About 129 million (or 40%) of Americans live with at least one chronic disease – such as heart disease and hypertension, cancer, diabetes, or asthma. Local health departments provide important community-level solutions to prevent chronic disease.

Chronic diseases are health conditions that can last anywhere from multiple months to a lifetime. They constitute five of the 10 top causes of death in the U.S., with heart disease and cancer sitting at #1 and #2 in 2022. Tobacco use also contributes to chronic disease burden and is the leading cause of preventable disease, death, and disability.

The costs of chronic disease are also great: a full 90% of the country’s annual $4.9 trillion health care expenditure goes to managing and treating chronic diseases and mental health conditions.

Medical interventions alone – the kind that doctors prescribe for individuals – can’t fully prevent or address chronic disease. Many of the most effective solutions happen at the local level in communities across the country, where people live, work, pray, and play. Local health departments use a host of health data, as well as their routine interactions with those who live in their communities, to identify health trends and needs. They are particularly adept at implementing programs, practices, and policies to address their cities’ specific needs.

Much of the funding for this work comes from the U.S. Centers for Disease Control and Prevention (CDC), making federal public health funding critical to local communities. Further, universities and other institutions across the country carry out research on routine and emergent trends in chronic disease, often funded at least in part by federal dollars. Every level of government has a role to play in protecting and promoting the public’s health.

Big city health departments across the U.S. work to successfully bring down chronic disease rates – and thereby keeping families living longer, healthier lives and driving down health care and sick day costs. Investment in local public health up front saves individuals, businesses, and the government in health-related costs down the road.

How big city health departments work to bring down chronic disease rates

Diabetes prevention + management

The Houston Health Department runs four Diabetes Awareness and Wellness Network (DAWN) Centers across the city to provide education and support for people to better manage their own nutrition, fitness, monitoring, and care.

New York City’s plan to reduce chronic disease includes a “More Veggies” pilot program that will provide 250 low-income diabetes patients with monthly stipends to buy produce at select supermarkets.

Alzheimer’s/dementia prevention + management

A five-year plan from DC Health will address Alzheimer’s and other dementias by improving public education, enhancing caregiver support, building a skilled workforce, integrating dementia care into emergency preparedness, and investing in data collection and evaluation.

Heart disease prevention

In addition to heart screenings and exercise programs available to all city residents, the Boston Public Health Commission partnered with barbershops to install blood pressure cuffs and train barbers to discuss hypertension risks. About 90% of the men screened through the program learned they had Stage 1 or 2 hypertension and were encouraged to seek care.

Preventing tobacco-related Illness + death

Thanks to persistent efforts by Columbus Public Health, the city passed ordinances restricting tobacco sales to adults 21 and up and banning sale of most flavored tobacco products. Since these policies went into effect, the smoking rate has dropped from 35% to 13% – a much sharper drop than smoking has seen nationally.

The Change for Life initiative supported by Mecklenburg County Public Health (Charlotte and neighboring communities) supports mental health and substance use treatment facilities with tobacco free policies and tobacco treatment as a part of the recovery journey.

Cancer prevention

Big city health departments across the country provide the human papillomavirus (HPV) vaccine, which helps prevent many types of cancer.

Preventing lead poisoning

Kansas City is using a $6.4 million Housing and Urban Development grant to remove lead from 170 older homes over the next four years. An additional 3,500 homes in the city need lead removal.

Asthma prevention + management

The Pima County Health Department (serving Tucson, AZ, and surrounding communities) has a Stock Inhaler in Schools Program that provides schools with medication, a standardized protocol for respiratory distress, and other support so they are better equipped to help students manage asthma.

Healthy food + exercise access + training

The Shelby County Health Department (serving Memphis and surrounding communities) operates a Senior Food Program that provides monthly healthy food packages to eligible seniors. Participants also receive $40 in vouchers each week during the summer months to spend at farmer’s markets.

Elizabeth Green is the communications director at Big Cities Health Coalition (BCHC), a forum for the leaders of America’s largest metropolitan health departments to exchange strategies and jointly address issues to promote and protect the health and safety of the 61 million people they serve. This article was originally published on the BCHC website.

• Grantee: Big Cities Health Coalition
• Location: Takoma Park, Maryland
• Program: Health and American Cities
• Grant amount: $750,000
• Year: 2025
• Purpose: This grant helps ensure investments in large urban health departments advance innovation and leadership and accelerate efforts to achieve health equity.