Stable state investments contribute directly to public health.

States’ and localities’ influence over health care, as well as many other social and economic, behavioral, and environmental factors that shape health, is most apparent in their budget decisions.[16] Health is one of the largest categories of state and local spending, making up more than a quarter of state and local expenditures.[17] It includes health coverage programs like Medicaid and the Children’s Health Insurance Program (CHIP), as well as spending on behavioral health services for people with mental health and substance use disorders, and public health departments that lead disease prevention and health promotion efforts such as vaccination programs, food safety, and disaster preparedness and response. These public investments directly affect residents’ health, and they play a critical role in determining health outcomes.[18]

While less obvious, aspects of nearly every other category of state and local expenditures can also affect health:

Education, like health, comprises more than a quarter of state and local expenditures. Investments to broaden access and improve the quality of education for students of all ages from early childhood through K-12 and higher education all are associated with students’ economic prospects and health.

Transit and transportation can improve health by broadening access to public transit and “active transportation” like bike and walking paths, connecting residents to jobs, health care, and other opportunities. Investments in public transit can facilitate more active lifestyles, reduce reliance on cars (which also improves air quality), and connect otherwise-isolated communities with broader opportunity.

Fire, safety, and police investments can improve community health through injury prevention, and enhance public safety through specific policies, like community policing, which evidence suggests reduces crime and facilitate positive relationships between police and the communities they serve.[19]

Water, sewer, and waste management investments enable states and localities to replace aging infrastructure, ensure water quality, and reduce residents’ exposure to harmful environmental toxins.

Parks, recreation, and libraries provide opportunities for social engagement and physical activity. Research suggests that these investments are associated with better resident health.[20]

Housing investments augment insufficient federal housing support and improve access to safe, affordable housing, which is integral for health.

Unemployment insurance plays an important economic role by replacing income lost when individuals lose a job and sustaining consumer demand during an economic downturn. Greater state investment in unemployment insurance also improves recipients’ access to health coverage and care following job loss and results in better self-reported health, research suggests.[21]

To the extent that these kinds of investments prevent or reduce poverty and promote economic opportunity — and the research suggests many of them do — they are likely to promote health. But these “non-health” investments also shape the opportunities available to people to engage in healthy behaviors (like eating nutritious foods and getting regular physical activity) and to avoid things that can harm health (like violence and environmental toxins).