Health Disparities
Income Inequality and Physical Health in the United States: The Mediating Role of Public Health Funding Kaelan Findlay* Kaelan Findlay Jason Mulimba Were Sze Yan Liu Roman Pabayo
Background: Income inequality has been previously linked to poorer physical health. However, the mechanisms underlying this relationship remain unclear. In this study we examined whether state income inequality is directly associated with physical health, if public health funding mediates this relationship, and whether these associations differ by gender, as suggested by prior research.
Methods: Individual-level data was drawn from the 2023 Behavioral Risk Factor Surveillance System, whereas state-level data were obtained from the 2019 U.S. Census, and the 2020 State Health Access Data Assistance Center. Our sample comprisedof 406,686 adults from 48 states and the District of Columbia. Physical health was measured using self-reported days of poor physical health in the past 30 days. Income inequality was measured using the state-level Gini coefficient, and public health funding was measured using per capita public health funding in each state. The data was analyzed using multilevel path models.
Results: In the full model, higher income inequality was significantly associated with more self-reported days of poor physical health (β = 0.11; 95% CI= 0.01, 0.21). In the stratified analysis, significant findings were observed among men. Higher income inequality was associated with more self-reported days of poor physical health (β = 0.13; 95% CI= 0.13, 0.61). However, public health funding did not significantly mediate this relationship in any of the models.
Conclusion: Policymakers should aim to reduce state income inequality, as it may help reduce poor physical health days in American adults, particularly among males, who may be disproportionately affected. More research is needed to identify mechanisms in which income inequality leads to poor physical health.