Big Cities Health Inventory:

The Health of Urban USA

In 1994, the Chicago Department of Public Health (CDPH) assembled and prepared the first Big Cities Health Inventory (BCHI). Seven years after the first edition, the Inventory continues to be one of the few reports presenting city-level health data in the U.S. This current edition, also prepared by CDPH, represents a collaborative commitment to providing information for improving community health. With funding in part by the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA), the collaborative entities consisted of the National Association of County and City Health Officials (NACCHO) and local health department partners. In addition to the data presented in the report, this edition examines the need for and uses of city-level data to identify local health priorities, design interventions, evaluate performance, and further public health policy.

There are relatively few sources that provide health-related data specific to cities. Most reports only present data at the state-level and those that describe low level data are often at the county or metropolitan statistical area-level (MSA). The purpose of this report is to focus specifically on the health of large cities in the U.S. In so doing the report intends to increase knowledge of the issues large cities face and stimulate dialogue that will lead to a healthier city population.

The report presents a broad overview of the health of more than 40,000,000 people residing in the 47 largest cities in the United States. These cities accounted for nearly 25% of all births and deaths in the United States. Overall, the health outcomes of these cities are less favorable than that of smaller urban and rural areas and compare poorly to the national overall. For instance only one city, Honolulu, had a mortality rate lower than that of the U.S. overall, whereas most other cities had a rate higher than the U.S.

The data presented in this and other studies analyzing urban health suggest that there is a unique urban health profile influenced by the dynamics particular to large cities. This information provides a benchmark for establishing current health status and highlights priority areas for reducing health disparities in minority populations.

The report focuses on 20 indicators of health: five indicators of communicable diseases, nine causes of mortality, and six indicators of maternal and child health (See Table).