Opportunity for Health

Social Mobility

The American Dream is based on the idea that anyone, regardless of race, gender, ethnicity, or other factors, can move up the socioeconomic ladder with hard work. A growing body of new research shows the possibility of achieving the American Dream is not the same for everyone.1,2,3 Upward mobility rates differ greatly geographically. On the whole, upward mobility has declined in America since the 1940s.[1] While these trends have clear economic consequences, they may also foster the divergence of health behaviors and outcomes.

Figure 1. Mechanisms linking economic opportunity to health behaviors and outcomes

In one of our earlier studies, “Economic Opportunity, Health Behavior, and Mortality in the United States” (2016), we used county-level data to assess the association between economic opportunity, health behaviors, and mortality. We found that counties in the top 20% in terms of economic opportunity were associated with a 16.7% decrease in all-cause mortality compared to counties in the bottom 20% in terms of economic opportunity. We also found that increases in county-level economic opportunity were associated with decreases in rates of smoking, obesity, hypertension, and diabetes.

We further examined the connection between economic opportunity and health in another study, “Economic opportunity, health behaviors, and health outcomes in the USA: a population-based cross-sectional study” (2016). We utilized data from the 2009-2012 United States Behavioral Risk Factor Surveillance Surveys (BRFSS). We found that for young adults (ages 25 to 35), increases in county-level economic opportunity were associated with greater self-reported overall physical and mental health.[2]

Figure 2. Spatial distribution of self-reported health and economic opportunity

(A) Average self-reported health from the 2009–12 United States Behavioral Risk Factor Surveillance Survey across counties. (B) Average upward mobility for the 25th percentile of the income distribution. Both indicators were scaled such that red reflects poorer average health and opportunity, respectively.

We followed these two studies with a detailed analysis in our “Association of Social Mobility with the Income-Related Mortality Gap in the United States: A Cross-Sectional, County-Level Study” (2020). Using county-level data from the Health Inequality Project database, we found a strong association between county-level social mobility and life expectancy among residents in the lowest income quartile. In addition, we found that increasing social mobility leads to decreases in the longevity gap by 1.4 years for men and 1.1 years for women.[3]

Figure 3. Unadjusted estimates of the association of life expectancy at age 40 years with social mobility by income quartile and sex

Estimates of the association of life expectancy at age 40 years with the social mobility measure obtained from separate nonparametric, local polynomial regression models estimated for women (A) and men (B) in the highest and lowest income quartiles. Each dot represents a county-income quartile observation, and the lines represent the fitted unadjusted, nonparametric association. Social mobility refers to the relative income mobility measure, Association of Social Mobility With the Income-Related Longevity Gap in the United States: A Cross-Sectional, County-Level Study which represents the association of a child’s income rank in his or her birth cohort’s income distribution as an adult with his or her parents’ income rank in their income distribution. This measure was multiplied by −1 so that higher values would reflect greater social mobility. A total of 1559 counties were included for all models.
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1 Chetty R, Grusky D, Hell M, Hendren N, Manduca R, Narang J.The fading American dream: trends in absolute income mobility since 1940. Science. 2017:10.1126/science.aal4617.

2 Chetty R, Hendren N, Kline P, Saez E. Where is the Land of Opportunity? The Geography of Intergenerational Mobility in the United States Quarterly Journal of Economics. 2014;129(4):1553-623.

3 Putnam R. Our Kids: The American Dream in Crisis. New York: Simon and Schuster; 2015.