A spatial analysis of county-level education context and population health and wellbeing

Background: Stark inequalities in health and wellbeing exist across US counties. Schools are a key feature of counties and residents often make decisions about where to live based on the quality of the local schools. How counties invest in their local schools may reflect one way that health and wellbeing become embedded in geo-graphic places. Methods: We constructed four indicators of county-level education context using administrative data from all US public schools and linked these to population health data from the RWJF County Health Rankings and Roadmaps Program. Using state-fixed effects spatial error models, we examined if county-level education context relates to county rankings on two indices of population health and wellbeing - quality of life and health behaviors - after adjusting for county-level demographic, economic, and social contexts. Results: Total county revenue from local sources and the percentage of a county's high school students enrolled in advanced placement coursework were associated with better county rankings on quality of life and health behavior. We also found a curvilinear relationship between county-level per-pupil spending and county rankings on our population health and wellbeing outcomes. In fully adjusted models, the education context indicators were attenuated; all three remained significantly associated with county rankings on health behavior, but only revenue from local sources was significantly associated with county rankings on quality of life. Conclusion: Providing a quality education context may yield health and wellbeing dividends at the county-level given the public education system's far-reaching influence on social and economic wellbeing.