This thesis consists of three chapters that investigate issues related to health economics, health behaviours, and labour outcomes. Using the longitudinal data from the National Population Health Survey (NPHS), Chapter 1 examines the association between minimum wage increases and a wide range of health outcomes and behaviours, such as physical health, mental health, chronic conditions, unmet health need, obesity, insurance, smoking, drinking, food insecurity and fruit and vegetable consumption using Difference-in-Difference (DD) and Difference-in-Difference-in-Difference (DDD) models. There is no evidence that minimum wage increases are associated with most health outcomes and behaviours, including better health. There is an association for low-education females with a higher probability of reporting overall fair or poor health, and excess drinking but a lower probability of work absences due to illness and being physically inactive. For low-education men, there is an association with improved mental health and less drinking and smoking. Broadly there is more evidence that minimum wage increases lead to healthier behaviours than evidence of an actual improvement in health, perhaps because of lags effects that are not captured in this analysis. Chapter 2 links the survey data from 2015-16 Canadian Community Health Survey (CCHS) to job characteristics from O*Net to explore the role of job characteristics in explaining the positive association between drinking alcohol and income, which is commonly found in the literature. The study finds that controlling for job characteristics reduces “income return to drinking” substantially (by between one fifth and one half, depending on gender and the measure of alcohol consumption). Last, using data from the Ontario sample of the 2020 CCHS, Chapter 3 estimates the marginal effects of an index of social capital (at the individual or aggregated level) on changes in intentions to get vaccinated. Results show that individual-level social capital is associated with a greater willingness to get vaccinated against Covid-19 at all ages, while aggregate-level social capital is associated with higher vaccination willingness only among older adults. / Dissertation / Doctor of Philosophy (PhD)

Health systems resilience is an emerging issue in health policy and systems research, yet limited information exists on how resilient health systems are developed and the different elements that contribute to whole (national) health systems resilience. In this study, resilience is understood from the socio-ecological lens applicable for complex adaptive systems. Resilience therefore is not only the ability of a health system to address disturbances and restore its basic structures and functions, but also the ability of a health system to transform or re-organise in response to a disturbance if the current system is no longer tenable for the context. Along with the rise in the interest in health systems resilience is a renewed focus on partnership with nonstate providers (NSPs) to complement national health systems. The role of NSPs in supporting health systems resilience however has been largely unexplored. This study thus explores the topic of resilience with respect to health systems and focuses on a particular NSP type – namely, faith-based health providers (FBHPs). It describes four country cases of Ghana, Malawi, the Democratic Republic of Congo, and South Sudan - where FBHPs, though their inclusion in the health system and the activities they undertook, appear to have influenced the resilience of national health systems. FBHPs have played critical roles in strengthening health systems, which has been argued to be a key source of resilience. Their presence also diversified the actors in the health system, enabling them to step in as an alternative service provider when government services were unavailable. Historically, FBHPs appeared to be more flexible which allowed them to respond more quickly during times of crises. This flexibility in operations, coupled with their mission to serve marginalized populations, have supported the development of innovations for the poor, which in some instances have been adopted by national governments. As such, FBHPs have not only acted as buffers in times of shocks or stressors, but have also supported the transformation of national health systems for the better. Recent trends of closer integration with governments however are increasing the interdependencies between FBHPs and the public sector, which have potential to make health systems more vulnerable and less resilient.

Addiction continues to impact millions of people in the US and remains a public health priority. Public health views addiction as a disease that can be prevented and treated. However, traditionally the public health system has viewed individuals and entire communities from the perspective of needs and problems, as opposed to strengths and assets. As a result, the data indicate that Latinos and Latinas have been disproportionately impacted by addiction. However, despite the fact that Latinos and Latinas possess enormous funds of knowledge and cultural capital, they are under-represented among credentialed counselors. Moreover, the literature on drug and alcohol credentialing has produced knowledge about and for addictions counselors, with little attention awarded to Latino/a-specific issues. This dissertation seeks to contribute to the literature and discourse on Latinas and Latinos and the credentialing processes. By employing the story-telling and counter-storytelling methodologies described in Latino Critical Race Theory (LatCrit) and Culturally Responsible Pedagogies, this research creates knowledge with Latino and Latina counselors, beginning from their lived-experiences. This dissertation includes Latino and Latina individuals in the development of knowledge about their experiences with micro-aggressions and the credentialing processes. This qualitative study includes seventeen in-depth interviews and two focus groups with eight credentialed and seven non-credentialed individuals from across Massachusetts. The participants in this research study eloquently talked about the role of class and how their families impacted their views about education. They also recounted their painful experiences with racism, racialization, sexism, colonialism, internalize oppression and other forms of micro-aggressions. It should be noted that a significant number of the participants are in addiction recovery and they talked about their recovery processes, the impact on their families, and their decisions to give back to the community. All of the participants also talked about their experiences with formal education, the impact of participatory versus banking education, and the credentialing process. The counter-narrative produced by their stories includes important recommendations and opportunities for praxis. Throughout the counter-stories one can note the impressive amounts of cultural and social capital, as well as funds of knowledge possessed by the participants. They also exhibit agency, self-determination, and resiliency.

The U.S. public health system is continually challenged by unexpected epidemiological events that pose significant risks to the health of the community and require a commensurate surge in the public health system capacity to stem the spread of the disease. The complexity and even changing nature of funding and surge events drives agencies to innovate in order to maintain and support a competent workforce as well as update, or evolve the knowledge, skills and abilities (KSA) necessary to prevent, mitigate, or even eliminate the health crisis arising from a disease. This research investigates the capability of an agent-based, online personalized (AOP) intelligent tutoring system (ITS) that adaptively uses aptitude treatment interaction (ATI) to deliver public health training and assure competency. Also, presented is a conceptual model that combines Davis' Technology Acceptance Model (TAM) and the Public Health Service's Health Behavior Model (HBM) concepts to understand actual use of new technology in the public health sector. TAM is used to evaluate the effectiveness and the behavioral intent to use the system. HBM is used to explain and predict the preventative health behavior of actual use of the ITS. Our findings indicate the use of the ITS increases participant performance while providing a high level of acceptance, ease of use, and competency assurance. Without the determination of casual sequence, the TAM/HBM conceptual model demonstrated the best fit for predicting actual use of an ITS with the constructs of attitude, cues to action, and perceived ease of use showing the most influence. However, discussion of our findings indicates limited potential for an ITS to make a major contribution to adding workforce surge capacity unless members are directed to utilize it and technology barriers in the current public health IT infrastructure overcome.

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