics, perhaps similar efforts could resonate amongst stakeholders and policymakers in Utica and improve housing costs, especially in high-need neighborhoods across the city.

When exploring poverty, around 30% of Utica’s residents are living under the federal poverty line compared to the Regional Hubs average of 24%, a challenge very much related to rent burden. For this measure, Hampton, VA is the highest performing Regional Hub city with a lower poverty rate of 14.9%.

Since 1990, the Hampton Roads Planning District Commission (HRPDC) has facilitated local government cooperation between seventeen cities across southeast Virginia, including Hampton, to work together to solve the region’s most pressing issues, including poverty. Hampton could serve as a peer to Utica, encouraging collaboration with regional neighbors to identify shared priorities and innovative policies to reduce poverty across the region.

More data to see what shapes health in your city

The City Health Dashboard now has more data and interactive features available on the site to help you improve health locally. For our smaller cities, the Dashboard provides city and neighborhood-level data for about 20 measures of health and its drivers, including healthy food access, unemployment, access to health insurance, and more. Because of greater data availability, for most cities over ~66,000 population there are 35+ measures on the Dashboard.

The website now also allows users to compare their city’s performance on all metrics to cities in their City Type, among other filters such as region, similar population sizes or demographic composition. On the Compare Cities page, just select the ‘Filter to Compare Cities’ dropdown, and select the City Type filter to select from all peer cities in your Type. For the purposes of the City Type filter, we also added a Type called “Big Cities” which contains all cities with populations over 500,000.

There is much more to discover in the report and Dashboard tools. By illuminating drivers of local and peer city outcomes, we hope the City Types report and accompanying interactive features offer a valuable framework for supporting and refining local efforts to advance health and equity in the years ahead.

Do you have any questions about your City Type, the report, or our analysis? Feel free to email us to learn more!