Economic Opportunity, Health Behaviors, and Mortality in the United States

One of our lab’s core theories is that increased economic opportunity – defined as the prospects of upward mobility – can affect our health by increasing access to material resources (like food, health care, and housing), raising perceived returns to investing in health, and increasing hope. This study represents a first test of this theory. It assesses the whether economic opportunity and health behaviors and outcomes across US counties. Economic opportunity was proxied by rates of upward mobility, namely the average income rank of adults who grew up in low-income families. The research focused on three main questions: the relationship between economic opportunity and adult mortality; whether this association was more pronounced among specific populations; and if the association could be explained by differences in key risk factors.

• Higher economic opportunity counties had better health. A one standard deviation increase in economic opportunity was associated with a 6.5% decrease in mortality, an association that held even after extensive adjustment for socioeconomic and health system covariates. Put differently, an increase in economic opportunity from the lowest to the highest quintile of counties was associated with a 17% decrease in mortality. The association held even after extensive adjustment for socioeconomic and health system covariates.
• The relationship between economic opportunity and mortality was notably greater for working-age adults, particularly those in the 25-54-year-old age groups.
• The association was also larger in magnitude for Black Americans, who have faced historical constraints to opportunity, than for Whites.
• Greater economic opportunity was associated with improved health behaviors and a reduction in several key risk factors. A one standard deviation increase in economic opportunity was significantly associated with decreases in the rates of smoking (11.2%), obesity (5.6%), diabetes (7.7%), and hypertension (2.8%)

The study concludes that economic opportunity is a robust, independent predictor of health in the United States, demonstrating that a substantial increase in opportunity (from the lowest to the highest quintile) is associated with a nearly % decrease in mortality. The findings add to the literature linking macroeconomic conditions to health and motivate further research on how economic policy can be leveraged to affect population health. This research also started our research agenda to assess cause-and-effect between policies and events that shift mortality and various health outcomes.