A Place-Based Approach to Health: The Effect of Rhode Island’s Health Equity Zones on Maternal and Neonatal Health Público
Mahoney, Sarah (Spring 2019)
Abstract
Health capital, a measure of an individual’s level of general health and wellbeing, is positively associated with productivity, income, and workforce participation, among other economic metrics. Establishing a foundation of good health during early development is critical in achieving good health in adulthood; therefore, policies that promote health in early life stages can manifest as positive economic returns in later life stages. In 2015 the Rhode Island Department of Health (RIDOH) implemented Health Equity Zones (HEZs), a public health initiative in which RIDOH identified nine geographically-delineated areas demonstrating health disparities within the zone and/or compared to the rest of the state. Each HEZ represents one of these regions in which a team, led by a backbone agency, utilizes a grassroots approach to implement a series of projects and initiatives intended to improve the health of HEZ residents. In this paper I employ a difference-in-differences analytical approach, comparing births of HEZ residents to those of non-HEZ residents pre- and post-HEZ implementation, to examine the effects of HEZs on maternal and neonatal health. Using data from birth certificates between the years 2005 and 2017, I perform regression analysis to determine the average impact of HEZs and the impact of individual HEZs on birthweight, the month prenatal care began, rates of smoking during pregnancy, and gestational age. Although I detect several statistically significant effects of HEZs on these health outcomes, confounding factors, including the HEZs’ varying degrees of maturity and tenuous satisfaction of the parallel trends assumption, make it difficult to decisively conclude the magnitude of the HEZs’ impacts on maternal and neonatal health. However, the trends in health outcomes within HEZs generally move in a direction of improvement, suggesting a positive net effect of the initiative. Given these promising results, the effects of HEZs on health warrant further examination, especially as more years of data become available and HEZs achieve a greater degree of maturity.
Table of Contents
ABSTRACT 1
INTRODUCTION 2
SOCIAL IMPACT STRATEGIES 4
RHODE ISLAND’S HEALTH EQUITY ZONES 5
IMPORTANCE OF GOOD HEALTH 8
MATERNAL, NEONATAL, AND CHILD HEALTH 10
GAPS IN THE LITERATURE 12
DATA 13
METHODOLOGY 17
ANALYTICAL MODEL 17
PARALLEL TRENDS ASSUMPTION 19
NO DIFFERENTIAL SHOCKS ASSUMPTION 20
DATA CLEANING AND CODING 20
RESULTS 22
PARALLEL TRENDS 23
POOLED 26
SEPARATED 30
DISCUSSION 40
METHODOLOGICAL DECISIONS 40
DATA 41
BIRTHWEIGHT 43
MONTH PRENATAL CARE BEGAN 44
RATES OF SMOKING DURING PREGNANCY 44
GESTATIONAL AGE 45
NEWPORT 46
CONCLUSION 47
APPENDIX 50
MAP OF RHODE ISLAND HEALTH EQUITY ZONES 50
HEALTH EQUITY ZONE DETAILS AND DESCRIPTIONS 51
ROBUSTNESS CHECKS 60
HOSPITAL DISCHARGE DATA 63
WORKS CITED 66
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