Author ORCID Identifier

https://orcid.org/0000-0003-0369-3650

Date of Award

5-6-2024

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Health

First Advisor

Daniel Whitaker

Second Advisor

Theres Pigott

Third Advisor

Karen Nielsen

Fourth Advisor

Andrew Heiss

Abstract

Introduction: A growing awareness of social determinants of health and their impact on health disparities has become a core focus of health research in the past two decades. Specifically, a movement towards equity-focused research has led to investigation of place-based research which emphasizes how human-human and human-nonhuman interactions occur within historical and spatial contexts to produce health disparities. While place-based research has the potential to develop sustainable and scalable interventions, continued underinvestment limits our understanding of the mechanisms through which health change may occur. There is a growing need for investigation into place-based factors such as housing, structural processes that shape the environment, and community-level factors to develop effective policies and interventions that address different levels of influence on health.

Methods: To investigate the impact of place-based social determinants of health, we conducted three different studies: 1) a meta-analysis on the impact of supportive housing on health and well-being, 2) a longitudinal multilevel model to determine differences in COVID-19 mortality based on residential characteristics, and 3) a structural equation model exploring relationships between neighborhood characteristics and immune functioning.

Results: Our meta-analysis yielded mixed results. Positive and significant effects were found on quality-of-life and housing stability, but there was little evidence of significant effects on other outcomes. The multilevel model determined that while rate of change in mortality over time was different for historically redlined versus non-redlined areas, race composition of both these areas has an identifiable independent effect on COVID-19 mortality over time. Results from our structural equation model are consistent with the current body of research that suggests that structural inequities in neighborhood disadvantage are linked to impaired immune function.

Conclusions: Well-developed and well-designed health policies can help to reduce differences in socioeconomic and health inequities by reducing barriers to accessing healthcare, increasing opportunities for employment and education, and by developing historically excluded spaces. A focus on access to safe and affordable housing, investment into communities of color, and community-focused research should be utilized to identify where and how resources should be allocated and help empower community members, leading to an overall improvement in health for all.

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