Doctor of Philosophy (PhD)



Document Type



Findings from numerous studies indicate that individuals living in more unequal societies are at greater risk for a variety of health problems. However, questions remain about the possible pathways that link health outcomes and income inequality. In general, the debate about how income inequality affects individual health centers around two issues: 1) whether the relationship is representative of the level of social cohesion within a given area, and/or 2) whether it is more indicative of the level of local investment in public health infrastructure. Each of these theories, then, represents a potential mediating mechanism through which income inequality impacts individual health. The purpose of this dissertation is to examine the social cohesion and local investment mechanisms through which income inequality may impact individual-level health outcomes. By examining variation in levels of social welfare spending and civic engagement, I investigate which of these competing variables has a stronger mediating effect in the relationship between income inequality and individual health outcomes. To address this research question, I use data from the Integrated Health Interview Series (IHIS)—a collection of microdata based on the public use files of the U.S National Health Interview Survey (NHIS) which is linked to the National Death Index (NDI). Using multi-level modeling techniques, I simultaneously examine the role of environmental-level effects (i.e. degree of local investment/social cohesion) and individual-level effects (e.g. income) on the likelihood of individual mortality in metropolitan areas. The findings presented in this dissertation contradict previous claims about the Income Inequality Hypothesis, which suggests that income inequality is detrimental to individual health. In addition, findings do not support the Social Cohesion or Local Investment Mechanisms as mediating pathways through which income inequality impacts individual health. These results raise questions about the causal effects of income inequality, and the sensitivity of this relationship to level of aggregation and to what factors research choose to control.



Document Availability at the Time of Submission

Release the entire work immediately for access worldwide.

Committee Chair

Blanchard, Troy C.



Included in

Sociology Commons