Urban sustainability has become a burgeoning practical and scholarly enterprise over the last two decades. Yet, there have been few attempts to systematically assess what cumulative knowledge this research is generating. We advance our understanding of urban sustainability by synthesising extant empirical findings to gauge progress made towards developing theoretical insight, and then testing a nonparametric predictive model that helps overcome methodological challenges in this literature. Drawing data from two national surveys of US local governments, we find that although organisational capacity appears to be the most important predictor, the broad range of activities grouped under the banner of ‘urban sustainability’ rely on distinct causal mechanisms, and use of composite models and measures of sustainability may hinder theoretical advancement. Implications for future research are discussed.

Sustainable cities are assumed to be healthier, but the relationship between sustainability policies and health outcomes is conspicuously overlooked in the empirical literature. We investigate this association by examining how local greenhouse gas (GHG) abatement, energy, alternative transportation, and land use-building policy activities relate to the prevalence of respiratory and obesity-related illnesses in medium and large U.S. cities. Merging local sustainability survey data with city-level estimates of chronic disease factors, we find that after controlling for key socioeconomic and demographic predictors of health, sustainability activities explain very little variation in the prevalence of such illnesses. However, we find stronger evidence for sustainability activities relating to health in smaller cities in our sample, and for physical activity mediating the relationship between some sustainability activities and obesity rates. We find less evidence that our air quality measures play a mediating role. Implications, data limitations, and avenues for future research are discussed.

Although public managers and nongovernmental actors play important roles in promoting sustainable communities, little is known about how these actors collaborate with each other across sectors when it comes to sustainability innovation. This case study illustrates how a policy entrepreneur partnered with local government, businesses, and community organizations to implement an innovative neighborhood energy competition that achieved community-wide energy savings and greenhouse gas (GHG) reductions. The outcome of this case suggests that local communities can promote bottom-up sustainability innovation through cross-sector collaboration that combines grassroots efforts led by policy entrepreneurs and nongovernmental actors with technical capacity provided by the government. The outcome also suggests that financial incentives are important, albeit with caveats, for motivating citizen participation in sustainability innovation. There are, however, a number of challenges associated with sustaining such innovation over time. This case offers useful insights into collaborative governance and practical recommendations for utilizing energy competitions as a sustainability policy tool.

Deaths due to synthetic opioids have increased at higher rates for Blacks and Hispanics than for Whites in the last decade. Meanwhile, Blacks and Hispanics experience lower opioid treatment rates and have less availability of medication-assisted treatment (MAT) via office-based buprenorphine in their counties compared to Whites. Racial/ethnic residential segregation is a recognized barrier to equal availability of MAT, but little is known about how such segregation is associated with opioid and substance use treatment availability over time and across Census regions and urban-rural lines. We combined data from the Substance Abuse and Mental Health Services Administration's National Survey of Substance Abuse Treatment Services for 2009, 2014, and 2019 with the 5-year American Community Surveys of 2009, 2014, and 2019 to examine associations between residential segregation indices of dissimilarity and interaction and substance use treatment facilities per 100,000 population, including those providing MAT, in US counties. Estimating county-level two-way fixed effects models and controlling for county-level covariates, we find modest evidence of associations. Despite mostly null findings, an increased likelihood of exposure of Whites to Blacks in a county is associated with fewer substance use treatment facilities per 100,000, particularly those providing MAT via buprenorphine and located in Northeastern and Midwestern counties. Also, a more unequal distribution of Hispanics is associated with fewer facilities per 100,000 providing MAT, and this association is strongest in Southern and Western counties. These associations are driven by recent years (2014–2019) when synthetic opioids became the leading cause of opioid mortality and Blacks and Hispanics began dying at faster rates than Whites. Mixed evidence, however, tempers conclusions for how residential segregation drives racial/ethnic disparities in MAT availability.