We can address the link between fiscal and physical health in cities

In Trenton, N.J., local government is facing an acute fiscal challenge that is largely driven by the local economy.   

At just over $34,000, Trenton’s median household income is less than half of the county and state median. The city’s poverty rate is almost 28 percent, more than double the statewide rate, while the poverty rate for families with young children (under age 5) is even higher. It’s no real surprise that the concentration of low-income and high-poverty residents translates into pressure on the tax base: the city’s taxable assessed value has remained essentially flat for the past two decades.

{mosads}The same economic challenges that affect Trenton’s fiscal health impact the physical health of its residents. Low income often goes hand in hand with food insecurity and reliance on less healthful foods. When unemployment is high, so are rates of stress and accompanying poorer mental and physical health outcomes. Poverty often leaves families unable to afford safe housing, resulting in health-degrading exposures to lead and mold.

When you compare Trenton residents to those in the 500 largest cities nationally, they average a higher unemployment rate, a lower rate of third-grade reading proficiency, and a higher rate of households that spend more than 30 percent of income on rent. On average, life expectancy is almost four years shorter, rates of diabetes among adults are 37 percent higher, and high blood pressure is 20 percent more common among Trenton residents than among residents in this large group of comparison cities.

We know there is a vicious circle where economic challenges drive physical health challenges, which have a direct impact on local economic competitiveness. Local employers face higher costs related to disability and unemployment. Obesity alone is associated with a staggering cost of job absenteeism — nationally, to the tune of $4.3 billion a year.  

There are other clear links between fiscal health and physical health. For example, in many large cities, more than 60 percent of all calls to fire departments are for medical emergencies rather than fires. Those first responses are not reimbursed by insurance, relying instead on public coffers.  

This link between economic, fiscal and physical health has become increasingly important to city leaders. A 2018 Menino Survey found that a quarter of all mayors interviewed identified obesity, diabetes and heart disease as top health challenges facing their communities. While most of the mayors indicated that they believe state and federal governments — not local governments — are best positioned to address issues of health and the environment, some mayors recognize the potential of their role to improve the physical and mental health of their cities’ populations. As one mayor in the study said, “Constituents don’t hold me accountable for asthma and obesity, but they should.”

Part of the problem for cities wanting to take on these health issues has been a lack of data.  While much data on economic and fiscal health are a click away, most health data historically have been available only at the county level. That is fine in cities that also are counties, such as Philadelphia. But when you try to understand health challenges in Compton, data for Los Angeles County really won’t do.

But all of this is changing. The health data for Trenton comes from a new resource — the City Health Dashboard. Developed with funding from the Robert Wood Johnson Foundation, through a partnership between New York University and the National Resource Network, the Dashboard provides data on 37 measures of health and economic status for residents of the 500 largest U.S. cities, representing approximately one-third of the U.S. population.

And the good news is that just as the problems of economic, fiscal and physical health are linked, so are the solutions. And mayors — empowered with information about the specifics in their cities — now can act to address all three. Economic incentives to situate a grocery store in a neighborhood that is a food desert could increase sales tax revenue, create jobs and begin to increase access to healthier foods to reduce rates of obesity. Increasing access to parks could drive property values, spur additional investment and help reduce high blood pressure.  

And by the way, virtually any improvement in health outcomes that stems from economic improvements — especially in cities such as Trenton, where the outcomes are below average — ultimately will help to save state and federal health care dollars. Now that the Dashboard offers mayors in these economically-challenged cities the data to develop local solutions, they need partners in Washington to help execute plans.

David Eichenthal is executive director of the National Resource Network and a managing director with PFM Group Consulting.  

Dr. Marc Gourevitch is professor and founding chair of the Department of Population Health at the New York University School of Medicine, where he led the development of the Dashboard.