Theses and Dissertations from UMD
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Item THE LONG TAIL OF HISTORY: COMBINING THE 1940 CENSUS, REDLINING MAPS, AND HRS: METHODS FOR ANALYZING THE IMPACT OF REDLINING ON HEALTH, ECONOMIC, AND HEALTHCARE OUTCOMES IN OLDER ADULTS TODAY(2023) Huang, Shuo Jim; Sehgal, Neil J; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)ABSTRACTTitle of Dissertation: THE LONG TAIL OF HISTORY: COMBINING THE 1940 CENSUS, REDLINING MAPS, AND HRS: METHODS FOR ANALYZING THE IMPACT OF REDLINING ON HEALTH, ECONOMIC, AND HEALTHCARE OUTCOMES IN OLDER ADULTS TODAY Shuo Huang, Doctor of Philosophy, 2023 Dissertation directed by: Neil Jay Sehgal, PhD, MPH Department of Health Policy Management BackgroundAs part of the New Deal in the 1930s, the Federal government used the Home Owners’ Loan Corporation (HOLC) to draw real estate security maps that were color coded or redlined to discourage lending in majority Black neighborhoods. Redlined areas still have worse health and economic outcomes in the present day. Current literature is focused on present-day residents of redlined areas. Tracking exposures to redlining and conditions of redlining close to the 1930s with present-day health is an unexplored area. Methods We utilize geo-referenced 1930s HOLC maps to locate individuals and map demographic considerations. We use novel algorithmic solutions to geolocate unknown 1940 enumeration districts. Using a 1940 census-linked sample of the Health and Retirement Study to locate individuals in HOLC areas at the time, we conduct survival analysis on HOLC categories’ effect on age at death as well as other analysis on health, economic, and healthcare utilization in the near present. We test for a potential mediator. Results Population density is not associated with either HOLC category or present day life expectancy, and is unlikely to be a mediator. In uncontrolled models, for HRS individuals in the 1940 census HOLC category is associated with greater hazards, worse odds of self-rated health, and worse economic outcomes. With controls, HOLC category is only associated with worse odds of self-rated health. HOLC category is not associated with health insurance or healthcare utilization in this sample. Conclusion Redlining is associated with health and economic outcomes which are attenuated when controlling for likely pathways between redlining and health. Future research should focus on whether individuals stay in redlined areas, and on identifying policy and initial state matrix that can describe what redlining may be a proxy for.Item Interdisciplinary Geospatial Assessment of Malaria Exposure in Ann Township, Myanmar(2020) Hall, Amanda Hoffman; Loboda, Tatiana V; Geography; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Despite considerable progress toward malaria elimination in Myanmar, challenges remain owing to the persistence of complex focal transmission reservoirs. Nearly all remaining infections are clinically silent, rendering them invisible to routine monitoring. Moreover, limited knowledge of population distributions and human activity on the landscape in remote regions of Myanmar hinders the development of targeted malaria elimination approaches, as advocated by the World Health Organization (WHO). This is especially true for Ann Township, a remote region of Myanmar with a high malaria burden, where a comprehensive understanding of local exposure, which includes the characterization of environmental settings and land use activities, is crucial to developing successful malaria elimination strategies. In this dissertation, I present an interdisciplinary approach that combines satellite earth observations with two separate on-the-ground surveys to assess human exposure to malaria at multiple scales. First, I mapped rural settlements using a fusion of Landsat imagery and multi-temporal auxiliary data sensitive to human activity patterns with a classification accuracy of 93.1%. A satellite data-based map of land cover and land use was then used to assess landscape-scale malaria exposure as a function of environmental settings for a subset of ten villages where a malaria prevalence survey was carried out. While multiple significant associations were discovered, the relationship found between malaria exposure and satellite-measured village forest cover was the most significant. Finally, a separate detailed survey that explored a variety of land use activities, including their frequency and duration along with testing for clinical or subclinical malaria, was used to identify and quantify factors promoting an individual’s likelihood of malaria infection regardless of the environmental settings. This analysis established strong associations between malaria and individual land use activities that bring respondents into direct contact with forested areas. These results highlight that the current Myanmar malaria elimination strategies, which focus on prevention from within the home (i.e., bednets and indoor spraying), are no longer sufficient to remove remaining malaria reservoirs in the country. A paradigm shift in malaria elimination strategies towards targeted interventions that can disrupt malaria transmission in the settings where the exposure occurs are critical to achieving country-wide malaria elimination.