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Factors Influencing Health Outcomes Across the Least, Average and Healthiest States in America

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Factors Influencing Health Outcomes Across the Least, Average and Healthiest States in America Old Dominion University ODU Digital Commons School of Public Service Theses & Dissertations School of Public Service Summer 2017 Factors Influencing Health Outcomes Across the Least, Average and Healthiest States in America Somayeh Hooshmand Old Dominion University, [email protected] Follow this and additional works at: https://digitalcommons.odu.edu/publicservice_etds Part of the Public Administration Commons Recommended Citation Hooshmand, Somayeh. "Factors Influencing Health Outcomes Across the Least, Average and Healthiest States in America" (2017). Doctor of Philosophy (PhD), Dissertation, School of Public Service, Old Dominion University, DOI: 10.25777/sqdq-xm77 https://digitalcommons.odu.edu/publicservice_etds/7 This Dissertation is brought to you for free and open access by the School of Public Service at ODU Digital Commons. It has been accepted for inclusion in School of Public Service Theses & Dissertations by an authorized administrator of ODU Digital Commons. For more information, please contact [email protected]. FACTORS INFLUENCING HEALTH OUTCOMES ACROSS THE LEAST, AVERAGE AND HEALTHIEST STATES IN AMERICA by Somayeh Hooshmand B.A. May 2005, Chamran University of Ahvaz, Iran Ph.D. September 2014, Universiti Putra Malaysia, Malaysia A Dissertation Submitted to the Faculty of Old Dominion University in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF PHILOSOPHY PUBLIC ADMINISTRATION AND POLICY OLD DOMINION UNIVERSITY August 2017 Approved by: Dr. John Morris (Director) Dr. Mohammad Najand (Member) Dr. Meagan Jordan (Member) ABSTRACT FACTORS INFLUENCING HEALTH OUTCOMES ACROSS THE LEAST, AVERAGE AND HEALTHIEST STATES IN AMERICA Somayeh Hooshmand Old Dominion University, 2017 Director: Dr. John Morris Although there is a growing literature that uses national and international data to investigate health outcomes and their link to the determinants of health, empirical studies on whether or not there is a causal relationship between health outcomes and the determinants of health, to our knowledge, has not been generally done previously. To fill this gap, the main focus of this dissertation is to empirically analyze the relationship existing between health determinants and health outcomes among the least healthy state (Mississippi), the middle ranked state (Virginia) and the healthiest state (Hawaii) as measured by American Health Ranking (AHR). This study uses multiple regression models in order to measure the impact of independent variables on health outcomes. For more in depth study of the casual relations between health outcomes and our independent variables, Vector Auto Regression Model (VAR) with embedded Granger causality is used. The data for this analysis are chiefly obtained from the American Health Rankings Organization. Premature death, cancer death, cardiovascular death, and infant mortality are used as proxy for health outcomes. Our independent variables, to measure what factors influence health outcomes, are divided into four categories: behavioral factors, environmental factor, socioeconomic factors, and policy factors. The measures of our independent variables for health behavior are smoking, excessive drinking, obesity and physical inactivity. The measure of environmental factor is air pollution. Education, change in personal iii income, unemployment rate and income disparity are included in this study as the measure of socioeconomic independent variables. The measures of policy factors are health insurance and public health funding. The results reveal that obesity, air pollution, income disparity, high school graduation rate, public health funding and health insurance influence health outcomes and are the main factors that affect the health outcomes of Mississippi, Virginia and Hawaii. The finding of this study may provide the useful information for researchers, health professionals and policymakers in assessing the conditions and possible improvements, which can be made within each determinants of health that have been identified as a leading cause of death to reduce health disparities. iv Copyright, 2017, Somayeh Hooshmand, All Rights Reserved. v This thesis is dedicated to improve the health of people all over the world. vi ACKNOWLEDGMENTS I acknowledge my sincere appreciation and gratitude to my parents and to my dearest siblings for their love, support and faith in my ability to achieve my goals. I would like to express my deepest appreciation to my thesis advisor Professor John Morris for his constructive support and useful guidance. I will never forget his kindness and care as well as the enthusiastic assistance he has so generously provided throughout my Ph.D. program. His willingness to give his time so generously has been very much appreciated. I would like to extend my deepest gratitude to my dissertation committee members. My sincere appreciation is extended to Dr. Meagan Jordan, for all of her help and suggestions throughout the development of this manuscript. I’m also deeply indebted to Professor Mohammad Najand who has consistently inspired me in this study and provided me precious suggestions and advice. I would like to acknowledge his comments and suggestions, which was crucial for the successful completion of this dissertation. His guidance and mentorship throughout my Ph.D. program and during my dissertation research was invaluable to my growth as a scholar and a researcher. I am deeply grateful to my classmates and friends for all of their support throughout this journey. vii TABLE OF CONTENTS Page LIST OF TABLES….......................................................................................................................x LIST OF FIGURES…..................................................................................................................xiv CHAPTER 1: INTRODUCTION...................................................................................................1 Problem Statement ..........................................................................................................................3 Statement of Research Importance .................................................................................................5 Research Objectives and Questions.................................................................................................9 Theoretical Approach and Overview of Methodology .................................................................10 Organization of this Dissertation...................................................................................................12 CHAPTER 2: LITERATURE REVIEW.......................................................................................13 Population Health Definition and Concept ...................................................................................13 Differences and Commonalities in the Definition of Population Health.......................................14 Relationship Between Individual and Population Health..............................................................17 Population Health Outcomes.........................................................................................................18 Population Health Framework.......................................................................................................19 Population Health Outcome Measures .........................................................................................21 Mortality...........................................................................................................................23 Life Expectancy................................................................................................................24 Life Expectancy at Birth ..................................................................................................24 Life Expectancy at Age 65...............................................................................................25 Summary Measures of Population Health.....................................................................................26 Attributes of Good Health Outcome Measures.............................................................................28 Determinants of Health..................................................................................................................29 1.Behavioral Factors........................................................................................................31 2.Environmental Factors..................................................................................................31 3.Social and Economic Conditions..................................................................................33 Education................................................................................................................33 Income ...................................................................................................................34 4.Health Care...................................................................................................................36 Health Policy and Health Expenditure ..................................................................36 Population Health in the Affordable Care Act ......................................................37 5.Genetics.........................................................................................................................40 A Model of Health Outcomes and Hypotheses Testing.................................................................41 Health
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