Big Cities Health Coalition – protecting your constituents’ health

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We are a forum for the leaders of America’s largest metropolitan health departments to exchange strategies and jointly address issues to promote and protect the health and safety of their residents.

Collectively, BCHC’s 35 member jurisdictions directly impact more than 61 million people, or one in five Americans.

Our members work on the front lines to address critical and chronic public health challenges, from infectious disease outbreaks to opioid overdose to natural disasters.

Our work directly benefits the health and well-being not just of city residents but everyone in the United States – because public health challenges – whether new outbreaks or new illicit drugs – typically start in cities but do not stay there. They spread to rural and suburban communities as well. When big city health departments can respond to these threats quickly and with all the best tools, everyone benefits.

Our core policy issues

Pandemic preparedness

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Pandemic preparedness: In the 118th Congress, the Pandemic and All-Hazards Preparedness Act (PAHPA) must be reauthorized for to maintain key legal authorities to bolster our nation’s preparedness for public health emergencies. It is also critically important to fund programs authorized under PAHPA at the highest levels possible and to directly resource large urban health departments to shore up their infrastructure and workforce. Many of these departments must respond to emergencies at the scope and scale of state agencies, all too often with insufficient resources.

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Infrastructure and capacity

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Public health infrastructure and capacity: Public health funding has been largely tied to specific diseases or conditions, with little investment in cross-cutting capabilities that are critical for effective public health. Health departments need funding that is not limited to a specific disease so they can respond rapidly to emergent threats.

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Injury and violence prevention

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Injury and violence prevention: Increase resources to CDC to support innovative violence and injury prevention practice and data collection at all levels of government. Authorize local programs to address the violence epidemic, promote common-sense gun laws to protect communities, and continue to invest in and expand systems to track local data on violence and injury.

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Substance use disorder

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Substance use disorder: Federal funding must emphasize primary prevention, not just respond to current overdose crises. Dollars must get local. Local and state health experts should be free to try promising, innovative harm reduction strategies without the threat of federal prosecution.

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Our FY24 appropriations priorities for CDC

Most federal funding goes to states before being distributed to cities. This is not always the most efficient approach, particularly during an emergency.

Recently, more federal dollars have started to reach large cities and counties directly, through Congressional directive and a better understanding of the importance of strong local public health. We encourage this trend to continue to the greatest extent possible.

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