San Antonio and Dallas are two national examples of local governments enacting public health policies that improve overall well being for their residents. That’s the opinion of CityHealth, a non-profit that evaluates local health priorities of the country’s largest cities.

For the last three years CityHealth has tracked attempts to improve public health in the 40 most populous cities in the country. President Shelley Hearne said they track nine different policies.

“Are they able to access high quality nutritious food? If someone is sick, can they stay home from work or take care of kids who are sick? Are you being protected – if you’re a young kid – from the dangers of tobacco?” she explained.

CityHealth awards medals ranging from bronze to gold. San Antonio and Dallas are two of eight cities nationwide wide to earn gold. They joined Boston, Chicago, LA, New York, San Francisco and Seattle.

Both Dallas and San Antonio ranked high on recently enacted paid sick leave policies, pre-K programs, smoke free-indoor air and complete streets. Over the last five years, San Antonio has emphasized several of these areas.

“These are areas that we as municipal government can change and can impact,” said Kathy Shields, San Antonio MetroHealth’s interim assistant director for Community Health. “These are areas that health departments across the country and cities across the country should be tackling if they want to see improved health.”

Each of Texas’ major cities were ranked. Austin, Houston, and Fort Worth all received Bronze medals for their overall health policies. El Paso received no medal.

Each ranked city in Texas received a gold medal for Tobacco 21 initiatives because the state signed into law its own policy barring people under 21 from buying tobacco products.

San Antonio was one of the first cities in Texas to pass Tobacco 21 on its own before state legislation. That gave Shields the hope it will have an impact at the national level on the other metrics measured.

“If the 40 largest cities across the country can move in this direction, then it becomes an opportunity for larger change at the federal to move cities in this direction,” she said.

While San Antonio and Dallas both received overall gold medals, CityHealth says there are areas for San Antonio and Dallas that need improvement. For example, Dallas received no medal in healthy food procurement.

Dr. Philip Huang, the director of Dallas County Health and Human Services, said there’s been a push to identify accessibility to healthy food.

“Food deserts are certainly a priority that we've identified, community partners have identified, Parkland (Hospital) has identified that we're going to be working on,” he said.

Part of that is equity.

“The other thing with healthy food access -- and this gets into some of the basic determinants, the basic needs that we need to address in the long term to address some of these disparities. South Dallas, Southeast Dallas need to have the same access to healthy foods that other parts of the community have," Huang explained.

San Antonio is in the first year of its affordable housing plan and received no medal for that category. San Antonio Mayor Ron Nirenberg initiated a housing policy that the city council adopted earlier this year.

“I will say that San Antonio’s affordable housing strategy ... is now being modeled in other areas around the country for just how forward looking it is,’ Nirenberg said. “We still have a lot of work to do but I’m happy to say we’re working proactively to prevent it from becoming a crisis like it is in other cities.”

Cities that receive gold in five or more rankings receive an overall gold status.

Miguel Perez at KERA in Dallas contributed to this report.

Joey Palacios can be reached at Joey@TPR.org and on Twitter at @Joeycules.