Social ecological environment and population health: Does where we live matter?

摘要

This dissertation investigates the effects of neighborhood social, economic, demographic, and cultural factors on population health. It attempts to shed light on the questions "does our residence matter to our health, and, if so, how?" The project comprises three empirical studies that investigate social ecological influences on three aspects of health---self-rated health, the onset of diseases in later life, and disease progression for older people. Specific diseases examined in this project include stroke, MI, CHF, hip fracture, and lung cancer. The primary goal of this dissertation is to identify collective properties of geographically anchored community that help shape the patterns of individual and population health. All three studies focus on within-city spatial unit of analysis---either neighborhood aggregated from contiguous census tracts or ZIP code area in the City of Chicago.; Emphasizing ecologic perspectives in health research, this work highlights the role of residential environment in contributing to social inequalities in health. Neighborhood affluence, education, physical and social environment are found to be associated with individual self-rated health after controlling for individual-level demographic, health-behavioral, and socioeconomic factors. Moreover, net of individual socio-demographic characteristics and baseline health, area-based measures of socioeconomic status (SES), physical environment, social organizations, subcultural factors, community stability, and ethnic heterogeneity appear to be potent predictors of disease progression for older people. There is also some evidence to demonstrate that communities with low SES, poor social and physical environment, and a subculture that generally tolerates risky behaviors suffer significantly higher lung cancer incidence rates in older people. Communities with higher level of tolerance of risk behaviors also show higher incidence rates of CHF and hip fracture and higher total incidence rate of the five diseases examined in this study.; Taken together, empirical findings from this research clearly suggest that for the purpose of understanding social inequalities in health and illness, it is crucial to go beyond the domains of proximate risk factors and gain insights into multi-level social ecological settings. This result, largely consistent with previous research, provides strong evidence to support community-based approaches to reducing health inequalities and improving population health.