McMaster University DOCTOR OF PHILOSOPHY (2019) Hamilton, Ontario (Health Research Methods, Evidence, and Impact) TITLE: Measuring International Health Inequalities and Socioeconomic Status Using Household Survey Data AUTHOR: Mathieu J.P. Poirier, B.Sc., M.P.H. (McMaster University) SUPERVISOR: Dr. Michel Grignon NUMBER OF PAGES: xii, 231 / The methods underlying the quantification of health inequalities have profound consequences for measuring progress in achieving health for all. In Chapter two, associations between household wealth indices, income, and consumption were systematically compiled and different methods of wealth index calculation were evaluated for appropriateness of use in a variety of settings. Researchers are presented with a synthesis of existing evidence about the appropriateness of use of wealth indices in urban and rural areas, their robustness to changes in the asset mix, future applications, and advantages and disadvantages of primary competing methods of quantifying SES using household survey data. In Chapter three, international microdata were analyzed to evaluate how magnitudes of health inequality are affected by different methods of quantifying household socioeconomic status (SES), including income, consumption, and asset wealth. In Chapter four, the need for a transnational approach to measuring health inequalities was justified and the new method was developed using an empirical example. Substantively, these chapters develop the most complete evaluation of the association between the asset wealth, consumption, and income using both critical interpretive synthesis and microdata analysis, as well as the first meta-analysis evaluating changes in health inequality magnitudes according to the SES measure used over time and across country-income levels. The transnational analysis of health inequalities uncovered previously hidden health disparities in the island of Hispaniola, and detailed instructions for all methodological aspects of the new method were presented. The distribution of disease between nations, subnational regions, and urban-rural areas in Hispaniola were analyzed from 1994 to 2013, and the first relative geospatial wealth ranking between Haiti and the Dominican Republic was presented. Global health researchers should strive to measure the equity of health between people, and this sometimes requires analyzing populations that are not neatly contained by national boundaries. / Thesis / Doctor of Philosophy (PhD) / This thesis investigates social inequalities in health and how to measure socioeconomic status (SES) using household surveys in a way that is robust across jurisdictions. It examines how wealth indices compare to income and consumption, and develops a new method to calculate transnational health inequalities. Chapter two conducts a comprehensive evaluation of evidence surrounding the use of wealth indices in urban and rural areas, robustness to changes in assets, future applications, and the advantages and disadvantages of the primary competing methods for quantifying household SES. The third chapter systematically evaluates how health inequality magnitudes evolve over time and across country-incomes according to SES measure. Finally, a transnational measurement of health inequalities was calculated for the island of Hispaniola in chapter four, uncovering the distribution of disease between nations, subnational regions, and urban-rural areas. Detailed instructions for all methodological aspects of the new transnational method are presented.

