Expert Commentary

Mayors’ views on health disparities documented in new study

Nearly one-third of mayors believe that city policies won’t lessen health disparities, according to new research from Drexel University.


Nearly one-third of mayors believe that city policies won’t lessen health disparities, according to new research from Drexel University.

The study surveyed mayors and health commissioners in the 758 American cities with a population of over 50,000. The survey asked respondents to share their opinions on the existence of health disparities in their cities, which factors influence them, the avoidability of such disparities, whether disparities are fair, and the role city policies have in addressing them. They also asked these local leaders about their social and fiscal ideologies.

The researchers write that past research has shown how city-level policies can address health disparities — consider, for example, local taxes on soft drinks, or New York City’s so-called “Soda Ban,” a proposal to limit the size of soft drinks available for purchase. However, the broader extent to which mayors and health commissioners are aware of disparities and feel capable of addressing them is less well documented.

Past research has shown that many Americans are unaware of health disparities. A paper published in Preventing Chronic Disease found that less than half of U.S. adults surveyed were aware of racial disparities in health. The researchers sought to identify whether these trends held among local leaders in order to guide future efforts to enact local policy change around health disparities.

In total, 535 mayors and commissioners responded to the survey. From their replies, the researchers found:

  • In general, health commissioners felt more strongly about the existence of disparities, whether they are avoidable and unfair, and the role of city policies in addressing them than mayors. Liberal and moderate ideology also were associated with these views among both groups.
  • Over 95 percent of mayors and health commissioners agreed or strongly agreed that health disparities exist. More health commissioners (61 percent) strongly agreed than mayors (42 percent).
  • Whereas 22 percent of mayors thought disparities were “very avoidable,” 35 percent of health commissioners did. Similarly, just 22 percent of mayors strongly agreed that city policies could have a “major impact” on disparities, while nearly 45 percent of health commissioners did.
  • 30 percent of mayors thought city policies could have little to no impact on disparities. Eight percent of health commissioners felt similarly.
  • Health commissioners and mayors both most commonly identified income as having a very strong effect on disparities. Both groups picked genetics the least as a factor influencing disparities.
  • “Opinions about health disparities were strongly associated with each other.” In other words, many mayors who strongly agreed that disparities exist in their cities also felt disparities were “very unfair” (48 percent). Many health commissioners who believed disparities were “very avoidable” also thought they were “very unfair” (76 percent).

The authors conclude that many local policymakers “are not fully aware of the potential of city policies to reduce health disparities.” They indicate that communication and education efforts could help address this issue.

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