Increasing partisanship in the United States was evident even before the COVID-19 pandemic disrupted public life in 2020.1 As state and national politicians moved toward partisan extremes, Americans struggled to find common ground on basic issues.2 Agreement on facts and trust of science has declined, partly as a result of increasing amounts of misinformation and disinformation described by the World Health Organization secretary general as an “infodemic.”3–5
The COVID-19 pandemic exacerbated these trends, making health a partisan issue and eroding confidence in public health.6 By October 2021, partisanship was the single strongest predictor of COVID-19 vaccination status, surpassing age, geography, education, insurance, and race.7 This division prolonged the pandemic and led to real health consequences.8 Other health issues are now being challenged. Legislation has been introduced or passed in 15 states to weaken public health authority, hindering its ability to carry out its basic functions.9 According to surveys of local health departments conducted in late 2020 and early 2021, 57% of respondents reported at least one type of harassment of their local health officials.10 It is imperative to find ways to bring people together and reclaim public health as a nonpartisan value.
In stark contrast to these partisan trends, the Move with the Mayor® (MWTM) initiative shows that local elected officials can depoliticize population health, build consensus, and unite stakeholders from the public, private, and civic sectors to advance shared public health goals.
INITIATION OF MOVE WITH THE MAYOR
The National Forum for Heart Disease and Stroke Prevention (hereafter National Forum) launched the MWTM initiative in 2014 with a walking event in Indianapolis, Indiana, led by then-mayor Greg Ballard and first lady Winnie Ballard. They engaged local employers, the city’s largest university, multiple local government departments, the city’s NFL and NBA teams, and the media to promote the following message: improving health starts with a single step.
After this successful pilot, the National Forum, a nonprofit cofounded by the Centers for Disease Control and Prevention, the American Heart Association, and the Association of State and Territorial Health Officials, expanded MWTM into a national initiative. Over 10 years, 205 mayors from 39 states have participated in MWTM, including 71 Democrats, 27 Republicans, 10 independents, 48 nonpartisan mayors, and 49 mayors with undisclosed parties (it is common in some states for mayors not to disclose their political affiliations). Participating mayors represent diverse communities across all regions of the country, from small, rural farming communities to medium and large suburbs and large cities.
EVOLUTION OF MOVE WITH THE MAYOR
Since beginning as a platform promoting physical activity, MWTM has steadily evolved in scope. In 2024, the initiative empowered mayors to implement evidence-based programs, policies, and infrastructure changes addressing multiple social determinants of health associated with heart disease and stroke risk. Key components of MWTM are described subsequently.
The National Forum provides mayors with messaging resources such as social media posts, graphics, public service announcement scripts, press releases, and proclamations. These resources are e-mailed regularly to mayors and their staff. Social media materials are based on health communication best practices and are reviewed by health scientists and trusted partners at national public health organizations. Messages draw on research and field testing conducted by the Ad Council, Luntz International, the DeBeaumont Foundation, and other organizations.
Mayors are encouraged to complete self-assessment tools developed by the National Forum. These tools help cities identify their strengths and opportunities to equitably improve population health. The National Forum provides evidence-based policy, program, and infrastructure change recommendations to mayors who complete the self-assessment through tailored reports, policy menus, and one-on-one meetings. The National Forum holds virtual briefings to highlight evidence-based policy and program recommendations and assigns mayors dedicated community engagement coordinators who serve as their points of contact throughout their involvement. The coordinators provide resources and develop rapport with mayors and their staff. The National Forum hosts regular webinars for mayors providing opportunities for them to learn from subject matter experts and one another. Mayors who are in geographic proximity have hosted joint events and encouraged neighboring mayors to participate.
These program components are part of MWTM campaigns and challenges that address a variety of risk factors for heart disease and stroke, including vaccination, which has been seen as politically divisive. The National Forum determines MWTM campaign topics on the basis of mayoral input, population health priorities, and timeliness (e.g., flu season).
The MWTM Flu Vaccination Campaign has been ongoing since 2021. Overall, 43 mayors have participated: 18 Democrats, nine Republicans, five independents, two nonpartisans, and nine with unknown affiliations. The MWTM Adult Vaccination Campaign ran from 2021 to 2023 with the goal of encouraging COVID-19 and routine vaccinations (e.g., flu, shingles, pneumonia, and tetanus); 88 mayors participated (44 Democrats, nine Republicans, six independents, 18 nonpartisans, and 11 with unknown affiliations). Nearly half (40) of the participating mayors came from states that voted for the Republican presidential nominee in the 2020 election, and 40% were from rural areas. Messages created from this campaign generated more than 134 million social media impressions and reached more than 9 million individuals on Facebook and Instagram.