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The rapid emergence of broadband, or always-on Internet, during the course of the last decade, has increased the importance of the so- called information society in urban and industrialized societies world- wide. Liberalized information and communications technology (ICT) market forces worldwide have however failed to supply these services to rural and low-income regions resulting in the so-called digital divide. One financial tool, adopted by many developing nations to drive broadband investments in underserved areas, is the universal service fund (USF), a public fund mainly levying its resources from ICT market players. USFs have previously been used to fund telecom networks but with the growing importance of broadband, structural and regulatory discrepancies are preventing USFs from adequately supporting broadband investments. Currently, little up-to-date academic theory exists within this field; thus, this thesis serves to outline principles that policy-makers and regulators need to consider when designing or reforming universal service fund mechanisms. The research is based on a series of qualitative country case studies investigating policy, procedural, and executional aspects related to USFs and rural broadband. Publicly available material has been complemented with interviews of stakeholders from various levels to establish a holistic empirical base upon which conclusions have been drawn. The conclusions outline principles governing public involvement in USFs, roles played by various stakeholders in the broadband ecosystem, and strategies for rural broadband network deployment. / Framfarten av bredband under det senaste årtiondet har ökat vikten av det så kallade informationssamhället i de industrialiserade och urbaniserade samhällen. Marknadskrafterna inom den liberaliserade informations- och kommunikationsindustrin har dock misslyckats med att göra dess tjänster tillgängliga till glesbefolkade och låginkomstregioner, vilket har lett till en digital klyfta. Ett finansiellt hjälpmedel som många utvecklingsländer har anammat för att påskynda bredbandsinvesteringar i regioner med få bredbandsuppkopplingar är fonder för samhällsomfattande tjänster (USF), som är en offentlig fond vilken får den största delen av sitt kapital genom en pålaga på intäkterna från aktörer inom informations- och kommunikationsindustrin. USF:er har tidigare använts för att finansiera telekomnätverk, men i takt med att bredbandets ökande genomslag i samhället har strukturella och regleringsmässiga problem med USF:erna uppdagats vilka hindrar dem från att effektivt stödja bredbandsinvesteringar. För närvarande finns lite akademisk teori på området, och sålunda syftar denna uppsatts till att tillhandahålla principer vilka beslutsfattare och regulatorer bör efterfölja vid utformning eller reformering av mekanismer för samhällsomfattande tjänster för bredband. Arbetet baseras på en serie kvalitativa fallstudier av länder med policy, procedurella och verkställande aspekter kopplade till USF:er i områden med få bredbandsuppkopplingar i fokus. Material tillgängligt för allmänheten har kompletterats med intervjuer av intressenter från olika organisations- och samhällsnivåer för att skapa en heltäckande empiri på området från vilka slutsatser har dragits. Slutsatserna innehåller principer som rör offentlig inblandning i USF:er, roller för samhällets olika intressenter i ett ekosystem för bredband, samt strategier för utbyggnad av bredbandsnätverk i glesbefolkade områden.

À travers cette recherche, nous avons étudié la violation des droits des travailleurs migrants haïtiens en République dominicaine à la lumière du principe de l’effectivité du droit international. L’étude analyse en profondeur deux aspects de cette violation : la question d’expulsion collective et la violation du droit à la nationalité. En réaction à celle-ci, nous analysons le problème de l’exécution des décisions de justice de la Cour régionale condamnant l’État dominicain. En premier lieu, l’histoire relate que dès l’époque coloniale, des différends survirent entre les deux puissances colonisatrices de l’île - la France (à l’ouest/Haïti) et l’Espagne (à l’est/la République dominicaine) - en vue du partage de cet espace géographique. Ces différends sont transmis comme héritage aux deux États (Haïti et la République dominicaine) issus de la colonisation. Avec le développement de la migration haïtienne sur le territoire voisin, les différends persistent en raison des traitements infligés aux travailleurs migrants haïtiens. Ils sont considérés comme étant des invités indésirables au point d’être qualifiés de problème. Dans l’espace public dominicain, il a été institué l’expression «el problema haitiano». Si Trujillo a tenté de résoudre ledit problème via le génocide, à partir des années 1990, les autorités préfèrent procéder par des vagues de déportations massives réalisées de façon sommaire contrairement au droit international. Par exemple, les garanties judiciaires ne sont pas respectées. En vue de mieux faciliter la déportation, l’État dominicain met en œuvre tout un processus de déchéance de nationalité. Ainsi, au cours des années 2000, les fonctionnaires de l’administration publique dominicaine refusaient d’enregistrer les enfants qui, selon la constitution, ont droit à