Twenty Local Health Departments, 46 Million People

B ig City Health Departments: Leadership Perspectives highlights innovative strategies and programs of the health commissioners of the largest American cities. Led by Drs Jonathan Fielding of Los Angeles and Thomas Frieden of New York City, the commissioners formed the Big Cities Health Coalition (BCHC) in 2002 to reflect their needs as distinct from those of the many smaller jurisdictions across the country. Working together, these cities have used their combined resources and experience to formulate new strategies and solutions to address common challenges. Originally based in New York City under the direction of Dr Frieden and then Dr Thomas Farley, it is now housed at the National Association of County and City Health Officials in Washington, DC, the association serving all 2800 local health departments (LHDs) across the country.1 Since 2012, the coalition has been supported by the de Beaumont Foundation and the Robert Wood Johnson Foundation. A needs assessment was performed in 2013 to identify the greatest policy and technical and human capital needs across the member cities. The 20 members of the BCHC serve approximately 46 million people, or about 15% of the current American population. The cities currently included are Boston, New York, Philadelphia, Baltimore, Washington, Atlanta, Miami, Detroit, Cleveland, Chicago, Denver, Dallas, Houston, San Antonio, Phoenix, San Diego, Los Angeles, San Jose, San Francisco, and Seattle. These cities are defined by their large populations and population density as well as by an “urban core,” with areas of concentrated poverty, health disparities, violence, and crime. The abilities of these health departments reflect their size, their geography, and the range of interests of their jurisdictions. All are working in an environment shaped by significant budget reductions from the re-