Health has many facets, but there's only so much individuals can do. Much depends on their surrounding environment, and San Antonians are in good hands, according to CityHealth, an initiative of the public health-focused de Beaumont Foundation and nonprofit healthcare provider Kaiser Permanente. In early December, it awarded the Alamo City a gold medal for its public health policies.

Only seven cities received gold medals in CityHealth's 2024 assessment, which compared 75 major US cities across 12 policy metrics that impact public health on a large scale: things like protected access to healthy food, green spaces, and fair housing.

A gold medal overall means the city received five or more gold medals within the specific categories. San Antonio was the only Texas city to receive an overall gold medal.

Each city has an interactive list that's easy to browse, because it breaks down each medal earned into an itemized list of policy choices. Copper means it fills some of the criteria, followed by silver and gold as the policies become more advanced. San Antonio earned individual gold medals in the following categories:

• Affordable Housing Trusts: The city has a trust fund for maintaining and expanding affordable housing.
• Complete Streets: People can safely move around the city as pedestrians, bikers, drivers, and more.
• Greenspace: Families from different socioeconomic backgrounds can all access parks.
• Healthy Food Purchasing: The city has nutrition-based food procurement standards for venues on its property, or by city agencies or contractors.
• High-Quality, Accessible Pre-K: Pre-K quality meets benchmarks by the National Institute for Early Education Research.
• Smoke Free Indoor Air: Smoking or vaping is banned in certain public venues.

The assessment points out that CityHealth has been working with San Antonio since 2020 on implementing its Complete Streets ordinance. "The city updated the ordinance this year after a long process of soliciting community input, consulting with experts, and strengthening the policy to ensure the ordinance was equitable and sustainable — earning the city an individual gold policy medal," it says. Local respondents' top concern according to the city website was adding bike lanes.

San Antonio earned one bronze medal for Eco-Friendly Purchasing, because the city requires annual reporting on its policy to purchase non-toxic products. However, the policy did not meet the report's higher standards.

That leaves five categories in which San Antonio did not win any medals, meaning it either did not have policies in place or the policies it did have not meet the report's base criteria. San Antonio lacked the following:

• Earned Sick Leave: The city has a law mandating that employees can accrue paid time off for medical situations impacting themselves or family members.
• Flavored Tobacco Restrictions: The city has bans in place on flavored tobacco products.
• Healthy Rental Housing: Rental properties of a certain size must undergo periodic inspections for detecting things like bad plumbing or mold.
• Legal Support for Renters: Renters are able to access legal protections even if they can't afford to hire representation directly.
• Safer Alcohol Sales: The city has alcohol sales laws and can close retailers that do not comply.

Elsewhere in Texas, Fort Worth, Dallas, and Houston all received overall bronze medals. Austin did not receive any overall medal, although it did receive a few individual medals including gold in Greenspace.

This is the second year in a row San Antonio has earned an overall gold medal. In 2022, only two cities received overall gold medals, and San Antonio received bronze. Before then, San Antonio had received gold more than once before.

Other overall gold cities across the country were Boston, Massachusetts; Denver, Colorado; Minneapolis, Minnesota; New Orleans, Louisiana; Portland, Oregon; and St. Louis, Missouri.