la nationalité dominicaine. D’autre part, ils ont saisi les documents d’identité des individus qui font partie de cette catégorie de personnes. En réaction à ces exactions, la Cour interaméricaine des droits de l’homme a condamné à deux reprises l’État dominicain. Par contre, dans les faits, ces décisions peinent à être exécutées. Dans l’arrêt rendu dans le cadre de l’affaire des enfants Yean et Boscico, les mesures les plus significatives ne sont pas exécutées. Dans l’affaire des personnes dominicaines et haïtiennes expulsées, en guise d’exécution, la réaction de l’État constitue, de préférence, des résistances nationales à l’exécution de ladite décision. Tant sur le plan politique que sur les plans judiciaire et administratif, le comportement de l’État va dans le sens contraire à l’exécution de la décision de la Cour de San José. Dans les faits, les règles de droit garantissant les droits en question restent lettres mortes vis-à-vis de l’État dominicain. Voilà ce qui permet de confirmer l’hypothèse principale de la recherche selon laquelle la violation du droit à la nationalité des personnes d’ascendance haïtienne en République dominicaine s’explique en raison de l’ineffectivité des règles de droit codifiées par le droit international public. Afin que les personnes d’ascendance haïtienne puissent jouir de leurs droits, nous faisons, entre autres, des recommandations à l’État dominicain, à la République d’Haïti et à la communauté internationale. / This research focuses on the problem of the violation of the rights of Haitian migrant workers in the Dominican Republic. We highlight two key points. The first one is the mass deportation; the second one refers to the violation of the right of nationality. In reaction to this one, we analyze the problem of execution of the decisions of the international jurisdictions precisely, the Court of San José that condemned the Dominican Republic. First, the history shows that since the colonial time, there were disputes between the two-colonizing superpower of the island - France (west, Haiti) and Spain (east, Dominican Republic) - about their part of the territory. Those misunderstandings are transmitted as a heritage to the two countries that share the geographic territory of the island at the end of the colonization. With the development of the Haitian migration on the territory of the Dominican Republic, the dispute increased between the two countries because of the treatment that Haitian cane cutters received. They considered them as unwanted guest and as a problem. So, in the Dominican society, people use the expression « el problema haitianno ». Via his genocide, Trujillo tried to solve that problem, but nowadays, since the beginning of the 1990s, the authorities preferred to organize the mass deportation of Haitian workers and their descents. It is a violation not only of the principles of public international law, but also of human rights. For example, the Dominican Republic violates the juridical guarantees codified by the Inter-American Convention on Human Rights. In order to facilitate the mass deportation, the State creates a process of denationalization. Therefore, during the 2000s, the officials of the Dominican public administration refused to deliver a birth certificate to children who have this right according to the constitution. On the other hand, the official use to seize and/or destroy documents of identity of this category of people. In reaction, the Inter-American Court of Human Right condemned twice the Dominican Republic because of those violations. But the state refuses to execute those decisions. In the case of the girls Yean and Boscico, the key points of the decision are not executed. In the case of the Dominican and Haitian expelled, the State reacted against the decision and refuse to execute it. Here are, among others, the arguments that confirm the principal hypothesis of the research that assimilates the violation of the right of nationality of Haitian migrants’ workers' descents in the Dominican Republic to the effectiveness of the rule of law of international public law. In order to repair the damages caused to the Haitian cane cutters and their descents, we make recommendations first, to Dominican State; secondly, to Haitian State and lastly to the members of the international society.

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This thesis examines contemporary musical and literary representations of female fatness in the Hispanic Caribbean. Chapter I explores the stereotype of a greater acceptance and valorization of fatness within the African Diaspora using contemporary feminist scholarship on cultural aesthetics and the body. Fatness is discussed as being both sexually transgressive and traditionally feminine. Chapter II juxtaposes male representations of “la gorda” in the lyrics of popular music of from Cuba, the Dominican Republic and Puerto Rico with the feminist politics of underground hip hop. Chapter III analyzes Guillermo Cabrera Infante’s hyperbolic representation of La Estrella, his fictionalization of Cuban bolero singer Fredy Rodriguez, in Ella cantaba boleros y “Metafinal” (1996). The aquatic subtexts and grotesque characterization of La Estrella’s body construct her as an icon of musical authenticity and exceptionality as well as a symbol of strength and resistance.