The first MWTM Mental Health Challenge was held in 2024 in response to strong mayoral interest. Mayors hosted events to bring their communities together while engaging in physical activity. Final participation numbers are still pending. MWTM Physical Activity Challenges continue each year.
The National Forum is assiduously nonpartisan and grounds all MWTM communications in sound science. Messages are free from political bias. All recommendations are evidence based, drawn from respected sources such as the Community Guide11 and the County Health Rankings.12 The National Forum does not exclude mayors from participation on the basis of political beliefs; mayors are free to participate in MWTM how they choose and can opt to share messages they think will most resonate with their constituents. Through these actions, mayors have come to trust MWTM and understand its nonpartisan nature.
Several large nonpartisan mayoral organizations have endorsed the MWTM initiative, such as the US Conference of Mayors and the African American Mayors Association. The US Conference of Mayors, which represents 1400 mayors from across the political spectrum, has unanimously passed resolutions over the past 5 years urging mayors “to engage members of their community to be more physically active to improve mental and physical health and strengthen individual and community resilience using programs such as Move with the Mayor®.”13
IMPLEMENTATION CHALLENGES
Recruiting mayors is time intensive. It requires rapport building and consistent engagement with mayors and their teams. Face-to-face interaction (at mayoral conferences) is helpful and requires further resources. Mayoral staff turnover adds to recruitment and retention challenges. To mitigate transitions, all communication with cities is tracked through customer relationship management software. Most social media engagements have been positive. However, trolls and negative comments have posed challenges. The National Forum addresses these challenges by moderating comments, linking to trusted resources, and turning off comments when necessary. Some mayors have struggled with low attendance at events or low engagement. Connecting with other mayors to brainstorm solutions or host joint events has often proven helpful.
OUTCOMES AND IMPACT
Evaluation surveys of participating mayors regularly show strong satisfaction with the MWTM program. In 2023, 83% of survey respondents found the resources provided through weekly e-mail updates very or extremely helpful. Similarly, 83% of respondents found ad hoc communication with their community engagement coordinators very or extremely helpful.
When asked about the best part of participating in MWTM, mayors frequently comment on the opportunities it creates, through events, to engage with their community. Mayors are eager to empower their constituents to make healthy choices.
[MWTM] is a great opportunity to get out and about with our neighbors here in this city, get moving: do our part around wellness, reducing our risk for cardiovascular disease, a great chance to talk with our neighbors about what’s going on in their lives, a great way to reduce stress, improve our mental and emotional well-being.
—Mayor Andrew Ginther, Columbus, Ohio
The National Forum has seen numerous policy changes directly tied to MWTM recommendations. Analyzing data from an MWTM self-assessment tool, the National Forum estimates that responding cities (22 in 2023) were implementing an average of nine evidence-based recommendations from the Community Guide.11 Systematic reviews have shown that these recommendations increase the amount of time people are physically active, reduce body mass index, and increase fruit and vegetable intake, among other benefits.11
In Columbia, South Carolina; Edinburg, Texas; and Green Bay, Wisconsin, decisions to build more sidewalks and trails have come about with MWTM participation. Mayor Ruben Pineda in West Chicago, Illinois, added water fountains in schools and parks to reduce sugary beverage consumption, a recommendation from an MWTM self-assessment report. Participating cities have taken steps toward increasing partnerships for health. Mayor Rod Craig of Hanover Park, Illinois, added a social worker to the police force as a means of allowing police officers to refer directly to health and social services. Mayor Will Hill of Louisville, Mississippi, worked closely with the business community to make improvements to playing fields, playgrounds, splash pads, and a multipurpose building, leading to significant economic development in addition to health benefits.
BUILDING COMMON GROUND WITH MOVE WITH THE MAYOR
Participating mayors represent all political parties; rural, urban, and suburban communities; and a range of races and ethnicities, ages, educational levels, and previous professional experiences. MWTM offers diverse communities the opportunity to come together and learn from one another.
