Date of Award

Summer 2017

Document Type


Degree Name

Doctor of Philosophy (PhD)


School of Public Service

Committee Director

John Morris

Committee Member

Mohammad Najand

Committee Member

Meagan Jordan


Although there is a growing literature that uses national and international data to investigate health outcomes and their link to the determinants of health, empirical studies on whether or not there is a causal relationship between health outcomes and the determinants of health, to our knowledge, has not been generally done previously. To fill this gap, the main focus of this dissertation is to empirically analyze the relationship existing between health determinants and health outcomes among the least healthy state (Mississippi), the middle ranked state (Virginia) and the healthiest state (Hawaii) as measured by American Health Ranking (AHR). This study uses multiple regression models in order to measure the impact of independent variables on health outcomes. For more in depth study of the casual relations between health outcomes and our independent variables, Vector Auto Regression Model (VAR) with embedded Granger causality is used. The data for this analysis are chiefly obtained from the American Health Rankings Organization. Premature death, cancer death, cardiovascular death, and infant mortality are used as proxy for health outcomes. Our independent variables, to measure what factors influence health outcomes, are divided into four categories: behavioral factors, environmental factor, socioeconomic factors, and policy factors. The measures of our independent variables for health behavior are smoking, excessive drinking, obesity and physical inactivity. The measure of environmental factor is air pollution. Education, change in personal income, unemployment rate and income disparity are included in this study as the measure of socioeconomic independent variables. The measures of policy factors are health insurance and public health funding.

The results reveal that obesity, air pollution, income disparity, high school graduation rate, public health funding and health insurance influence health outcomes and are the main factors that affect the health outcomes of Mississippi, Virginia and Hawaii. The finding of this study may provide the useful information for researchers, health professionals and policymakers in assessing the conditions and possible improvements, which can be made within each determinants of health that have been identified as a leading cause of death to reduce health disparities.


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