Life in the Big City: Building a Culture of Health

I n 2012, the Robert Wood Johnson Foundation (RWJF) teamed up with the de Beaumont Foundation to cofund the Big Cities Health Coalition (BCHC), which now comprises 20 city and county health departments across the country, including in the 10 largest metropolitan areas. Two additional large metropolitan health departments were invited to join the BCHC in 2014. Together, these 20 health departments promote and protect the health of 46 million people, or almost 15% of the US population. The BCHC is based at the National Association of County & City Health Officials, with which RWJF has a long history of partnership. Why did RWJF choose to support the BCHC? Big city health departments have a powerful ability to create healthy living opportunities on a large scale. The actions of these departments are more visible, the number of people impacted by these actions is large enough to fairly rapidly document improvement, and when an agency is supported by a mayor or council, its innovations and policies can send a clarion call across the nation. This is particularly true when the big cities can act in concert—and the role of the BCHC is to enable exchange of innovations and united voices on policies that protect and promote health. At the same time, big city health departments face daunting challenges. All BCHC departments have an urban core and are constantly confronted with the effects of poverty and other social determinants of health. There is no hope that they can solve the health issues of their cities unless they work collaboratively with other sectors of government, the health care sector, and business. They also must be able to engage diverse community groups operating in different neighborhoods in prioritizing and implementing action, and must appropriately adapt strategies to the context while still seeking alignment across the jurisdiction. Their multiethnic populations signal the increasing diversity of the national population. RWJF made the commitment to support the BCHC because big cities provide an opportunity to create a