UC Berkeley

This dissertation examines whether spatial measures of health determinants and health outcomes are being used appropriately and effectively to improve the health of marginalized populations in the United States. I concentrate on three spatial measures that have received significant policy and regulatory attention in California and nationally: access to healthful foods, climate change, and housing quality. I find that measures of these health determinants have both significant limitations and unrealized potential for addressing health disparities and promoting health equity.

I define spatial triage as a process of using spatial data to screen or select place-based communities for targeted investments, policy action, and/or regulatory attention. Chapter 1 describes the historical context of spatial triage and how it relates to ongoing health equity research and policy. In Chapter 2, I evaluate spatial measures of community nutrition environments by comparing data from in-person store surveys against data from a commercial database. I find that stores in neighborhoods with higher population density or higher percentage of people of color have lower availability of healthful foods and that inaccuracies in commercial databases may produce biased measures of healthful food availability.

Chapter 3 focuses on spatial measures of climate change vulnerability. I find that currently used spatial measures of "disadvantaged communities" ignore many important factors, such as community assets, region-specific risks, and occupation-based hazards that contribute to place-based vulnerability. I draw from examples of successful actions by community-based environmental justice organizations and reframe "disadvantaged" communities as sites of solutions where innovative programs are being used to simultaneously address climate mitigation, adaptation, and equity goals.

In Chapter 4, I combine electronic health records, public housing locations, and census data to evaluate patterns of healthcare utilization and health outcomes for low-income children in San Francisco. I find that children who live in redeveloped public housing are less likely to have more than one acute care hospital visit within a year than children who live in older, traditional public housing. These results demonstrate how integrating patient-level data across hospitals and with data from other sectors can identify new types of place-based health disparities. Chapter 5 details recommendations for analytic, participatory, and cross-sector approaches to guide the development and implementation of more effective health equity research and policy.