Fiscal Sustainability, Demographics, and the Social Determinants of Health Driving Intergenerational Equity

The research developed in this chapter identifies intergenerational equity as a function of three dynamics: local government fiscal sustainability, demographic drivers, and place-based health equity. Intergeneration equity is researched from three related sets of pressures: One, the cost increases threatening the fiscal sustainability. Two, demographic changes result in a lower growth rate of working population. Three, persistent social inequities linked directly to neighborhoods correlate with wide disparities in life expectancy. The research develops a deeper understanding of each of these three dynamics, including the individual impact as well as the collective impact through their interconnectedness. This combined analytic framework better identifies the institutional mechanisms that can address these issues. The chapter concludes with mapping ways for local government to move forward by applying the design principals developed from research in sustainability of common pool resources.