Associations Between County Wealth, Health and Social Services Spending, and Health Outcomes

Am J Prev Med. 2017 Nov;53(5):592-598. doi: 10.1016/j.amepre.2017.05.005. Epub 2017 Jul 5.


Introduction: Each year, the County Health Rankings rate the health outcomes of each county in the U.S. A common refrain is that poor counties perform worse than wealthier ones. This article examines that assumption and specifically analyzes characteristics of counties that have performed better in terms of health outcomes than their wealth alone would suggest.

Methods: Data from the 2013 County Health Rankings were used, as were 2012 financial and demographic information collected by the U.S. Census Bureau. A logistic model was constructed to examine the odds of a county "overperforming" in the rankings relative to community wealth. Analyses were performed in 2016.

Results: Communities that were wealthier performed better on the rankings. However, more than 800 of 3,141 counties overperformed by ranking in a better health outcomes quartile than their county's wealth alone would suggest. Regression analyses found that for each additional percentage point of total public spending that was allocated toward community health care and public health, the odds of being an overperformer increased by 3.7%.

Conclusions: Community wealth correlates with health, but not always. Population health outcomes in hundreds of counties overperform what would be expected given community wealth alone. These counties tend to invest more in community health care and public health spending and other social services. Although the level of a community's wealth is outside the control of practitioners, shifting the proportion of spending to certain social services may positively impact population health.

MeSH terms

  • Censuses
  • Community Health Services / statistics & numerical data*
  • Female
  • Financing, Government / economics*
  • Health Behavior
  • Humans
  • Male
  • Population Health / statistics & numerical data*
  • Public Health / statistics & numerical data
  • Quality of Health Care / economics*
  • Social Work*
  • Socioeconomic Factors
  • United States