Luangrath and Wen Respond

We thank Purtle for his response to our editorial, “The Role of US Mayors and Health Commissioners in Combating Health Disparities.”

We agree that there is still “room for improvement to educate city policymakers about the connections between socioeconomic factors and health,” and commend Purtle for advancing an important conversation. However, we place less weight on party identification and partisan media coverage to determine whether and to what degree policymakers connect the social determinants of health and government policy.

First, we should be wary of overemphasizing political polarization and party identification on local policymakers’ decisions and their views on health disparities. Political science literature is far from conclusive about the role partisanship plays in decisions about funding for programs on the municipal level. For example, Gerber and Hopkins found that the effect of party identification on local policymakers’ decisions is negligible in areas where federal and state actors exert more authority.¹ They argue that although party identification is not meaningless on the city level, we should be careful about applying the same models and assumptions governing national politics to local politics, given unique institutional, funding, and legal constraints facing local policymakers.¹

Second, crafting communications strategies for policymakers is insufficient to compel government actions that promote health equity. Making the case for “health in all things”² can certainly involve framing the connections among housing, employment, and public safety in ways that resonate with city policymakers’ individual political ideologies. But we ask Purtle if that means, for example, merely framing health interventions to a conservative mayor as a long-term economic investment (i.e., a healthier population is a healthier workforce). Or might all local elected officials, regardless of party identification, embrace proposals that would improve schools, reduce crime, and promote jobs—and make the connection back to health?

Limiting ourselves to developing communications strategies that fit within an assumed paradigm for a given policymaker prevents us from engaging in a more radical reimagining of the role of government in society and rethinking the relationship between government and civil society in advancing health equity. The original study by Purtle et al. noted that “increasing knowledge about the existence and avoidability of disparities might improve understandings of policy impact.”^3(p640) This work requires connecting city policies—and the ways they shape wealth and power distribution—to social determinants of health. Thus, it is incumbent upon health commissioners to convene other leaders in government, academia, and civil society to clearly draw the connection between health and other priorities for elected officials.

We commend Purtle et al. for advancing efforts to educate city policymakers about the social determinants of health. Their study’s goal of informing communications strategies to cultivate political will to promote health equity is important, but we urge the authors to think broader and to go beyond appealing to “liberal” or “conservative” binaries, instead considering the diverse array of policy options that actually affect residents’ lives on the city level.