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Title page for ETD etd-07012015-144850

Type of Document Dissertation
Author Dagadu, Helena Eyram
Author's Email Address helena.dagadu@vanderbilt.edu
URN etd-07012015-144850
Title Placing a Health Equity Lens on Non-Communicable Diseases: Origin and Destination Considerations
Degree PhD
Department Sociology
Advisory Committee
Advisor Name Title
C. André Christie-Mizell Committee Chair
Daniel B. Cornfield Committee Member
Derek M. Griffith Committee Member
Evelyn J. Patterson Committee Member
  • epidemiological transition
  • chronic non-communicable diseases
  • African immigrant health
  • health disparities
  • Ghana
Date of Defense 2015-05-07
Availability unrestricted
This dissertation draws on the concept of health equity to examine how the key stratifying constructs of socioeconomic status (SES) and gender affect the non-communicable disease outcomes in two contexts: Ghana and the U.S., which, respectively, represent important origin and destination countries for Africans. In African countries like Ghana, scholars have observed that high SES is associated with high morbidity and mortality from non-communicable diseases, i.e., the reversal hypothesis. In the U.S., scholars have observed the healthy immigrant effect, which states that due to selectivity, African immigrants arrive in the U.S. with better non-communicable disease outcomes than their native-born counterparts. My three paper dissertation examined whether these western based explanations for understanding the relationship between SES—measured as education, employment status, and income—and non-communicable disease vary by gender.

Utilizing the World Health Organization Study on Global Ageing and Adult Health, Wave 1, Papers 1 and 2 focused on diabetes and hypertension, respectively. Results showed that, consistent with the reversal hypothesis, increased years of schooling increased the odds of diabetes for Ghanaian men, while increased income increased the odds of hypertension for Ghanaian men. For both conditions, Ghanaian women had higher odds compared to Ghanaian men regardless of education or income levels.

Moving from Ghana as origin to the U.S. as destination, Paper 3 utilized 10 waves of the National Health Interview Survey to examine diabetes and hypertension among African immigrants. Results from Paper 3 showed that African men had the worst diabetes and hypertension outcomes of all groups: worse than African women and worse than native-born African American men and native-born whites. Paper 3 also showed that, contrary to the healthy immigrant effect, newly arrived African immigrants did not consistently have better diabetes and hypertension outcomes than immigrants who had been in the U.S. longer. Future studies that build on this work will help in crafting equitable policies in both origin and destination countries that are informed by stratifying factors like SES and gender.

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