Public Health Policy & Administration

Public Health Policy & Administration (PHPA) faculty include: D. Phuong (Phoenix) Do, Mustafa Hussein, and Linnea Laestadius. Current PHPA research explores the role of policy in influencing population health, as well as the drivers for policy development. This multidisciplinary program includes research on tobacco control, neighborhood context, residential racial and economic segregation, health services and healthcare among immigrants and vulnerable populations, the social determinants of health inequities, and the health impacts of socioeconomic policies. Learn more about selected research projects by PHPA faculty:

Living wage policies and health inequalities

Mustafa Hussein

Many cities in the US enacted living wage policies in the 1990s, thanks to unrelenting community-organizing efforts and labor market activism across urban communities. These policies aimed to lift low-wage workers out of poverty, by often indexing the minimum wage floors in those jurisdictions to the federal poverty level. The economic effects of these policies appear to be sizable, despite limited coverage in the target population. Little is known, however, about the impact of these policies on health or health inequalities. This work uses quasi-experimental methods to derive estimates of the effects of living wage policies on inequalities in mental and physical health, as well as access to healthcare, by race/ethnicity, gender, and socioeconomic position.

The Affordable Care Act and changes in healthcare utilization and financial protection among vulnerable populations

Mustafa Hussein

The Affordable Care Act extended health insurance coverage to millions of low-income Americans, who bear not only a disproportionate share of disease burden but also more catastrophic economic consequences of illness. Focusing on low-income and minority populations, this work examines the extent to which implementation of the ACA, and subsequent coverage and payment policy changes, has affected their levels of unmet healthcare needs, access to preventive care, and the financial burden of medical care utilization.

A marginal structural modeling strategy investigating short and long-term exposure to neighborhood poverty on BMI among U.S. black and white adults

D. Phuong (Phoenix) Do, Cheng Zheng

Estimating the causal impact of neighborhood effects from observational data has proven to be a challenge. Omission of relevant factors may lead to overestimating the effects of neighborhoods on health while inclusion of time-varying confounders that may also be mediators (e.g., income, labor force status) may lead to underestimation. Because policy inferences and anticipated impacts of interventions rely on estimates of causal versus associational connections, addressing these sources of bias are important to make appropriate policy recommendations. Using longitudinal data from the 1999 to 2013 years of the Panel Study of Income Dynamics, this study investigates the link between neighborhood poverty and body weight. We address the issue of possible downward bias due to adjusting for mediating factors by employing a marginal structural modeling strategy, which appropriately adjusts for simultaneous mediating and confounding factors. We then compare conventional naïve estimates to those recovered from marginal structural modeling. To address the issue of possible upward bias due to omitted variables, we conduct a sensitivity analysis to assess the robustness of results against unobserved confounding.

State and local agency responses to community health concerns associated with industrial farm animal production

Jillian Parry Fry, Linnea Laestadius, Clare Grehis, Keeve Nachman, Roni Neff

Large-scale industrial farm animal production (IFAP) operations have been associated with a number of health concerns for individuals residing near facilities. This study sought to examine the ways in which state and local agencies respond to and prevent community-driven health concerns associated with IFAP facilities. An initial manuscript focused on state and county health department responses was published in PLOS ONE in 2013. A follow up manuscript examining state departments of agriculture and facility permitting agencies is currently under review.

The Ties that Bind: Investigating the interconnections between metropolitan segregation, neighborhood context, and racial/ethnic health disparities

D. Phuong (Phoenix) Do, Reanne Frank, John Iceland

Though neighborhood conditions, such as poverty and disorder, are thought to be the primary means through which segregation affects health, we know very little about how segregation and neighborhoods interact together to influence the health. Are the effects of metropolitan segregation conditioned on neighborhood factors or are the effects uniform across all neighborhood types? Do the effects of neighborhood-level (local) segregation on health differ from the effects of metropolitan- level (metro) segregation? Using data from the National Health Interview Survey, this study comprehensively examines the interconnections between metropolitan segregation, neighborhood context, and individual health. We utilize spatial measures of metro and local segregation, account for neighborhood conditions, and apply three-level hierarchal models to asses how contextual factors at different levels interact to affect the health of blacks, Hispanics, and whites in the U.S. This fundamental determinants perspective underscores the potentially immense impact of housing policies, urban design, and the spatial allocation of resources and risk exposures to combat the root cause of racial/ethnic health disparities in the U.S.

Associations of neighborhood segregation with BMI and obesity in the Multi-ethnic Study of Atherosclerosis (MESA)

D. Phuong (Phoenix) Do, Ana Diez Roux, Kiarri Kershaw, Mahasin Mujahid, Mercedes Carnethon

Racial/ethnic differences in obesity, an epidemic in the U.S., are only partially accounted for by individual-level socioeconomic status, suggesting that examination of the causes and correlates of overweight and obesity ought to include other factors patterned by race and ethnicity, including various features of the environments in which groups live. Using the longitudinal data from the Multi-ethnic Study of Atherosclerosis (MESA), this study investigates the association between local spatial measures of segregation and BMI and whether these associations differ between blacks, Hispanics, and whites. We also investigate whether specific physical and social features of neighborhoods (e.g., social cohesion, safety, food access) explain any associations found. Three- level hierarchal models with repeated measures nested within persons nested within neighborhoods are applied across multiple MESA sites, providing a detailed and comparative analysis of the relationship between local segregation and BMI across multiple cities in the U.S.

The political economy of healthcare systems and health inequalities

Mustafa Hussein

In modern democracies, society’s negotiated preferences between market-based solutions and egalitarian commitments have translated to institutional arrangements with varying degrees of public and private control. The healthcare system, as an institution, is one place where these tensions have palpable presence and rather direct consequences, especially for vulnerable groups in the population. On one end, this work considers the impact of societal values and attitudes, and how effectively they are translated, through democratic processes, into structural health-system policies. On the other end, the impact of the emerging structure of the healthcare system on health outcomes among disadvantaged populations is considered. While these analyses use data from developed countries, findings could have implications for the development and strengthening of health systems in low- and middle-income countries.