Mayors and Health Commissioners on Their City’s Health


A city map printed on a stack of small individual blocks

Public opinion research is a tool for policy advocacy to reduce health disparities. Public opinion research sheds light on what the public knows and thinks about health disparities (e.g., whether they think that disparities exist, what groups they think disparities affect, what they think the causes of disparities are ). These findings can inform the design of communication interventions that engage, persuade, and compel people to advocate for policy change.

Numerous public opinion studies have found disappointingly low levels of knowledge about the existence and causes of health disparities among the US general public. No studies, however, have documented opinions about health disparities among the policymakers who make decisions that can ameliorate or exacerbate disparities.

We wanted to know: what do US city mayors and health commissioners think and know about health disparities in their cities?

To find out, we surveyed 535 mayors, health commissioners, and their senior staff in late 2016. To understand opinions about health disparities, the survey asked questions about differences in health between “socially advantaged and socially disadvantaged groups.” Socially disadvantaged groups were defined in the survey as groups “that, on average, have less wealth, power, and prestige in a society. Examples of groups that have historically been socially disadvantaged in the United States include racial and ethnic minorities, people with low incomes, and people with low levels of education.”

Here’s what the survey found.

The Good News

First, almost all mayor (95%) and health commissioner (97%) respondents “agreed” or “strongly agreed” that health disparities exist in their city. Although only 42% of mayor respondents and 61% of health commissioner respondents “strongly agreed” (the correct answer), the survey indicates that mayors, health commissioners, and their senior staff generally understand that health disparities exist.

Second, both mayors and health commissioners appear to be more aware of the impact of socioeconomic factors (e.g., income, education) on health than the general public, as opposed to individual-level factors (e.g., knowledge about how to live a healthy life, genetics). Income was the number one factor that both mayor (68%) and health commissioner (83%) respondents implicated as having a “very strong effect” on health disparities. Genetics was identified least frequently among both types of city policymakers (28% and 19%, respectively).

The Bad News

Nearly one-third of mayor respondents and 10% of health commissioner respondents thought that city policies have “little” or “no impact” on health disparities. Although city governments have less policy authority than state governments, evidence certainly suggests that city policies impact health disparities—for better or worse.

Most Surprising

Mayor and health commissioner respondents who were ideologically conservative were substantially less likely than liberal and moderate respondents to “strongly agree” that health disparities existed in their cities. They were also less likely to believe that disparities were “very avoidable” and “very unfair” and less likely to think that city policies can have a “major impact” on disparities. Although similar associations between conservative ideology and opinions about disparities have been observed in surveys of the general public, we were surprised to find that the strength of these associations persisted among policymakers.

The Implications

Our findings highlight a need to communicate more effectively with city policymakers about how the policies they enact can impact health disparities. Specifically, we need to tailor communications for policymakers with conservative world views (e.g., emphasizing values of loyalty, authority, and sanctity) and disseminate these messages via sources that conservatives perceive as trustworthy.

Opinion research is by no means a be-all-end-all solution to cultivating policy change, but it is an important step towards data-driven approaches to advocacy for policies that reduce health disparities.

Feature image: ewg3D/iStock