By Shoshanna Levine

What is the smoking rate in Lafayette, Louisiana? Which neighborhoods have the highest rates of childhood poverty in St. Paul, Minnesota? How does Spokane, Washington’s walkability compare to that of other midsize cities in the Pacific Northwest?

Until recently, questions like these have been difficult for communities to answer, as most data on health factors and health drivers are available at the county or state level, not at the city level. This makes it difficult for local government managers, health departments, community leaders, and other important stakeholders to make decisions concerning policies and programs to improve the health and well-being of their communities.

That’s where the City Health Dashboard (the Dashboard) (https://www.cityhealthdashboard.com) comes in.

This new online resource, which was launched in May 2018, enables local leaders and community members in the nation’s 500 largest cities—those with populations of about 66,000 or above—to easily see where their city or specific neighborhoods stand on 36 key measures of health and the drivers of health. These include more traditional health measures like obesity and primary-care physician coverage, as well as such health determinants as housing affordability and graduation rates.

By providing city and neighborhood-specific data, community leaders have a clearer picture of the biggest challenges in their communities and are better positioned to drive change.

Built by the Department of Population Health at the NYU School of Medicine, in partnership with NYU’s Robert F. Wagner Graduate School of Public Service, ICMA, the National Resource Network, and the National League of Cities, the Dashboard is available with funding from the Robert Wood Johnson Foundation. This tool equips cities with a one-stop resource allowing users to view and compare data on health and the factors that shape health from multiple sources.

This data can be used to guide local solutions, thus creating healthier and more equitable communities.

The Dashboard was piloted in four cities beginning in January 2017: Kansas City, Kansas; Flint, Michigan; Providence, Rhode Island; and Waco, Texas. To build a tool that would meet the needs of users, in the pilot phase, the NYU team worked closely with partners in each of these local governments and community organizations to select rigorous and actionable measures of health and health drivers. After compiling an initial list of all potential measures, we presented it to city partners to determine which were the most relevant and filled their data gaps. It was through this iterative process that a final list was developed.

In scaling up the resource to reach 500 cities, the Dashboard team again worked with the pilot cities and an additional 11 cities, representing a range of geographies, sizes, and governing structures, to ensure that the site was built to support city-led action.

This City Advisory Committee helped the team decide which new measures to add, gave feedback on such new features as the “peer city finder” tool described below, and provided input on layout and design concepts, among other guidance.

This iterative, collaborative process helped the Dashboard team build a tool equipped to help users uncover which health and social challenges, from chronic absenteeism to lack of proper prenatal care, are most pressing for their residents.

By using Dashboard data to identify priority matters for the city as a whole and specific populations and neighborhoods within the city, city leaders can better target policies and programs to those most affected by these issues.

So what exactly is the City Health Dashboard?

Measures

Health is more than what happens in the doctor’s office. To improve health and well-being, people must look beyond the medical system and focus on solutions both inside and outside of health care.

To reflect a definition of health that recognizes that health also happens in the places where we live, learn, work, and play, 36 measures¹ were chosen that fall across five overarching domains:

1. Health outcomes look at health in relation to death and disease. Such measures as diabetes and obesity rates, cardiovascular disease deaths, and opioid overdose deaths can give cities a sense of how their communities fare on more traditional health and disease endpoints.

2. Health behaviors look at actions that people take, like binge drinking, smoking, and physical activity rates, that can influence health.

3. Clinical care examines factors that relate to the health-care system. Lack of health insurance and access to various health services can all impact the ability of individuals to get and stay healthy.

4. Social and economic factors examine drivers of health from the social environment. Measures that look at such factors as educational attainment, poverty and inequality, and housing costs can help draw a broader picture of the factors that influence the health of a community.

5. Physical environment looks at how places can influence health. Access to healthy foods and places to safely walk outside, clean air, and housing free from lead exposure are key for building healthy communities.

All measures are available at the city level to facilitate decision making and policy implementation by local officials. For 21 measures, where the underlying data are sufficiently detailed, measures are also presented at the census-tract level, allowing cities to compare outcomes across neighborhoods and target resources to best drive change.

To limit data collection burden on cities, the data presented on the Dashboard are drawn centrally from federal, state, and other datasets that adhere to rigorous standards of data collection and analysis. The City Health Dashboard team then analyzes these national and state data down to city and neighborhood boundaries to calculate the local estimates presented on the Dashboard.

Data sources include the U.S. Census Bureau, the Centers for Disease Control and Prevention, and the Environmental Protection Agency, among others.

Design and Features

Every city is unique and will develop its own road map toward better health. Data from the City Health Dashboard give communities the ability to see health outcomes and the factors impacting health, both within their own cities and compared to other cities of similar size.

