Increasing evidence suggests that the environment is related to many public
health challenges. Unequal distributions of services and resources needed for healthy
lifestyles may contribute to increasing levels of health disparity. However, empirical
studies are not sufficient to understand the relationship between health disparity and the
built environment.
This dissertation examines how health disparity are associated with the built
environment and if the environmental conditions that support physical activity and
healthy diet are associated with lower health disparity. This research uses a multidisciplinary
approach, drawing from urban planning, regional economics and public
health.
The data came from the Behavioral Risk Factor Surveillance System, and the
GIS derived environmental data and the 608-respondent survey data from a larger study
conducted in urbanized King County, Washington. Health disparity was measured with
the Gini-coefficient, and health status and obesity were used as indicators of health. Hot spot analysis was used to identify the spatial aggregations of high health disparity, and
multiple regression models identified the environmental correlates of health disparity.
The overall trend showed that disparity has increased in most states in the US
over the past decade and the southern states showed the highest disparity levels. Strong
spatial autocorrelations were found for disparities, indicating that disparity levels are not
equally distributed across different geographic areas. From the multivariate analyses
estimating disparity levels, spatial regression models significantly improved the overall
model fit compared to the ordinary least-square models. Areas with more supportive
built environments for physical activity had lower health disparities, including proximity
to downtown (+) and access to parks (+), day care centers (+), offices (+), schools (+),
theaters (+), big box shopping centers (-), and libraries (-). Overall results showed that
the built environment, compared to the personal factors, was more strongly correlated
with health disparities.
This study brings attention to the problem of health disparity in the US, and
provides evidence supporting the existence of spatial disparity in the environmental
support for a healthy lifestyle. Further research is needed to better understand
environmental and socioeconomic conditions associated with health disparity among
more diverse population groups and in different environmental settings.
| Identifer | oai:union.ndltd.org:tamu.edu/oai:repository.tamu.edu:1969.1/ETD-TAMU-1631 |
| Date | 15 May 2009 |
| Creators | Kim, Eun Jung |
| Contributors | Lee, Chanam |
| Source Sets | Texas A and M University |
| Language | en_US |
| Detected Language | English |
| Type | Book, Thesis, Electronic Dissertation, text |
| Format | electronic, application/pdf, born digital |
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