We have a multi-round research process. NIRH staff conduct the first round of research independently by reviewing municipal websites, including from the city and county government, local and state departments of health, departments of education and school districts, and other relevant government agencies and commissions, as well as publicly available information from local community-based organizations and local media. Next, we conduct phone and email interviews with people and organizations in the community. Interviewees represent organizations in our partnership network, other community-based organizations, departments of health, school districts, and city and county officials in each of the cities. Then, we share our initial draft of the scorecard with local advocates and the heads of city or county departments of health for review. Final City Scores are based on the sum of this work. 

These indicators and the policies and principles of the Model City are based on NIRH’s expertise and values developed over more than a decade of local advocacy, as well as feedback from our partner organizations and the work of allied social justice movements. For indicators we did not have direct expertise in, we reached out to national and state-level experts for advice starting with the first edition of the report in 2017. These experts include A Better Balance, Advocates for Youth, All* Above All, Bold Futures, CityMatCH, FairVote, Fight for $15, National Latina Institute for Reproductive Justice, RepresentWomen, Sex Workers Outreach Project (SWOP) USA, and Sex Workers Outreach Project (SWOP) Behind Bars. The indicators have been refined over the years as we learned from our research and received feedback from partner organizations and local advocates. 

NIRH considers several factors when determining the value of an indicator. Several indicators that protect abortion access are rated as 2 points because these policies remain rare at the local level compared to other indicators we review. We also consider the difficulty of passing a given policy and the policy’s impact on reproductive freedom.  

We added the indicator “Initiative to address pregnancy-related mortality” this year to reflect the importance of localities in addressing the ever-growing crisis of pregnancy-related mortality. Since 2017, NIRH has tracked pregnancy-related mortality data, but these data are challenging to collect at the local level and are rarely disaggregated by race, masking stark race-based disparities.

Our research process defaults to city policy, so we first check if the city has any policies or programs in place that meet our metrics. If so, the indicator is scored based on these findings. If we can’t find data at the city level, we then research county-level policies and score the indicators based on our findings. City-level policies are marked on the scorecard as a square, while county-level policies are marked as a circle.

If an indicator is preempted by state policy, we remove the points for that indicator from the denominator and do not give any points in the numerator, so preempted indicators do not impact the final score. NIRH considers a policy to be preempted if a state bans a municipality from acting on that issue, such as restricting cities from setting their own minimum wage, or if a state passes a policy comprehensive enough that it does not require a city to take further action, such as a statewide comprehensive sexuality education mandate.

We have tools for you! You can use our Self-Scoring Tool to do your own research on your city’s indicators and create a Scorecard. You can also use the Model City and Roadmap as a framework to build a policy agenda for your city.  

Send us an email at partnerships@nirhealth.org, and we’ll add you to our outreach database for the next report! 

We know we aren’t perfect – conducting original research on 50 cities and counties is hard. We welcome the opportunity to review our research with you and, if necessary, to correct our findings. If you think there might be a mistake, please email partnerships@nirhealth.org with the subject line “Proposed Correction for [CITY].”