The cross-sectional association between state-level public health funding per capita and physical health among adults in the United States

TL;DR

This study found that higher public health funding per capita may help reduce poor physical health days in low-income individuals, but not in others.

Contribution

The study reveals that public health funding benefits low-income individuals more, potentially reducing health inequities.

Findings

A one SD increase in public health funding per capita was not significantly associated with fewer poor physical health days overall.

Low-income individuals experienced lower predicted probabilities of poor physical health with higher public health funding.

Education level also influenced the association, with less-educated individuals benefiting more from higher funding.

Abstract

This study examined the association between state-level public health funding per capita and the odds of poor physical health.

Cross-sectional.

Data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) were used. Participants’ self-reported physical health was reported using the CDC Healthy Days Core Module. State-level public health funding per capita was obtained from the State Health Access Data Assistance Center website. Multilevel logistic regression was used to adjust for self-reported individual-level characteristics and state-level characteristics from the 2018 American Community Survey. We also tested whether household income or education attainment moderated any observed associations.

A one SD increase in state-level public health funding per capita was not associated with the odds ≥  14 days of poor physical health (OR = 0.96, 95% CI: 0.90, 1.01). However, heterogeneity across household income was observed. Greater public health funding per capita was associated with lower predicted probabilities of reporting ≥  14 days of poor physical health among respondents from low household income backgrounds ( <$35,000 USD) compared to participants with high household incomes (>$75,000 USD). No associations were observed among those with moderate ($35,000 – $70,000 USD) household incomes. A similar finding was observed among participants with less than high school education when compared to participants with post-secondary education.

Greater state-level public health funding per capita appears to have a protective association against reporting ≥  14 days of poor physical health in individuals with lower household incomes and may be helpful in reducing health inequities. Future research is needed to determine whether this association is causal.

Figures