# 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.

## Key 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.