This thesis examines contemporary musical and literary representations of female fatness in the Hispanic Caribbean. Chapter I explores the stereotype of a greater acceptance and valorization of fatness within the African Diaspora using contemporary feminist scholarship on cultural aesthetics and the body. Fatness is discussed as being both sexually transgressive and traditionally feminine. Chapter II juxtaposes male representations of “la gorda” in the lyrics of popular music of from Cuba, the Dominican Republic and Puerto Rico with the feminist politics of underground hip hop. Chapter III analyzes Guillermo Cabrera Infante’s hyperbolic representation of La Estrella, his fictionalization of Cuban bolero singer Fredy Rodriguez, in Ella cantaba boleros y “Metafinal” (1996). The aquatic subtexts and grotesque characterization of La Estrella’s body construct her as an icon of musical authenticity and exceptionality as well as a symbol of strength and resistance.

La plupart des études en gestion sur la performance des entreprises sont centréessur l'explication de la relation entre les facteurs internes ou des caractéristiquesintrinsèques de l'entreprise (niveau d'endettement, diversification des produits, lastratégie concurrentielle, etc.) et son performance. Cette thèse vise à déterminerquels sont les facteurs de risque exogènes qui ont un impact sur la performance desentreprises en République Dominicaine? Ces facteurs, affectent-ils différemment lesmicro, petites et moyennes entreprises en fonction de leur secteur d'activité. Quelest le risque pour chacun des plus représentatifs sous-secteurs des entreprisesDominicaines? Nous avons constaté que les facteurs de risque les plusstatistiquement significatifs sont les dépenses de consommation des ménages, letaux d'intérêt des banques commerciales, l'investissement total, le taux de changede DOP à USD et le déficit de la balance commerciale. La composition etl'importance des facteurs varient considérablement en fonction de la taille desentreprises et le sous-secteur auquel ils appartiennent. Les grandes entreprises sonten moyenne moins risqué que des moyennes, petites et micro entreprises, n’importequel que soit le sous-secteur auquel ils appartiennent. / Many of the management studies on the performance of the company are focusedon explaining the relationship between the internal factors or intrinsic characteristicsof the firm (debt level, diversification of products, competitive strategy, etc.) and itsperformance. This thesis seeks to determine, what are the exogenous risk factorsthat impact the performance of all companies in the Dominican Republic? Thesefactors differentially affect the micro, small and medium enterprises according to theirbusiness sector. What is the risk on each of the most representative sub-sectors ofthe Dominican companies? We found that the most statistically significant riskfactors are the household consumption expenditure, the interest rate of commercialbanks, the total investment, the DOP to USD exchange rate and the deficit on thetrade balance. The composition and importance of the factors significantly variesdepending on the size of the company and the sub-sector to which it belongs. Also,large firms are on average less risky than medium, small and micro regardless of thesub-sector they belong. / Muchos de los estudios de gestión sobre el performance de la empresa se enfocanen explicar la relación que existe entre los factores o características intrínsecas de laempresa (nivel de endeudamiento, diversificación de productos, estrategiacompetitiva, etc.) y el performance de la misma. Esta tesis busca determinar¿cuáles son los factores exógenos de riesgo que impactan el performance de lasempresas de la República Dominicana? Si estos factores afectan de forma diferentea la micro, pequeña y mediana empresa según su actividad empresarial. ¿Cuál es elriesgo que tiene cada uno de los sub-sectores más representativos de las empresasdominicanas? Encontramos que los factores de riesgo estadísticamente mássignificativos son el consumo de los hogares, la tasa de interés de los bancoscomerciales, la inversión total, la tasa de cambio de DOP a USD y el déficit en labalanza comercial. La importancia y composición de los factores varíasignificativamente según el tamaño de la empresa y el sub-sector al que pertenece.También, en promedio, las empresas grandes tienen menos riesgos que lasmedianas, pequeñas y micro sin importar al sub-sector que pertenezcan.