WASHINGTON, D.C.—Healthy communities don’t just happen. They are created by a multitude of social, economic, environmental, and behavioral factors. And local governments play a critical role in shaping a community’s public health, according to a new report released by ICMA, the International City/County Management Association.


Improving Quality of Life: The Effect of Aligning Local Service Delivery and Public Health Goals” advances the conversation about viewing and managing local government infrastructure, transportation systems, water and sanitation, land use and planning, and other services as part of broader efforts to contribute to a healthy environment and support healthy lifestyles. The report discusses how the services that general local governments provide place them in a leadership position in terms of public health responsibility. It also considers new opportunities for local government collaboration, public engagement and education, decision making, and governance.


“At a time when many jurisdictions are experiencing significant population change, uneven economic growth, and increases in demands on local services, it is important that community health considerations are woven into all local programs and policies to improve the quality of life of all residents,” said Joshua Franzel, Ph.D., ICMA and the Center for State and Local Government Excellence, who co-authored the report.

Local leaders increasingly are recognizing that healthy communities have established a culture that is supportive of healthy choices, and that to better shape community health in an increasingly complex environment, jurisdictions must implement innovative service delivery approaches, collaboration, and partnerships.


“Our efforts to improve public health are evolving, which will require greater collaboration, public engagement, and focus on prevention,” added report co-author Paula Sanford, Ph.D., University of Georgia, Carl Vinson Institute of Government. “Local governments can serve as the linchpin as we address new health crises like combatting chronic diseases.”

Through a review of existing research, a series of expert interviews, and analysis of global examples, “Improving Quality of Life” examines the management of more traditional assets and services (i.e., public safety, water and water treatment, and local sanitation) through a health-oriented lens, while also exploring new opportunities to improve resident health. Key report findings include


  • Public health is not a department but rather a community value.

  • Efforts to improve public health encompass myriad local services. In addition to those service areas with traditional public health roles—i.e., public safety, water, and sanitation—local governments increasingly realize that planning, infrastructure, parks and recreation, public transportation, and community development also greatly impact public health.

  • One of the leading public health challenges is combating global epidemics resulting from such unhealthy behaviors as physical inactivity and obesity, which often lead to chronic diseases. In 2014, for example, more than 39 percent of the global population were overweight, and of those, 600 million or 13 percent were obese, according to the World Health Organization.

  • Creating a healthy community can improve residents’ quality of life, save resources, and enhance economic and labor force development. Because healthy communities are desirable places to live, say Burden and Litman in America Needs Complete Streets, investments in sidewalks and walkability can increase land values by roughly 70 to 300 percent.

  • Despite bearing a relatively small portion of national health costs, cities, towns, and counties are in many respects the most influential level of government when it comes to improving public health because they create the environments in which people live, work, and play. Local governments and their leaders realize that building a healthy community must be a multifaceted and multidisciplinary endeavor that integrates public outreach and long-term policy changes.

  • Ensuring that public health considerations are woven into all aspects of planning, programs, and policy will enable local governments to best position their communities for the challenges and opportunities ahead. The day-to-day needs of managing a city or country can make it difficult to bring longer-term issues such as health promotion to the forefront of a governing body’s attention. More research on the correlation between active environments such as sidewalks and bike lanes is needed to fully address the complex decision making involved with lifestyle choices.

  • Addressing climate change as a public health concern. The effects of climate change, e.g., flooding as a result of sea level rise and the impact on coastal communities, will dramatically impact thousands of communities across the globe.

A downloadable copy of the report is available through the Local Government Knowledge Network, a partnership between ICMA, Arizona State University, and the Alliance for Innovation.

About ICMA

ICMA, the International City/County Management Association, advances professional local government worldwide. The organization’s mission is to create excellence in local governance by developing and fostering professional management to build sustainable communities that improve people’s lives. ICMA provides member support, publications, data and information, peer and results-oriented assistance, and training and professional development to 10,000 appointed city, town, and county leaders and other individuals and organizations throughout the world. The management decisions made by ICMA's members affect millions of individuals living in thousands of communities throughout the world, from small villages and towns to large metropolitan areas.

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