Small and midsize cities are home to twice as many Americans as large cities and face many of the same health disparities. However, they often do not receive the same attention or resources. A new report by researchers in the Department of Population Health at NYU Langone and NYU Wagner Graduate School of Public Service examining 719 small and midsize cities across the United States paints a picture of uneven economic growth and recovery, growing income inequality and poverty, and excessively high rent burden in nearly every city examined.
To better understand the health and equity trends in small and midsize cities specifically, researchers created a first-of-its-kind, health-focused typology for the 719 U.S. cities with populations of 50,000 to 500,000. This new “City Types” framework groups cities into 10 unique types based on changes in population, household poverty, life expectancy, manufacturing sector employment, income inequality, and other factors that drive health—using data from 2000 to 2017—and tracked changes over time.
The City Types research builds on the health data for cities available on the City Health Dashboard, a free, online resource created by the NYU Grossman School of Medicine and NYU Wagner Graduate School of Public Service team, and supported by the Robert Wood Johnson Foundation, that provides community-level health, social, and economic data for more than 750 cities across the United States. Careful examination of these new City Types shows that race and poverty affect the opportunities for health for residents in small and midsize cities. And as racial and economic disparities widened over time, so have health disparities.
“The fact that poverty, rent burden, and income inequality grew over time across all City Types underscores the urgency with which city leaders must address the drivers of inequity,” says Marc N. Gourevitch, MD, MPH, the Muriel G. and George W. Singer Professor and chair of the Department of Population Health at NYU Langone, and principal architect of the City Health Dashboard. “Bold policy action is needed to overcome the legacy of disinvestment and structural racism that is reflected in this report.”
Given that the United States is now in the midst of the 2019 coronavirus disease (COVID-19) pandemic, accompanied by the worst economic crisis since the Great Depression, Dr. Gourevitch warns that inequities faced by those living in small and midsize cities will be further exacerbated without swift and tailored interventions.
Last month, the City Health Dashboard launched a city-oriented COVID Local Risk Index to help municipal leaders identify neighborhoods with populations at higher risk of COVID-19 infection and more severe COVID-19 illness by synthesizing key risk factors including race and ethnicity, age, household crowding, poverty, and underlying health conditions like diabetes and obesity. In using this new City Types framework to understand COVID-19 risk, the researchers also found that City Types with high local risk for COVID-19 tend to also have higher rates of child poverty and shorter life expectancies.
Understanding America’s Small and Midsize Cities: Key Findings
Using the typology framework, the research team identified the following City Types : Emerging Cities, Small Stable-Size Cities, Big Metro Exurbs, Smaller Commuter Suburbs, Diverse Ring Cities, Latino-Predominant Enclaves, Working Towns, Regional Hubs, Small Industrial-Legacy Cities, and College Cities.
Additional findings from the report include:
- Poverty, rent burden (renters spending more than 30 percent of their annual income on housing), and income inequality grew across all City Types. The proportion of rent-burdened households increased for nearly all cities, from an overall average of 41percent of renters in 2000 to 52 percent of renters in 2017. The median income for non-Hispanic Black households in 2000 was 13 percent lower than that of non-Hispanic white households; by 2017 that gap grew to 28 percent. But some city types, including Working Towns and Regional Hubs, had significantly larger Black–white income gaps. In those city types, Black households earned 41 percent and 46 percent less than their white counterparts, respectively.
- Wealth and better health outcomes are concentrated in city types that are predominantly white. The two city types with large low-income and large Black populations (Regional Hubs and Small Industrial-Legacy Cities) had the highest burdens of disease and mortality. On average, these more impoverished city types also had the greatest income inequality and life expectancy gaps between neighborhoods within cities, averaging 10 years.
- Region and proximity to bigger cities drive local socioeconomic disparities. High-poverty cities located near the largest U.S. cities tend to have better health outcomes compared with other peer cities with high poverty.
“The City Health Dashboard’s new City Type framework gives city leaders, policymakers, and other stakeholders unique insight into what influences health and wellbeing in their communities,” says George Hobor, PhD, program officer at the Robert Wood Johnson Foundation. “With this new typology and the data around it, decision makers can identify health trends and the drivers of those trends within their cities and across peer cities. We believe that can lead to greater opportunities to improve health for all,” says Dr. Hobor.
Data used in the report have been incorporated into the City Health Dashboard, along with a new filter to easily find and compare measures among peer cities.
“COVID-19 has exposed longstanding health disparities in our country. We can no longer afford to ignore these issues or the policies that created them,” says Adrian Perkins, mayor of Shreveport, Louisiana. “As this report illustrates, we must break through systems of racial injustice in order to build more equitable, thriving communities.”
Register for a webinar at 2:00PM ET on Thursday, August 6, to explore the City Health Dashboard’s new health-focused framework for more than 700 small and midsize U.S. cities. Learn how city leaders and their partners are using the dashboard to identify local health trends within and across City Types, understand how health disparities in their communities are driven by social factors like income inequality and rent burden, and learn about potential solutions to improve health for all. Explore more about your City Type and important drivers of health.
About the City Health Dashboard
More than 80 percent of U.S. residents live in urban areas. However, until recently, few measures have been available for cities to assess health, the factors that shape it, and the drivers of health equity in their communities. The City Health Dashboard provides city leaders with an array of regularly refreshed data to support health policies and equity-related decision-making.
With support from the Robert Wood Johnson Foundation, the City Health Dashboard was developed by NYU Grossman School of Medicine, in partnership with NYU Wagner Graduate School of Public Service, the National Resource Network, ICMA, and the National League of Cities. The website launched in 2018 to offer data on more than 35 measures for the 500 largest U.S. cities—those with populations of about 66,000 or more—representing approximately one third of the U.S. population. In May 2020, the dashboard expanded to smaller cities—now covering more than 750 cities with population 50,000 and larger. Equipped with these data, local leaders have a clearer picture of the challenges facing their communities and how to address them.