Essays on Determinants of Health
Open Access
- Author:
- Yang, Di
- Graduate Program:
- Health Policy and Administration
- Degree:
- Doctor of Philosophy
- Document Type:
- Dissertation
- Date of Defense:
- May 22, 2023
- Committee Members:
- Chris Hollenbeak, Program Head/Chair
David Vanness, Major Field Member
Yubraj Acharya, Chair & Dissertation Advisor
Joel Segel, Major Field Member
Kristin Sznajder, Outside Unit & Field Member - Keywords:
- Determinants of Health
Health Equity
Population Health
Social Health Insurance Consolidation
Housing Demolition
Machine Learning - Abstract:
- My dissertation seeks to better understand multiple determinants of health, thus informing the design of policies that target various determinants of health to improve population health and health equality. Chapter 1 briefly introduces the adapted Kindig Framework. In Chapter 2 and 3, I use data from the China Family Panel Studies survey to investigate how two different government policies and interventions can affect health inequality and health outcomes. Chapter 2 evaluates the near-term impact of the consolidation of two social health insurance programs in China. This chapter uses an augmented difference-in-differences model to analyze whether the consolidation reduced health inequality between urban and rural residents. The results contribute to the debates on the ongoing health care reform in China, particularly from a health inequality perspective. Chapter 3 uses two-part model and fixed-effects model to examine the health effects of housing demolition and relocation, as housing is a crucial socioeconomic determinant of health. The findings suggest that housing demolition increases the amount of medical expenditure, conditional on incurring one. The increase is not immediate, but two years after the housing demolition. For the rural population, experiencing housing demolition also worsens self-rated health but increases confidence in the future. Further exploratory analysis shows that demolition compensation is not associated with medical expenditure, self-reported health, or confidence in the future. These results suggest a need for more comprehensive support to families that lose their homes in development projects. Given the multiple ways that housing demolition can affect families beyond direct loss of property, additional support systems may be needed—beyond the provision of cash compensation or replacement housing. Chapter 4 investigates the relative importance and elasticity of population health measures with respect to changes in multiple health determinants. The study uses a machine learning approach and takes advantage of the comprehensive and longitudinal County Health Rankings datasets to reveal the relative elasticity of multiple determinants of health with respect to age-adjusted years of potential life lost at U.S. county level. The results show that baseline obesity rate, baseline physical inactivity rate, and baseline unemployment rate are the top three factors for future potential life years lost in terms of elasticity. These results, when connected with the cost of improving the health determinants, can offer guidance on how to prioritize competing social and health care investments to improve population health.