Effects of U.S. States’ Social Welfare Systems on Population Health
Abstract
Social scientists have studied the welfare state extensively. Many studies seek to understand the determinants of the welfare state; however, a few have explored the social consequences of social welfare systems, especially on health outcomes of the population. Even though cross‐national comparative studies support the thesis that the welfare state regime type, which represents different levels of commitment on social welfare, is closely linked to population health, there is little research to support this argument at a sub‐national level. To fill the gap, this study explores the effects of the U.S. states' social welfare systems on health using age‐adjusted mortality rates as a proxy for population health. By operationalizing social welfare systems as three dimensions—public expenditures, tax structures, and welfare program rules—we find that more generous education spending, progressive tax systems, and more lenient welfare program rules help to improve population health. The model corrects for first‐order serial correlation using Prais‐Winsten regression methods and is estimated with state and year‐fixed effects.
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A one percent increase in smoking rates was associated with an increase of one death per 100,000 population.
“a one percent increase in smoking and obesity rates was associated with an increase of one and two deaths per 100,000 population, respectively.”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [23]
Every $100 increase in spending on public education led to two fewer deaths per 100,000 population.
“every $100 increase in spending on public education led to two fewer deaths per 100,000 population”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [23]
A one percent increase in obesity rates was associated with an increase of two deaths per 100,000 population.
“a one percent increase in smoking and obesity rates was associated with an increase of one and two deaths per 100,000 population, respectively.”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [23]
U.S. states with higher spending on education, greater public expenditures, less regressive taxes, and more generous welfare policies had better health as measured by lower death rates, with effects stronger for overall mortality than infant mortality.
“U.S. states with higher spending on education, greater public expenditures, less regressive taxes, and more generous welfare policies (as reflected in Temporary Assistance to Needy Families (TANF) and Medicaid program rules) had better health as measured by lower death rates, with the effects being stronger for overall mortality than for infant mortality [23].”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [23]
A one standard deviation change in tax progressivity resulted in 6 fewer deaths per 100,000 population.
“a one standard deviation change in tax progressivity resulted in 6 fewer deaths per 100,000 population.”
From Reducing Racial Inequities in Health: Using What We Already Know to Take Action (2019) · cites this paper as [23]
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Miles to Go before We Sleep: Racial Inequities in Health
Williams, D. R. (2012) · Journal of Health and Social Behavior · doi:10.1177/0022146512455804 · Cited by 507 · see citing works
“…spending on education, more progressive taxation systems, and more humane (lenient) Temporary Assistance for Needy Families and Medicaid program rules had better overall population health, with the effects being stronger for overall mortality than for infant mortality (Kim and Jennings 2009).”
BackgroundReducing Racial Inequities in Health: Using What We Already Know to Take Action
Williams, D. R., & Cooper, L. A. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16040606 · Cited by 415 · see citing works
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Rigby, E., & Hatch, M. E. (2016) · Health Affairs · doi:10.1377/hlthaff.2016.0710 · Cited by 31 · see citing works
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Seltzer, N. (2020) · SSM - Population Health · doi:10.1016/j.ssmph.2020.100679 · Cited by 23 · see citing works
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Jackson, M. I., Rauscher, E. A., & Burns, A. (2022) · Demography · doi:10.1215/00703370-10230542 · Cited by 11 · see citing works
“Stubbornly high levels of child socioeconomic disadvantage in the United States (Brady and Parolin 2020; Chen and Corak 2008; Gornick and Jäntti spending on health (Bradley et al. 2016; Kim and Jennings 2009; Ronzio et al. 2004).”
Association of State-Level Tax Policy and Infant Mortality in the United States, 1996-2019
Jean, A., Lee, L. K., Fleegler, E. W., Monuteaux, M. C., Niescierenko, M. L., & Stewart, A. M. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.9646 · Cited by 8 · see citing works
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Kindig, D. (2015) · Preventing Chronic Disease · doi:10.5888/pcd12.150010 · Cited by 8
Are Community-Level Financial Data Adequate to Assess Population Health Investments?
