Untangling the role of income inequality and public health funding on youth mental health before and after the COVID-19 pandemic.

Even prior to the COVID-19 pandemic, youth mental health was a public health problem. During the pandemic, public health measures, such as school closures, social distancing, and stay-at-home orders, may have worsened these mental health conditions among youth. The gap between rich and poor in a residential area, such as a city or county, has proven to be linked with mental health conditions such as depression and anxiety. We propose to study data collected before and after the COVID-19 pandemic to determine if this gap between rich and poor is associated with mental health. We will also test if the gap between rich and poor leads to lower public health funding and programming, leading to mental health conditions. Ontario is unique in that public health authority is decentralized such that there are 34 individual public health units (PHU) that cater to the health needs of their communities. Therefore, public health programming and funding differs across these 34 PHU's. This gives us an opportunity to study such variability in public health services and its association with population health and health equity. To accomplish this goal, we will use data from the Canadian Health Survey on Children and Youth (CHSCY) collected before and after the COVID-19 pandemic among children aged 1 to 17 years living in Ontario, Canada. We will analyze the relationship between income inequality and youth mental health, and test whether any observed association differs across genders, socioeconomic status, and public health funding per capita. Finally, we will use path analysis to determine if public health funding and programming mediate the relationship between income inequality and mental health.