Katrina Forrest

Public Health Post: CityHealth evaluates our nation’s largest cities on a wide range of health-related policies. Broadly speaking, which cities fared the best during the pandemic and what policies did they have in place that made them more successful?

Katrina Forrest: I want to lay some context and say city leaders in particular were called to do more with less during Covid-19. They had to navigate immense uncertainty, job losses, and economic pressures. And they did it with such grace and such determination. Their strength and resilience in the face of considerable adversity was admirable.

In terms of who fared better, it’s hard to assess because there are so many components that make up community resilience and preparedness. Policy is one measure of that. But two policies in particular – Complete Streets and Earned Sick Leave – were more readily adopted in cities than perhaps ever before in the wake of Covid.

For example, Complete Streets policies ensure all residents have safe, convenient ways of getting around and staying active, regardless of their age or ability. These include policies dealing with street lighting, bike lanes, crosswalks, and public transportation. Seattle and Minneapolis are two cities that were able to quickly stand up these initiatives because they already had robust and comprehensive Complete Street policies prior to the pandemic.

In general, cities that had better resources, some political will, and that already had these policies in place, were better positioned to withstand some of the blows that Covid dealt.

What are some examples of cities that are intentionally using policy to reduce inequities exacerbated by the pandemic?

One really good example is Multnomah County, Oregon, which encompasses the city of Portland. They recently adopted a universal pre-K program. When you think about inequities this past year in education – virtual learning and learning losses – it’s usually around the digital divide. You very quickly realize the importance of a pre-K policy when you consider the impact on young people and parents trying to work from home while also educating their children.

Another example is Louisville, Kentucky, who just adopted a Legal Assistance for At-Risk Renters policy. On average, 90% of landlords have representation when they go to landlord or tenant court, compared to only 10% of renters. Louisville not only passed this policy, but they invested about $400,000 to stand it up.

How do city policies fit into the larger scheme of changing state and federal policy to build a healthier and more resilient nation?

City policies are often the catalyst for state and federal policy change. The more local jurisdictions tackle issues, the more momentum there is statewide. And that just escalates up to the national level.

We have a great example of that with Tobacco 21, which is a policy that increases the smoking age from 18 to 21. In 2018, the city of San Antonio adopted a very strong Tobacco 21 policy. Everyone thought their City Hall was crazy. But San Antonio was the first city in Texas to adopt this policy. And the very next year, in 2019, the state legislature passed it. Then at the end of 2019, it passed federally.

If you can pass policies at the local level, it demonstrates feasibility. It helps increase awareness and creates the momentum to accelerate policy change at higher levels.

What does a healthy, sustainable, and resilient city look like to you?

I think healthy, sustainable, resilient cities are nimble. They are adaptive. And they are empathetic. They are places committed to continuous improvement and are intentional about building community power and removing institutional barriers.

They are also places where everyone – regardless of who they are, where they come from, how they identify, the color of their skin – is afforded the fair and just opportunity to live their best, highest, healthiest possible lives in body, mind, and community.

These are places where people aren’t just living day-to-day, but they are thriving.

Katrina Forrest will be a part of the Boston University School of Public Health virtual Public Health Conversation Coming Back Better: Building Healthy, Sustainable, and Resilient Cities post-Covid-19 on Thursday, July 1, 2021 at 4:30 p.m. Register here to participate.

Photo courtesy of Katrina Forrest