A Look at Health Inequity Using the 500 Cities Dataset Restricted; Files Only

Slaughter, Douglas (Fall 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/cr56n228m?locale=es
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Abstract

This thesis explores how preventative health behaviors and services such as frequency of doctors’ visits and insurance coverage might be associated with within-city inequality of various adverse health outcomes. Some of the value in considering these measures as exposures of interest is that they are modifiable--which means that there is a greater opportunity for public health agency. Because cities and counties make policy decisions that have a direct impact on the availability of preventative services, being able to inform legislators about the potential consequences of their decisions is critically important to improving population health. Further, stakeholders at the grassroots level are able to engage public officials in discussions on meaningful policy change based on what the data tell us, making them more effective advocates.

To that end, in order to estimate the association between the prevalence of uninsured adults and the between-neighborhood variation in adverse health outcome, we fit crude and adjusted linear regression models where the coefficient of variation (a coarse proxy for inequity) for each adverse health event (twelve events in all) was the outcome and the exposure was prevalence of the uninsured. Similarly, to estimate the association between the prevalence of adults having been for a check-up within the last 12 months and between-neighborhood variation in each outcome, we fit similar crude and adjusted linear regression models where the exposure was the prevalence of adults having had a check-up. The adjusted models controlled for racial and poverty concentration by including the percentage of blacks and percentage of those in poverty.

We found Based on the results, it appears that neighborhood segregation by race and class plays a crucial role in how we address inequity. Although the two exposures of interest are critically important, increasing access to insurance and more frequent doctors’ visits are not enough to narrow the health inequity gap alone. A big piece of health equity is driven by differential diffusion of access to resources. Because neighborhoods can act as a regulator of access to resources, segregation functions as a de-facto resource limiter to marginalized populations.

Table of Contents

Background...........................................................................................................................................................................................................................................................5

Methods................................................................................................................................................................................................................................................................8

Results................................................................................................................................................................................................................................................................11

Discussion...........................................................................................................................................................................................................................................................14

References...........................................................................................................................................................................................................................................................16

Tables/Figures.....................................................................................................................................................................................................................................................19

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