Gomez-Vidal Cristina, Palmer Ashley N, Kitchens Katherine, Ratliff G Allen, Graaf Genevieve
School of Social Welfare, University of California, Berkeley 120 Haviland Hall, Berkeley, CA, 94709, USA.
Department of Social Work, Harris College of Nursing & Health Sciences, Texas Christian University, 2800 South University Drive, Fort Worth, TX, 76109, USA.
SSM Popul Health. 2024 Nov 19;28:101728. doi: 10.1016/j.ssmph.2024.101728. eCollection 2024 Dec.
Local government policies and practices shape the context of the places that can alter a population's life chances through socioeconomic factors, built environments, and healthcare access. County governments, one of the most ubiquitous U.S. political structures, impact health outcomes within their jurisdiction through multiple policy levers and pathways. By identifying which political determinants within counties are associated with variation in life expectancy and premature death, we can better intervene on modifiable factors. One overlooked political determinant from public health studies is the county's responsibility as the primary local government for approximately a third of the U.S. population and 93% of land in unincorporated areas. To conduct an ecological study and assess associations between county population health and county responsibility for unincorporated areas and populations, we created and tested two county indicators of unincorporation. Multilevel multivariable regression results showed that larger proportions of unincorporated land within a county are associated with lower average county life expectancy. More testing of the measurement is needed to understand the relationship between unincorporation, county government, and population health outcomes.
地方政府的政策和做法塑造了相关场所的环境，这些环境可通过社会经济因素、建筑环境和医疗保健可及性来改变人口的生活机遇。县政府是美国最普遍的政治结构之一，它通过多种政策杠杆和途径影响其辖区内的健康结果。通过确定县内哪些政治决定因素与预期寿命和过早死亡的差异相关联，我们可以更好地干预可改变的因素。公共卫生研究中一个被忽视的政治决定因素是，县政府作为主要地方政府，负责约三分之一的美国人口以及非建制地区93%的土地。为了进行一项生态研究并评估县人口健康与县政府对非建制地区及人口的责任之间的关联，我们创建并测试了两个非建制县指标。多层次多变量回归结果表明，一个县内非建制土地比例越大，该县的平均预期寿命越低。需要对该测量方法进行更多测试，以了解非建制状态、县政府与人口健康结果之间的关系。
