The purpose of this study was to determine the characteristics of cities, if any, that influence the passage of innovative, progressive health policies in the US. We did this through the application of fs/QCA techniques to data from the National Association of City and County Health Officials, the US Census, a database of the structure of local governments in the US, and original data collection. We looked at three key health policies in nine US cities (trans-fats reductions, clean fuel transportation policies, and taxes on sugar-sweetened beverages) and determined the most relevant attributes of the civic and policy environment that led to a passage or blockage of those policies. Our results highlight some unique relationships and add more nuance to what the existing literature has already established. In particular, demographic characteristics of top executives, resource munificence, and distribution of authority are found to have compelling results.