Abstract
SummaryBackgroundInequality of opportunity, defined as differences in the prospects for upward social mobility, might have important consequences for health. Diminished opportunity can lower the motivation to invest in future health by reducing economic returns to health investments and undermining hope. We estimated the association between county-level economic opportunity and individual-level health in young adults in the general US population.MethodsIn this population-based cross-sectional study, we used individual-level data from the 2009–12 United States Behavioral Risk Factor Surveillance Surveys. Our primary outcomes were current self-reported overall health and the number of days of poor physical and mental health in the last month. Economic opportunity was measured by the county-averaged national income rank attained by individuals born to families in the lowest income quartile. We restricted our sample to adults aged 25–35 years old to match the data used to assign exposure. Multivariable ordinary least squares and probit models were used to estimate the association between the outcomes and economic opportunity. We adjusted for a range of demographic and socioeconomic characteristics, including age, sex, race, education, income, access to health care, area income inequality, segregation, and social capital.FindingsWe assessed nearly 147 000 individuals between the ages of 25 years and 35 years surveyed from 2009 to 2012. In models adjusting for individual-level demographics and county-level socioeconomic characteristics, increases in county-level economic opportunity were associated with greater self-reported overall health. An interdecile increase in economic opportunity was associated with 0·76 fewer days of poor mental health (95% CI −1·26 to −0·25) and 0·53 fewer days of poor physical health (−0·96 to −0·09) in the last month. The results were robust to sensitivity analyses.InterpretationEconomic opportunity is independently associated with self-reported health and health behaviours. Policies seeking to expand economic opportunities might have important spillover effects on health.FundingRobert Wood Johnson Foundation Health and Society Scholars Program.
Highlights
Inequality of economic opportunity, defined as disparities in the prospects for upward social mobility, has come to the forefront of public discourse in the USA and Europe.[1,2] Research has shown that for many people in the USA, their life chances are contingent on geographic and temporal factors.[3,4]In addition to threatening economic status and social values, inequality of opportunity might adversely affect health in three ways
We addressed the possibility of non-random migration within the past year induced by county economic opportunity using data from the publicly available Current Population Survey and American Community Surveys
The final sample accounts for 78% of all Behavioral Risk Factor Surveillance Survey (BRFSS) observations; an analysis of missing data, which are inconsequential for the results, is shown in the appendix
Summary
Inequality of economic opportunity, defined as disparities in the prospects for upward social mobility, has come to the forefront of public discourse in the USA and Europe.[1,2] Research has shown that for many people in the USA, their life chances are contingent on geographic and temporal factors.[3,4]. In addition to threatening economic status and social values, inequality of opportunity might adversely affect health in three ways. Economic theories of human capital suggest that reduced economic opportunity can harm health by lowering economic and social returns to health investments.[5] Restrictions on future possibilities for economic gain make it less probable that the economic benefits of being healthier (eg, higher wages) will materialise. These mechanisms can occur independently of any effects of area-level income or income inequality.[4]
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