The Dashboard has several distinctive features to help communities understand their challenges and their opportunities to take action and drive change.

• Data views and visualizations. The Dashboard presents data using a variety of interactive maps, tables, and charts so that different users can find a view and cut of the data that help meet their specific needs.

City average values can provide information on what factors, including unemployment rates, look like for the city as a whole, while census tract values can drill down to highlight neighborhood-specific needs and cause for action.

Demographic disaggregations allow further granularity for determining how factors affect different populations within a city and allow the city’s leadership to make data-informed decisions.

• City comparisons. In speaking with cities like Kansas City, Kansas, the team found that many had a hard time finding valid comparisons for benchmarking their progress. Often, a city would be compared to one within its state that was close geographically but different in terms of characteristics, simply because that is what the data allowed.

Because the data within the Dashboard are standard across all cities, comparisons can be made with any of the 500 included cities. And that’s not all: cities can use the Dashboard’s “peer city finder” tool to find others like them on a variety of factors—size, region, demographic features, and others—and make comparisons.

• Resources for taking action. The Dashboard offers several resources to help community leaders create healthier places for people, including evidence-informed policies and programs. Resources,² consisting of model ordinances, guidelines for successful program implementation, and best practices from across disciplines, can help community leaders and practitioners take the next step from information and insight to action.

In addition, our team of partners is building a collection of city success stories³ that will hopefully spark collaborations between cities seeking to make positive change and those that are already on the path to improved health and well-being.

The Dashboard in Action

People working with the Dashboard are excited to begin to collect examples on how it is being used as numbers expand from four to 500 cities. Some examples are already available on how the Dashboard has helped them make progress toward improved health and well-being.

• Strengthening collaboration across sectors in Waco. Waco’s collective impact initiative, called Prosper Waco, works to improve health, education, and financial security for city residents. It is, however, easy for each of these sectors to become siloed within its own way of working and area of focus.

With data visualizations from the Dashboard, though, these sectors have been able to demonstrate the complex and interrelated natures of these issues, showing how health measures are related to education and economic indicators in particular neighborhoods of focus.

One example is that they have worked with local businesses to demonstrate the link between health and financial security and make the case that having a healthy workforce is better for both employees and employers.

This data have helped strengthen the city’s ability to collaborate across sectors and reinforce the key message that it really does take a collective impact to begin to see movement in their community.

• Bringing in new resources in Providence. The Healthy Communities Office in Providence relies heavily on grants to fund its work, ensuring that residents of the city have reasonable access to the resources they need to lead healthy lives.

Most of the data received are for Providence County, not the city. Using the Dashboard, the office has been able to more accurately highlight city-specific health needs to bring in the resources needed to drive change in the community.

For a funding opportunity around affordable housing, for example, they have brought together data on housing cost burden, health, and chronic absenteeism to weave together a narrative around how these issues affect one another. This allowed them to develop a proposal addressing the unique challenges that specific Providence neighborhoods are facing around these issues.

• Grounding ideas in data in Lake Charles. As in other cities, leaders in Lake Charles, Louisiana, have had theories about what health looks like in different neighborhoods across the city. Since they have often had to rely on county data for most health indicators, however, they didn’t have all the information that they would have liked to paint a specific picture of health for the city.

With the launch of the City Health Dashboard, members of city government have been able to connect measures of physical activity, walkability, and poverty to ground their thoughts and ideas in hard facts. This has allowed them to begin to put together programming to address these issues in the neighborhoods with the highest need across the city.

In today’s data-driven world, it is a given that you can only move what you measure. And yet health data are often not suited to meet the needs of policymakers and broader communities. With the City Health Dashboard, cities across the United States will leverage the power of data to improve the health and well-being of everyone in their communities.

Endnotes and References

1 https://www.cityhealthdashboard.com/metrics

2 https://www.cityhealthdashboard.com/resources

3 https://www.cityhealthdashboard.com/stories

Shoshanna Levine, DrPH, is program director, Department of Population Health, NYU School of Medicine, New York, New York (Shoshanna.Levine2@nyumc.org).

Resources

City Health Dashboard: https://www.cityhealthdashboard.com

Department of Population Health at the New York University’s (NYU) School of Medicine: https://med.nyu.edu/pophealth/department-population-health

NYU’s Robert F. Wagner Graduate School of Public Service: https://wagner.nyu.edu

National Resource Network: http://www.nationalresourcenetwork.org/en/home

ICMA: https://icma.org

National League of Cities: https://www.nlc.org

Prosper Waco (Texas): https://prosperwaco.org

Greater Flint (Michigan) Health Coalition: https://gfhc.org

Healthy Communities Office in Providence, Rhode Island: http://www.providenceri.gov/healthy-communities

Kansas City, Kansas: http://wycokck.org/Home.aspx