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Economic and Social Factors Influencing Health and Crime Outcomes Across U.S. States

Political Research I

March 1st,2026

Economic and Social Factors Influencing Health and Crime Outcomes Across U.S. States The health of U.S. states differs significantly, with certain states recording higher life

expectancy, preventable mortality, and overall population health as compared to others.

Demography indicates that more recent demographic studies reveal the escalating differences in

life expectancy and health expectancy throughout the United States (Crimmins, 2025). Likewise,

the American Journal of Public Health records an increasing national inequality in health

compared to other countries and the inequalities within the country (Woolf, 2023). These patterns

raise an important political science question: What factors explain variation in overall health

outcomes across U.S. states?

This literature review discusses three key factors explaining the variations in health across states:

(1) the economic resources, in this case, median household income; (2) the Medicaid expansion

by the Affordable Care Act; and (3) the healthcare spending and the system performance at the

state level. The different explanations represent the different theoretical approaches, the social

determinants of health theory, the policy feedback theory, and the health system performance

theory. Although the three can be related to health variation, the literature indicates different

probabilities of the explanatory power.

Hypothesis 1 Section: Economic Resources and Health Outcomes

The former rationale focuses on household median income as a determinant of health outcomes.

The social determinants of health model states that economic resources predispose access to

nutrition, housing, education, preventative care, and less stressful environments. Better health

outcomes would be seen to be demonstrated by states whose median incomes are higher. In

Demography, Crimmins (2025) provides evidence that the growth of life expectancy is

intimately related to the general socioeconomic factors, such as levels of education and income

distribution. The paper has brought to the fore fact that economic advantage can be converted to

a longer life in terms of health rather than life as such. Likewise, Woolf (2023) in the American

Journal of Public Health states that Americans are on the road to health decline, which is not

only in health care but in the structural economic disparities of living conditions.

The present study, in the context of the COVID-19 process, continues to support this argument.

In the article published in BMC Medicine, Wu et al. (2025) discovered that states with already

established socioeconomic disadvantage had a stronger impact on health deterioration in the

pandemic. Financial instability increases mortality and health inequalities. Even though the

studies do not directly measure median household income, they all tend to indicate that

population health is highly predicted by structural economic resources. The literature has a

general agreement that economic resources are determinants of health in their foundation. Critics

observe that income per se is not a guarantee of access when healthcare systems are inefficient or

there are policies that limit access. Nevertheless, of the three explanations, the economic

determinants argument seems to be a theoretically comprehensive one since it has an influence

on several pathways at the same time.

Hypothesis 2 Section: Medicaid Expansion and Health Outcomes The second reason is the consideration of whether a state enacted the Medicaid expansion

legislation under the Affordable Care Act (ACA). According to policy feedback theory, the

government programs influence the social outcomes by changing access to resources and

institutional involvement. According to Guth et al. (2020), who report results of the Kaiser

Family Foundation, they summarize a large body of evidence that the Medicaid expansion had

positively impacted insurance coverage, primary care access, and reduced economic burden on

low-income communities. These enhancements are hypothetically part of the improved health

outcomes. According to the literature, expansion has a more slow-acting impact on long-term

mortality and life expectancy, although it enhances coverage. In Health Services Research,

Lescinsky et al. (2025) analyze the decades of changes in healthcare value across the states and

conclude that the growth of insurance is not sufficient to explain the differences in cross-state

performance.

A study by The Lancet Public Health (Lescinsky et al., 2025) analyzing the performance of

county health systems has shown that insurance coverage is not the only measure of system

performance. Structural determinants and resource allocation remain to have significant roles. As

explained in the literature, there is moderate support regarding the role of Medicaid expansion in

the literature. It has a definite beneficial effect on access and financial protection, though its

impact on general life expectancy or preventable death is inconsistent with other larger

socioeconomic influences.

Hypothesis 3 Section: Healthcare Spending and System Performance The third explanation investigates the state healthcare expenditure per capita and the

performance of the systems. The theoretical suggestion in this case is that investing more in

healthcare infrastructure must yield better health results. In the JAMA Health Forum, Dieleman

et al. (2025) discovered a large disparity in healthcare expenditure between counties and states in

the U.S. Nevertheless, they mention that increased expenditure may not necessarily lead to

improved health outcomes. This observation makes it difficult to assume that population health is

solely dependent on spending.

The Lancet Public Health by Lescinsky et al. (2025) assesses the health-care system performance

of the U.S. with the help of a triple-aim framework (health outcomes, quality, and cost). These

two come to the conclusion that system efficiency and coordination are not any less important

than total expenditure. The authors of The Lancet Public Health, Ding et al. (2025), give

evidence of the connection between physical activity and better health outcomes, which shows

that behavioral and preventive health factors, which are frequently influenced by the non-clinical

environment, have a significant impact on health statuses. The articles indicate that per capita

healthcare expenditure is more conditionally affected. Investment enhances results when it is

efficiently allocated and integrated with preventive measures. Nevertheless, non-structural

reforms and expenditure do not assure better health. Weaker evidence of spending alone as the

primary explanatory variable is thus provided by the literature.

Conclusion The literature that studies variation in health outcomes in the U.S. states has offered three broad

explanations, and they include economic resources, Medicaid expansion, and healthcare

spending/system performance. Socioeconomic resources like median household income are

supported best and with the highest degree of consistency. The studies of Demography and the

American Journal of Public Health indicate that the structural economic conditions determine the

long-term life expectancy and health expectancy in various ways. Expanding Medicaid has

significant, albeit less significant, impacts. The summary of the evidence provided by the Kaiser

Family Foundation has shown that there is better access and financial protection, but broader

health outcomes are influenced by other structural factors. The impacts of healthcare expenditure

per capita reflect two-sided impacts. According to the results of the JAMA Health Forum,

increased expenditure does not necessarily result in better health outcomes unless the system is

efficient. The available literature indicates that adoption of policies and investment in health care

matters; however, the structural economic conditions have a more comprehensive and long-term

effect on the health of the population. The hypothesis according to which a greater median

household income will lead to more favorable overall health outcomes among states seems to be

the most robust one compared with the alternatives.

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