Greater childhood exposure to community resource spending was associated with improved overall and cardiovascular health in adulthood, with variation in public spending levels potentially partially explaining geographic differences in US health outcomes.
Key Findings
Results
A 1% increase in childhood community resource spending was associated with a 0.20 percentage point decrease in adult fair or poor health.
95% CI: 0.04–0.35 percentage points
Spending was measured as total per capita operational spending on community resources summed across city, county, and school district levels for the year and city when the respondent was 9 years of age
Among 2,214 adults, 389 (17%) reported fair or poor health
Analyses used weighted linear probability models adjusted for demographics
Results
A 1% increase in childhood community resource spending was associated with a 0.25 percentage point decrease in adult cardiovascular disease (CVD).
95% CI: 0.07–0.44 percentage points
458 of 2,214 adults (22%) reported CVD
CVD was a secondary outcome measured in 2019 via the Panel Study of Income Dynamics
Results
Shifting from the 25th to 75th percentile of community resource spending reduced the estimated probability of reporting adult fair or poor health from 19.38% to 12.87%.
This represents a reduction of 6.51 percentage points (95% CI: 1.38–11.64)
This contextualizes the magnitude of the association between spending levels and health outcomes
The 25th and 75th percentile comparison was used as the primary margin estimate
Results
A 1% increase in education spending was associated with better overall health and lower CVD in adulthood.
Education spending associated with 0.15 percentage point decrease in fair or poor health (95% CI: 0.02–0.29)
Education spending associated with 0.23 percentage point decrease in CVD (95% CI: 0.07–0.39)
Education was one of four community resource sectors analyzed alongside libraries, parks and recreation, and community development and housing
Results
A 1% increase in library spending was associated with a 0.05 percentage point decrease in adult fair or poor health.
95% CI: 0.01–0.10 percentage points
Library spending was one of four community resource sectors individually analyzed
Library spending was not reported to have a statistically significant association with CVD separately from the combined spending measure
Results
A 1% increase in community development and housing spending was associated with a 0.04 percentage point decrease in adult CVD.
95% CI: 0.01–0.08 percentage points
Community development and housing was one of the four individual sector components analyzed
This association was specific to CVD; no significant association was found for overall health
Results
No association was found between overall community resource spending or any of the four individual spending sectors and adult anxiety or depression.
184 of 2,214 adults (10%) reported anxiety or depression
Anxiety and depression were pre-specified secondary outcomes
This null finding applied to both total spending and all four individual components: education, libraries, parks and recreation, and community development and housing
Methods
The study cohort consisted of 2,214 US urban adults with a mean age of 38.9 years in 2019, drawn from the Panel Study of Income Dynamics.
Mean (SD) age was 38.9 (10.2) years; 1,223 (52%) were female
Participants were born between 1960 and 2000 and lived in a medium to large city (at least 150,000 residents in 1980) before age 18
Childhood public finance data covered 1977 through 2017; adult health was measured in 2019
This was a retrospective cohort study using linked national datasets from 1977 through 2019
Analyses were performed from August 2024 to March 2026
What This Means
This research suggests that the amount of money cities and counties spent on public resources — such as schools, libraries, parks, and housing programs — during a person's childhood is linked to how healthy that person is as an adult. Using data spanning more than four decades and linking government spending records to a national health survey, researchers found that people who grew up in areas with higher per-person public spending were less likely to report poor overall health or cardiovascular disease (such as heart disease) in adulthood. Specifically, moving from a lower-spending to a higher-spending city was associated with cutting the likelihood of reporting poor health by more than a third — from about 19% down to about 13%.
The associations were strongest for education spending, which was linked to both better general health and lower rates of heart disease, but library spending and community development and housing spending were also linked to better health outcomes. Parks and recreation spending did not show a statistically significant independent association. Interestingly, no connection was found between childhood community spending and adult anxiety or depression, suggesting the health benefits may operate through physical rather than mental health pathways, or that mental health outcomes may be influenced by different factors.
This research suggests that public investment decisions made at the city and county level — often debated primarily in terms of economics or education — may have lasting consequences for population health decades later. The findings imply that geographic disparities in health across the United States may be partly explained by longstanding differences in how much communities invest in shared public resources for children. This could inform policy discussions about how local budget priorities might serve as tools for promoting long-term health equity.
La Charite J, Dudovitz R, Choi K, Chen K, Jackson N, Nuckols T, et al.. (2026). Investments in Childhood Community Resources and Subsequent Adult Health Outcomes.. JAMA network open. https://doi.org/10.1001/jamanetworkopen.2026.16711