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Economic opportunity may significantly impact physical and mental health in young adults

Study finds that individuals living in areas with higher economic opportunity report fewer days of poor health

Massachusetts General Hospital

A team of researchers led by a Massachusetts General Hospital (MGH) physician reports that economic opportunity is strongly associated with measures of physical and mental health in young adults. The findings published in the inaugural issue of The Lancet Public Health support those of a previous study from the same group, published last year in the American Journal of Public Health, which found a relationship between economic opportunity and mortality.

"The idea that prospects for upward social mobility - which is how we define economic opportunity - may be declining is a key economic policy issue for many Americans," says lead researcher Atheendar Venkataramani, MD, PhD, of the MGH Division of General Medicine. "Our study shows that opportunity may matter for public health too. People living in places with higher opportunity report fewer days of poor physical and mental health, and they also appear to adopt healthier behaviors."

The current study combines data on health outcomes from nearly 150,000 Americans ages 25 to 35 with recently developed measures of economic opportunity. These opportunity measures - compiled from millions of income tax records by economists at Harvard University, Stanford University, and the University of California-Berkeley - reflect on a county-by-county level how the average incomes of individuals relate to the incomes of their parents. The researchers examined the relationship between these measures and health outcomes reported to the U.S. Behavioral Risk Factor Surveillance Survey - specifically respondents' answers to questions about general health, about recent days when either physical or mental health were not good, and about behavioral risk factors.

Overall the study found that higher levels of economic opportunity were associated with survey respondents' reporting better physical and mental health and fewer behavioral risk factors. For example, individuals living in counties in the highest 10 percent of economic opportunity reported 20 percent fewer days of poor mental or physical health in the past month than did those living in the lowest-opportunity 10 percent of counties. The results remained similar even after adjusting for a number of other individual and county-level factors and using alternate definitions of economic opportunity. Respondents from low-opportunity counties were more likely to report smoking and engaging in behaviors that risked transmission of HIV, such as intravenous drug use and unprotected anal intercourse.

"Economic opportunity may affect health in a number of ways," says senior author Alexander Tsai MD, PhD, of the Chester M. Pierce Division of Global Psychiatry at MGH and an assistant professor of Psychiatry at Harvard Medical School (HMS). "Greater opportunity means that people have access to better jobs. Access to better jobs both raises the importance of being healthy in order to take advantage of them and also raises income and education, which we know from other work are strongly associated with better health. Greater opportunity may also raise hopes for a better future, which could directly influence health. Our study does not allow us to distinguish between these pathways, and it remains possible that our findings may be biased by other factors that affect both opportunity and health that we do not observe. These are all areas that would benefit from further study."

Venkataramani, who is an assistant professor of Medicine at HMS and a faculty affiliate of the Harvard Center for Population and Development Studies also states that, at a time when anxiety over the "American Dream" is high, future research should examine the role and potential health impacts of economic policies that alter opportunities. He points to innovative work at the community level seeking to leverage these links, including the "Better Health through Economic Opportunity" campaign, a recent joint effort by the U.S. Chamber of Commerce Foundation and the Robert Wood Johnson Foundation.

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Additional co-authors of The Lancet Public Health are Rachel Brigell, MPH, and Ichiro Kawachi, MBChB, PhD, Harvard T.H. Chan School of Public Health; Rourke O'Brien, PhD, University of Wisconsin-Madison, and Paula Chatterjee, MD, MPH, Brigham and Women's Hospital, are co-authors. The study was supported by the Robert Wood Johnson Foundation Health and Society Scholars Program and by National Institutes of Health grants K23 MHMH106362 and K23 MH096620.

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $800 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals, earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service. In August 2016 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of "America's Best Hospitals."

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