Casper, T., & Kindig, D. (2012) · Preventing Chronic Disease · doi:10.5888/pcd9.120066 · Cited by 8
The Effect of Women’s Descriptive Representation on Premature Mortality
Patton, D. J., & Fording, R. C. (2020) · Social Forces · doi:10.1093/sf/soaa022 · Cited by 9 · see citing works
“Despite the mounting evidence of the connection between politics and health at the US state level (Kim and Jennings 2009; Patton 2014), and the city level (Ronzio, Pamuk, and Squires 2004; Costich and Patton 2012), scholars have only recently begun to turn their attention to the potential…”
BackgroundState-Level Safety Net Spending and Educational Gaps in Maternal Time with Children
Jackson, M. I., Song, H., & Kalil, A. (2023) · Journal of Marriage and Family · doi:10.1111/jomf.12960 · Cited by 5
Akyüz, M. (2024) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228241287816 · Cited by 4 · see citing works
“Studies in the existing literature on the socioeconomic determinants of suicide mortality have produced mixed evidence (Dunn et al., 2005; Kim & Jennings, 2009; Stuckler et al., 2010).”
Association Between Local Government Social Expenditures and Mortality Levels in Korea
Ko, H., Kim, J., Kim, D., Kim, S., Park, Y., & Kim, C.-Y. (2013) · Journal of preventive medicine and public health = Yebang Uihakhoe chi · doi:10.3961/jpmph.2013.46.1.1 · Cited by 3
“Kim and Jennings’ study [13] using panel data also had a limitation, in that the standardized mortality rate was the only dependent variable.”
BackgroundPrayoga, D., Idris, I., & Ariusni, A. (2019) · Ecosains: Jurnal Ilmiah Ekonomi dan Pembangunan · doi:10.24036/ecosains.11522757.00 · Cited by 2
An evaluation of social assistance programs on infant health
Florida Agency for Health Administration, T., Swanson, J., & Chavez, J. (2020) · Social Work and Social Welfare · doi:10.25082/swsw.2020.01.002 · Cited by 1 · see citing works
“Do the outputs of social assistance programs reach their intended beneficiaries? One example of this kind of research in political science is Kim and Jennings[2] who study the impact of state welfare systems on population health.”
BackgroundAssociation of affirmative action with health and education outcomes and services in India
Pandey, P., Sahadevan, K., & Hastings, P. (2025) · Proceedings of the National Academy of Sciences of the United States of America · doi:10.1073/pnas.2502290122 · Cited by 1
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Bromo, F., Pacek, A. C., & Radcliff, B. (2026) · Social Indicators Research · doi:10.1007/s11205-026-03912-x
“Prior studies have also connected welfare institutions to population health and life expectancy more directly (Kim & Jennings, 2009; Lundberg et al., 2008; Reynolds and Avendano 2018).”
State-Level Tax Policy, Cancer Screening, and Mortality Rates in the US
Chatzipanagiotou, O. P., Khalil, M., Waqar, U., Woldesenbet, S., Catalano, G., & Pawlik, T. M. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.8455
Sandeep (2016) · doi:10.9790/0837-02107021823
“Although programs like Medicaid address needs of thenonworking poor, the vast majority of recipients are generally considered deserving,e.g., Children, the elderly, and those with disabilities (Kim and Jennings 2009).”
Background
- Authors
- Kim, A., & Jennings, E. T.
- Affiliations
- Indiana University – Purdue University Fort Wayne (US)
- University of Kentucky (US)
- Venue
- Policy Studies Journal
- Publisher
- Wiley
- Published
- 2009-10-20
- Volume
- 37
- Issue
- 4
- Pages
- 745-767
- ISSN
- 0190-292X (ISSN-L)
- 1541-0072
- OpenAlex
- W2072931760
- Cited by
- 27
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 2 · 2020: 3 · 2019: 1 · 2017: 3 · 2016: 4 · 2015: 3 · 2014: 1 · 2013: 1 · 2012: 2
- FWCI
- 6.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Policy Studies Journal (publishedVersion)
- Opus: Research & Creativity (Indiana University – Purdue University Fort Wayne) (submittedVersion)
- Topics
- Social Sciences › Political Science and International Relations › Social Policy and Reform Studies
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- welfare system, population health, age-adjusted mortality, welfare regimes, education funding, progressive taxation, United States states
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