Mayors recognize that a strong federal, state, and local partnership is vital to ensuring that everyone has the services they deserve to live healthy and productive lives. Equitable access for all to affordable quality health care and comprehensive human services; robust and coordinated systems of care; easy access to public transit and open space; safe and affordable housing; access to healthy and nutritious foods; and walkable/bikeable neighborhoods shall be top priorities at this most critical moment for change in our Nation.

As cities continue to address the ongoing COVID-19 pandemic and prioritize equity, mayors reaffirm support for the fundamental principle that all persons must have an equitable opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential.  Yet, racial and ethnic health inequities, including discrimination, poverty, lack of quality education, access to good jobs with fair pay, health care, human services, nutritious foods, safe housing, clean environments, and many other longstanding socio-economic factors have continued to place too great a burden on significant portions of our Nation’s population.

The crucial choices we make now to address the social determinants of health and improve our health care infrastructure while helping us rebound from the devastating impact of COVID-19 will also help to unlock the full potential of our residents. As we continue to work on strategies to prevent, contain, and eventually eliminate the spread of the pandemic in our cities, we strongly urge the President and Congress to consider the following key priorities:

• Create a health in all policies approach, recognizing that all Departments have a role to play in ensuring everyone can live a long and healthy life, and ensuring a process whereby all federal legislation is evaluated with an equity lens to untap our Nation’s full potential.
• Ensure that any restriction of care decisions expressly prohibit and do not deny equal access to care for the poor, people of color, persons with disabilities, and persons with chronic conditions; and ensure that any criteria does not replicate either past or ongoing discrimination.
• Invest in Testing, Contact Tracing, and Supported Isolation for all,  with a focus on essential workers, uninsured and underinsured persons, communities of highest risk such as communities of color, homeless, the incarcerated, and the working poor – or others with limited healthcare access to suppress or mitigate highly infectious and dangerous diseases.
• Track and collect robust, disaggregated data by multiple demographic factors such as race, ethnicity, primary language, geographic location, socioeconomic status, gender identity, sexual orientation, age, occupation, and disability status to better respond and target resources for federal, state, and local governments to better address the coronavirus pandemic and implement programs that address health equity.
• Adopt “critical context” testing as an important element of testing policies; these critical contexts include health care settings, elder care facilities, correctional facilities, meatpacking plants and other assembly line-type conditions (e.g. retail warehouses), grocery stores, and military installations; and place high priority on minority communities experiencing the disparate impact of COVID-19, and higher infection fatality rates, when implementing testing regime.
• Support the Pandemic Response and Opportunity Through National Service Act (HR 6702/S. 3964) to expand partnerships between AmeriCorps and health and education agencies and provide prioritized funding for activities directly related to our response and recovery, such as public health services, emergency logistics, workforce and reemployment services, education support (including for adult learners), and services that combat nutrition insecurity.
• Require and incentivize the collection of patient and social and behavioral risk data through Medicare, Medicaid, and commercial insurance value-based payment programs, with appropriate privacy and anti-discrimination protections to improve data collection.
• Purchase and disburse personal protective equipment to those who contribute to patient care or other essential services (i.e., front-line workers), including by using the Defense Production Act.
• Build and invest in a diverse, culturally competent state and local health care workforce.
• Expand the availability of telehealth.
• Open a national special enrollment period for health coverage.
• Improve access to home and community-based services.
• Expand Medicaid in all States nationwide to fill the coverage gap for the uninsured, people of color, workers with low incomes or loss of jobs, and people living in places that were already struggling financially before the economic downturn to ensure access to care for the most vulnerable.
• Increase funding for community clinics and federally qualified health centers (FQHC).
• Provide direct cash assistance to US residents severely impacted by COVID-19.
• Increase food security programs as a cornerstone element of Congress’ next COVID-19 relief package or future appropriation legislation now and beyond so that no one is left hungry. This includes: 1) Increasing flexibility in the SNAP program and increasing the benefits per household; 2) Providing an increase in the Special Supplemental Nutrition Program for Women Infants and Children (WIC) benefits and loosening rules around eligible products; 3) Increasing funding for The Emergency Food Assistance Program (TEFAP) and Senior Nutrition Programs in the Older Americans Act; and 4) Additional funding to provide emergency financial relief to school meal providers and USDA’s Child and Adult Care Food Program.
• Invest in additional school nurses, who serve as a bridge between health care and
  education systems.
• Ensure minority communities are included in clinical trials for coronavirus vaccines and therapies to ensure safe, effective, and equitable treatments.