Understanding mayors’ motivations is a crucial component of building common ground with MWTM. Many mayors have joined the initiative because it resonates with their personal experiences and values. Mayor Steven Sherlin (Athens, Tennessee) is a stroke survivor. Mayor Rachel Proctor (DeSoto, Texas) lost her father to a stroke. Mayors Keith Sydnor (Laurel, Maryland) and Derrick Wood (Dumfries, Virginia) have been engaged in the military and athletics throughout their lives. Investing time in personal relationships—through dedicated community engagement coordinators—to understand these unique motivations has been crucial to the MWTM initiative. Starting from a shared motivation begins the conversation and provides a bridge to other topic areas in which a common understanding does not exist.
Through MWTM, the National Forum found that mayors understand that a healthy community underlies a socially and economically thriving community. Political differences can be overcome if this is recognized as a motivating factor. With MWTM, the National Forum has worked with cities through mayoral administration changes and as they change political parties (including from Democrat to Republican), and support for MWTM activities continues. As shared by one mayor:
If there’s anything that we can rally around, it is the health of our communities. It’s not a Republican issue, not a Democratic issue, or an Independent issue. Working towards health helps improve our entire community.
—Mayor Quentin M. Hart, Waterloo, Iowa
Mayors are experts in getting things done. More so than state or federal leaders, residents see their mayor’s impact on their lives. Because of this, mayors are pragmatists. When mayors are presented with evidence-based policies, programs, and infrastructure improvements, they listen and act. Mayors who have repeatedly completed an MWTM self-assessment tool—which incorporates evidence-based policies, programs, and infrastructure improvements—have used it to find more opportunities to promote health.
Completing the [self-assessment] has been a great way for city departments and partners to review our accomplishments over the year and see what we are doing well and see what we can improve. Each additional year we complete the [self-assessment] is a chance to see how far we have progressed.
—Mayor Kim Norton, Rochester, Minnesota
HOW MAYORS BUILD COMMON GROUND FOR HEALTH
Mayors are uniquely positioned to be trusted advisors, building common ground in their own communities. In addition, they are skilled at tailoring messages to their communities. To be effective, mayors must have an up-to-date reading of their community’s pulse. They must understand how to communicate with residents to serve all segments of the community. Mayors have adeptly changed the framing and wording of MWTM public health messages to resonate with their communities. They have translated materials into other languages to reach specific segments of their population.
MWTM media campaigns featuring mayors have routinely exceeded social media audience engagement benchmarks, demonstrating the value of these tailored campaigns highlighting local champions. When mayors lead by example and are provided tools to do so, people pay attention and norms shift. As Mayor Lori Bagwell (Carson City, Nevada) shared:
I was super hesitant to do a video on getting your vaccines. But I went ahead and did it and yesterday, I was going through a drive-through at Starbucks and the young man that handed me my drinks said, “You’re our mayor and I went and got my flu shot because you told me to.” It showed you how a simple statement or a simple thing that you do can have impact.
Mayors have convening power, a crucial tool for creating common ground in the name of health. They can rapidly bring together public, private, and nonprofit stakeholders to discuss, plan, and act on shared objectives. Mayors Sharon Weston Broome (Baton Rouge, Louisiana), Ruben Pineda (West Chicago, Illinois), and Jim Ross (Arlington, Virginia) established multisector wellness councils linking businesses and health. Within these councils, mayors use MWTM resources to inform their programming.
In conservative Findlay, Ohio, Republican Mayor Christina Muryn (one of the authors) collaborates closely with community leaders, local media, hospitals, and the county health department. Through this collaboration, they have successfully generated community support for science-based approaches to population health. The mayor has framed public health messages to help residents recognize that the information aligns with their values and concerns. Mayor Muryn shares personal stories and concerns and directly addresses misinformation that is being circulated locally. Similarly, she has advanced programs for underserved members of the community.
Furthermore, mayors either directly oversee or indirectly influence many of the public sectors that affect the social determinants of health, including schools, parks and recreation, and transportation, among others.14 In Allentown, Pennsylvania, Mayor Matt Tuerk prioritized health by making the health director a member of his cabinet, literally seating public health at the table when policy and resource decisions are made. His efforts culminated in Allentown’s first city-specific community health assessment, which identified residents’ priorities, engaged new stakeholders in the health planning process, and will be used to guide decisions across government going forward. As he described:
All of the decisions we make as city leaders are public health decisions. The way we support our police and fire departments has an impact on public health. The investments we make in our streets or streetscapes are public health decisions.
CONCLUSION
MWTM has shown that there is a large cohort of mayors who are motivated and willing to be advocates for health in their communities. The approach has been successful in engaging mayors in physical activity and more divisive issues such as COVID-19 vaccinations; it could readily be applied to a wide array of public health topics, even those that may be viewed as divisive. Mayors can play valuable roles in long-term, nonpartisan strategies to build community support for public health. They have powerful potential to bridge diverse stakeholders, serve as trusted messengers, and ultimately champion public health at the local level.
