Manage the Margins: Three Essays on Effective Policymaking for Social Inequality in Health

This dissertation includes three studies, devoted to trying to understand inequality in health between people from different social groups in a democratic society. In the U.S., social inequality in health takes various forms and the key to understanding how democracy solves the problem of inequality lies in a complex set of political and social factors. I take an institutional approach and focus on examining how political and policy institutions, their administrative processes, and the policy implementation environment are linked to social inequality in health. The first essay, Whose Baby Matters More, uses a theoretical framework for evaluating heterogeneous group responses to public health policies and depicts how racial disparities in health are rooted in group heterogeneity in policy responses. The second essay, Anxious Girls and Inactive Boys, focuses on how state-level policy interventions and social capital interactively affect gender differences in health. The third essay, Responsibility for Equity, explores the link between publicness of state healthcare systems and social equity in healthcare access. In the first essay, I focus on racial disparities in infant mortality rates and pool state-level data from 1990 to 2006. The empirical analysis suggests that enhancing the capacity of state healthcare systems is critical to improving population health. Blacks and whites, nevertheless, exhibit different responses to the same policy. Racial disparities could be reduced only when policy interventions generate more relative benefits for Blacks. In the second essay, I find that social capital conditions the effect of public health policies with regard to managing childhood obesity. There are gender differences, moreover, in health outcomes and behavioral responses to state and local-level obesity policies. In the third essay, I find that different institutional factors exhibit different impact on inequality in healthcare access. While public finance resources may reduce inequality in healthcare access, public ownership and the public healthcare workforce do not have significant association with inequality in healthcare access. State Medicaid eligibility rules exhibit moderate impact on inequality in healthcare access.