Progressive Local Government for the 21st Century

Health Equity

This roadmap is under construction!

Thank you for visiting We are currently working to revise a number of our policy roadmaps. This roadmap is scheduled for revision in July 2021. In the meantime, feel free to explore our existing roadmaps while we work to fix broken hyperlinks and incorporate new and updated policy resources.


The Problems & Progressive Local Solutions

Progressive local governments face a myriad of challenges when attempting to improve the health of their communities that often seem outside of their control. These challenges include federal and state oversight, the environment, and epidemics like the opioid and mental health crises. Despite these outside forces there are numerous opportunities for local governments to improve the health of their communities through a holistic progressive approach.

Improving local health requires increased access to affordable healthcare for all residents. Establishing benefits standards for working families such as paid sick leave would also improve health outcomes. Elected officials can also work on tackling food issues (see Food) to make their communities healthier by addressing healthy food scarcity and obesity issues. Next, progressive governments should work to improve the local environment. Finally, local governments looking to take it to the next level must work to ensure equal access to all residents which includes tackling issues such as mental health and addiction.

Available Local Levers & Targets of Reforms

Health is determined by many factors, from healthcare to food to environment. The Mayors Innovation Project’s Cities at Work guide outlines the need for cities to develop metric-based wellness plans and then focus on core issues such as healthcare access, local food systems, obesity, and workplace-wellness. The CDC has created a guide that offers a design-centered overview for how to improve a community’s physical and mental health.

Current Reforms & Tools to Fight for Them

Where possible and not preempted by state law, local government should explore providing healthcare access. The UC Berkeley Labor Center’s outline for a New Social Compact in San Francisco includes details for establishing a municipal universal access program. Similarly, they showed that where California counties were able to increase low-income healthcare spending under the state’s Medicaid expansion, those counties experienced positive economic spillover effects. Policy Matter Ohio provides a helpful guide and example of how to calculate the costs of an affordable health care program. Minneapolis has implemented an innovative community approach to health care, which aims to holistically treat residents who rely on public health care through addressing the underlying causes of health disparities – not just the health issues themselves.

States should consider health issues when setting local wage and benefits standards (see Wages and Benefits). If possible, local governments should require healthcare provision in local living wage ordinances, as the LA Airport living wage law did. Ensuring workers have access to medical leave and paid sick days is also crucial, as such policies have clear benefits. Paid sick laws have been passed in Denver, Jersey City, Seattle, Portland, OR, Milwaukee, and Chicago.

Ensuring a healthy local food system and fighting obesity, especially in children, is a crucial goal of local progressive governance. Fighting obesity can also decrease your spending on healthcare in the long run. Please see ProGov21’s food roadmap for a full overview of the subject. ChangeLabs and NPLAN’s model obesity ordinance which coordinates health and food policy aims to address childhood obesity.

Considering health holistically requires considering environmental health. Ensuring clean air, water, and land is crucial for local communities and helps combat climate change, see ProGov21’s Environment Roadmap for a full overview. SiX Action’s policy guide to local clean energy and the Meister guide to transforming municipal energy supply aim to create clean air.

Similarly, a Portland, OR ordinance requiring minimum fuel blends and that city vehicles maximize use of renewable fuels illustrates how clean procurement can improve local health. Baltimore’s zoning code reform plan seeks to address environmental degradation and create opportunities for physical activity. Finally, banning smoking in public spaces and places of work including through smoke-free indoor air ordinances or smoke-free workplace ordinances can dramatically increase public health and reduce problems associated with secondhand smoke.

Taking it to the Next Level

Addressing health disparities means overcoming health inequalities due to poverty, inequality, and racism. The National Center for Transgender Equality and the National Gay and Lesbian Task Force wrote an excellent guide to ending transgender discrimination including in healthcare. Flint passed an anti-discrimination ordinance that includes transgender and HIV status protections. A Dane County, WI ordinance requires county contractors provide employees reproductive healthcare coverage. Toolkits exist to help local elected officials in efforts aimed at preventing sexual assault and supporting survivors. Immigrant communities are typically woefully under-serviced – UC Berkeley’s assessment of local attempts to provide undocumented residents health care illustrates the problem, and cities can work toward solutions through proactive solutions such as Hartford ordinance ensuring equal access to city services for immigrants including healthcare.

Local authorities could do much more to address substance use disorder and create community-based mental health service providers that offer comprehensive coverage. Providing such services both saves lives and curtails down-stream costs through facilitating prevention. Treating the opioid epidemic seriously requires substantial reform to existing policy, including safe consumption facilities. This effort requires coordination with law enforcement to avoid criminalizing substance use disorder or other crimes of mental illness. City and county police departments can develop mental health collaboration programs, and there are many resources available to establish integrated mental health responses when relevant criminal matters arise. Where cases cannot be declined, it is critical that local district attorneys partner with public health officials and divert people with mental illness from jails into community-based treatment programs.

Helpers & Allies