ACKNOWLEDGMENTS
Funding for the Move with the Mayor initiative has been provided by the Centers for Disease Control and Prevention in partnership with the American Public Health Association, the National Association of Chronic Disease Directors, and the National Association of County and City Health Officials.
We acknowledge the mayors from across the country and their staff who have dedicated themselves to promoting health in all that they do. We also thank the many team members who have worked on the program and contributed to its numerous successes. Finally, we thank the funders that have made this work possible.
CONFLICTS OF INTEREST
The authors have no potential conflicts of interest to declare.
REFERENCES
- 1.Pew Research Center. Political polarization in the American public. Available at: https://www.pewresearch.org/politics/2014/06/12/political-polarization-in-the-american-public. Accessed May 22, 2024.
- 2.US Department of Health and Human Services. Confronting health misinformation: the U.S. surgeon general’s advisory on building a healthy information environment. Available at: https://www.hhs.gov/sites/default/files/surgeon-general-misinformation-advisory.pdf. Accessed May 22, 2024. [PubMed]
- 3.Kennedy B, Tyson A, Funk C. Americans’ trust in scientists, other groups declines. Available at: https://www.pewresearch.org/science/2022/02/15/americans-trust-in-scientists-other-groups-declines. Accessed May 22, 2024.
- 4.Lupia A, Allison DB, Jamieson KH, Heimberg J, Skipper M, Wolf SM. Trends in U.S. public confidence in science and opportunities for progress. Proc Natl Acad Sci U S A. 2024;121(11):e2319488121. 10.1073/pnas.2319488121 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.World Health Organization. Managing the COVID-19 infodemic: promoting healthy behaviours and mitigating the harm from misinformation and disinformation. Available at: https://www.who.int/news/item/23-09-2020-managing-the-covid-19-infodemic-promoting-healthy-behaviours-and-mitigating-the-harm-from-misinformation-and-disinformation. Accessed May 22, 2024.
- 6.Kirzinger A, Presiado M, Valdes I, Hamel L, Brodie M. The COVID-19 pandemic: insights from three years of KFF polling. Available at: https://www.kff.org/coronavirus-covid-19/poll-finding/the-covid-19-pandemic-insights-from-three-years-of-kff-polling. Accessed May 31, 2024.
- 7.Kirzinger A, Kearney A, Hamel L, Brodie M. COVID-19 vaccine monitor: the increasing importance of partisanship in predicting COVID-19 vaccination status. Available at: https://www.kff.org/coronavirus-covid-19/poll-finding/importance-of-partisanship-predicting-vaccination-status. Accessed May 22, 2024.
- 8.Shah A, Seervia S, Schneider E. How can the U.S. catch up with other countries on COVID-19 vaccination? Available at: https://www.commonwealthfund.org/blog/2021/how-can-us-catch-other-countries-covid-19-vaccination. Accessed May 22, 2024.
- 9.Network for Public Health Law. Proposed limits on public health authority dangerous for public health. Available at: https://www.networkforphl.org/wp-content/uploads/2021/06/Proposed-Limits-on-Public-Health-Authority-Dangerous-for-Public-Health-FINAL.pdf. Accessed May 22, 2024.
- 10.Ward JA, Stone EM, Mui P, Resnick B. Pandemic-related workplace violence and its impact on public health officials, March 2020–January 2021. Am J Public Health. 2022;112(5):736–746. 10.2105/AJPH.2021.306649 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Centers for Disease Control and Prevention. Community Guide home page. Available at: https://www.thecommunityguide.org/index.html. Accessed May 31, 2024.
- 12.University of Wisconsin Population Health Institute. County health rankings and roadmaps. Available at: https://www.countyhealthrankings.org. Accessed May 31, 2024.
- 13. United States Conference of Mayors. Resolutions. Available at: https://www.usmayors.org/the-conference/resolutions/?category=a0F4N00000S4uUZUAZ&meeting=91st%20Annual%20Meeting . Accessed May 31 , 2024. .
- 14.Godinez Puig L, Lusk K, Glick D, Einstein K, Palmer M, Fox S, Wang ML. Perceptions of public health priorities and accountability among US mayors. Public Health Rep. 2021;136(2):161–171. 10.1177/0033354920966050 [DOI] [PMC free article] [PubMed] [Google Scholar]