Investments in Childhood Community Resources and Subsequent Adult Health Outcomes

Community resources may benefit children's long-term health, but the lasting impact of public spending in childhood is unclear. Identifying policies to address residential wealth and opportunity disparities could promote long-term health equity.

To assess whether childhood exposure to public spending on community resources (public primary and secondary education, libraries, parks and recreation, and community development and housing) is associated with subsequent adult health.

This retrospective cohort study used linked national datasets from 1977 through 2019. US cities with at least 150 000 residents in 1980 were included. Childhood public finance data covered 1977 through 2017, and adult health was measured in 2019. Included adults were in the 2019 Panel Study of Income Dynamics, were born between 1960 and 2000, and lived in a medium to large city before 18 years of age. Analyses were performed from August 2024 to March 2026.

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.

The main outcome was overall adult health rated as fair or poor. Secondary outcomes included cardiovascular disease (CVD), anxiety, and depression diagnoses. Data were analyzed using weighted linear probability models adjusted for demographics. Estimated margins compared the 25th and 75th percentiles of spending.

Among 2214 adults (mean [SD] age in 2019, 38.9 [10.2] years; 1223 [52%] female), 389 (17%) reported fair or poor health, 458 (22%) reported CVD, and 184 (10%) reported anxiety or depression. A 1% increase in childhood community resource spending was associated with a 0.20 (95% CI, 0.04-0.35) percentage point decrease in adult fair or poor health and a 0.25 (95% CI, 0.07-0.44) percentage point decrease in adult CVD. To contextualize the magnitude, shifting from the 25th to 75th spending percentile decreased the estimated probability of reporting adult fair or poor health from 19.38% to 12.87%, a reduction of 6.51 (95% CI, 1.38-11.64) percentage points. A 1% increase in education (0.15 [95% CI, 0.02-0.29] percentage points) or library (0.05 [95% CI, 0.01-0.10] percentage points) spending was correlated with better overall health. Education (0.23 [95% CI, 0.07-0.39] percentage points) and community development and housing (0.04 [95% CI, 0.01-0.08] percentage points) spending were associated with lower CVD. No association was found for overall community resource spending or its individual four component sectors and anxiety or depression.

In this cohort study of US urban adults, greater childhood exposure to community resource spending was associated with improved overall and cardiovascular health in adulthood. Variation in public spending levels may partially explain geographic differences in US health outcomes.