These priorities are not only critical now to prevent, control, and contain the spread of COVID-19; but will also have lasting effects as we forge a stronger and healthier future. We must also remain vigilant about strengthening access to comprehensive, quality health care and social services as this is a critical pathway for promoting and maintaining health, preventing and managing diseases, reducing unnecessary disability and premature death, and achieving health equity for all Americans. We owe our shared residents the choice and control they want, the affordability they need, and the access to care they deserve.

The Affordable Care Act (ACA) decreased the number of uninsured, expanded health care coverage, and ended barriers to treatment for millions of residents in our cities. Additionally, ACA reduced medical gaps in coverage to ensure that essential health services like emergency, rehabilitative, pediatric, maternal and newborn care, lab, prevention and wellness, and mental health and substance use disorder benefits are protected. These gains must never be lost;
and we continue to support efforts to build and strengthen the ACA. Thus, we must:

• Invest in prevention and wellness; improve patient safety, quality, and affordability of care; assure affordable, quality health coverage for all Americans; require comprehensive mental health and substance use disorder treatment options in all insurance policies; maintain coverage when someone changes or loses a job; and continue to reduce barriers to coverage for people with pre-existing medical conditions.
• Strengthen public health, health care, and social infrastructure to foster resilience; and reverse steady cuts to the public health workforce, research, laboratory, and data systems.
• Explore options to get additional funding directly to local government through reduced federal bureaucracy, changes in eligibility requirements of existing programs, and/or create dedicated funding for local governments to address mental health and substance use disorders in our communities.
• Protect families from bankruptcy or debt driven by health care costs.
• Invest in public health interventions to curb violence.
• Support incentives or pilot programs in federal programs for states and local governments that advance health and racial equity by engaging community members in policy development and implementation.
• Expand coverage for maternal health care, address disparities, and provide a minimum of six weeks of paid parental leave.
• Expand support for child-care and early childhood development.
• Invest in affordable, accessible high-speed internet to help expand access and quality of health care for all.
• Increase trauma-informed approaches in healthcare systems and schools to promote improved mental health.
• Ensure access to interpretation and other support services, so that limited English proficiency speakers and people with disabilities are able to better understand treatment options and can effectively communicate these choices with loved ones.
• Encourage partnerships with hospitals, health systems, and service providers, educators and school administrators, nonprofit organizations, and others to reduce stigma and foster inclusive cultures online and in our communities.
• Engage youth in the development of mental health resources and encourage the implementation of youth-led, community-wide solutions to improve mental health outcomes for youth.
• Support Universal Basic Income policies and funding to alleviate poverty, income inequality, and improve health.
• Combat the growing youth vaping epidemic by supporting federal, state, and local anti-tobacco initiatives.
• Evaluate pricing for prescription drugs based on their effectiveness and treatment outcomes; enact measures to prevent companies from using price gouging to increase profits; require drug advertisers to inform viewers of the cost of their medications and include clear enforcement mechanisms to protect the American consumer.

Lastly, obesity and diet-related chronic disease remain a growing epidemic. Yet, we know they are largely preventable. Healthy food and food insecurity have been established as important considerations for local governments as they are fundamentally linked to issues such as chronic health problems, economic inequity, environmental sustainability and economic development. Federal nutrition and emergency assistance programs offer a vital safety net, while other important public-private programs are increasing access to healthy foods, stimulating new economic activity, creating links between cities and rural communities, and ensuring environmental stewardship. Thus, mayors continue to call on the President and Congress to:

• Craft a comprehensive national food policy that provides nutritious food for the hungry, supports small farmers in urban and rural areas, promotes policies that allow for urban farming, and promotes access to healthy and affordable food for all residents in urban, suburban, and rural communities. This includes strengthening incentives and infrastructure for local food production and distribution as well as environmentally sustainable farming practices. It also includes providing better access to fresh foods, investment in programs providing healthy food, expansion of programs that help communities invest in retail markets or food-based businesses, increased access to farmers’ markets, and expansion of farm-to-cafeteria programs that bring the freshest locally-grown food into school lunch programs, hospitals, and other institutions.
• Reauthorize the Child Nutrition Act, WIC, and Older Americans Act, so that every American knows he or she will always be protected.
• Support and strengthen local and regional food system infrastructure to ensure access to healthy and affordable food.
• Support innovations in food production, processing, and distribution to ensure healthier, nutritious, and sustainable options to feed a growing global population.