PHD, Doctor of Philosophy
Dissertation - Open Access
School of Public Administration and Policy
Feiock C. Richard
Recent research on local sustainability investigates the challenges to public health triggered by health disparities and inequalities. Modern public health sectors recognize that health behavioral changes among small groups and populations are not enough to promote health equality and healthy communities. Many health professions stress that the physical environment has become a key feature for reducing health disparities and accomplishing community wealth by which the environment must be managed by social, economic, and demographic circumstances.
To deal with modern public health concerns and the interests of physical environment, many local governments devise a comprehensive plan to address public health improvement. The purposes of the comprehensive plan are to integrate public health interests with local policy sectors as well as to seek developmental growth and environmental protection. While many local governments attempt to reconnect between the comprehensive plan and the goals of public health, not all local governments do provide a comprehensive plan for public health improvement.
The variation among local governments can be explained by the concept of healthy urban governance which includes the nature of urban politics, collaborative actions, and existing population health status. Since healthy urban governance retains interactive processes to produce a comprehensive set of urban plans, the political market framework and urban governance are applied to help understand interactive processes in terms of inter-sectoral and inter-organizational collaboration; consensus building; and advancement of political bargaining and negotiating instead of one-single way of urban plan.
This dissertation investigates four questions to explore the policy choice of comprehensive planning to explicitly address public health: 1) which local contextual factors affect the adoption of the comprehensive plan, 2) to the extent of the first question, which factors including urban politics and collaborative planning governance create the integrative set in order to incorporate public health in local policy sectors , 3) which health outcomes and factors associated with the existing population health status influence the adoption of the plan, and finally 4) to the extent of third question, what are the direct and indirect causalities among health factors, urban politics, and the adoption of the plan.
In terms of the above research questions, this dissertation highlights three theoretical perspectives. The first perspective is urban politics by which a political institution takes into account the mediating effect of institutions as a product of interactive processes among elected politicians, the community, and interest groups. It is more likely for the politics in healthy urban governance to be highlighted in terms of collective will and whether or not a political institution can pursue a majority rule. Second is the multidisciplinary policy action which encompasses the joint actions among inter-sectoral and inter-organizational collaboration. This perspective suggests that, rather than bureaucratic fragmentation, health policy oriented specialization and professionalization, the multilateral policy actions should be operated in light of collective will, shared norms, and agreements. Third is a place-based population health which views population health as differently shaped by existing physical, social, and environmental conditions. Moreover, this view concentrates on the presumption that the creation of efficient and effective interaction among people, environment, and economy comes first so as to increase high accessibility toward physical activities; so as to promote social inclusion; and so as to enhance social connectivity.
In five published data sources (i.e, 2011 survey of `Comprehensive Planning For Public Health', U.S Census Bureau, National Population Health in Wisconsin Health Institute, Municipal Year Book), Heckman Selection Model and Path analysis are utilized as analytical methods. The empirical results explore whether urban politics, collaborative planning governance, and place-based population health influence the adoption of the comprehensive plan and the integrative sets of the plan.
The empirical evidence shows that the adoption and integrative set of the comprehensive plan for public health improvement are a product of the willingness of local politics which represent governmental responsibility and accountability; a product of inter-sectoral policy collaboration; a product of collective action between local planning agencies and health departments; a product of poorly-shaped community health status; and a result of the mediating role of political institutions with community health status.
This dissertation suggests that the combination of entire urban plan and the goals of public health is an aggregated preference of citizen, local politics, governing bodies, interest groups, and existing population health status, and physical environment. To achieve the comprehensive set of the urban plan, the local politics should have not only a strong willingness to commit but also a mediating role reflecting community-wide needs of population health. On the other hand, the administrative function of both planning and health agencies should create a collective will to reduce organizational and policy sectoral goal conflicts, resulting in multidisciplinary policy commitments and formulation of an integrative set of urban plan.
Lastly, this dissertation provides an agenda for future research. First, the effects of regional organizations and state governments can be expanded by the assumption that the benefits of physical environment cannot be isolated. Regional-wide organizations, as much as the unit of local government, can have a critical role in attracting the collective actions of local governments which attain the summative benefits of improved public health. Second, while this dissertation tests the policy output of local government, the policy outcome of the comprehensive plan for public health must be investigated in the future. Since the data for the adoption and integrative set of comprehensive plan are restricted in 2011, testing health outcomes cannot be attributed to the effect of the plan. To establish a synthesis of theoretical and analytical models, this dissertation will be expanded from analysis of policy output of local government to analysis of policy outcomes as improved public health.
Park, Sang Chul, "Sustainability, Smart Growth And The Improvement Of Public Health: Regarding Healthy Urban Governance And Physical Environment" (2012). Electronic Theses, Treatises and Dissertations. Paper 5094.