Date of Award

1-1-2017

Language

English

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College/School/Department

Department of Public Administration and Policy

Content Description

1 online resource (ii, v, 127 pages) : illustrations (some color)

Dissertation/Thesis Chair

Erika G Martin

Committee Members

Patricia Strach, Brian Nussbaum

Keywords

Discretion, Emergency preparedness, Evaluation, Policy, Public Health, Social equity, Public health administration, Emergency management, Equality, First responders, Health services accessibility

Subject Categories

Public Administration | Public Health

Abstract

In the past 20 years, large-scale disasters have generated economic loss of $660 billion in the United States. Research has identified that low income individuals and economically vulnerable communities are at heightened risk and often experience disadvantages in access to public services during emergencies. Public administration literature has claimed that social equity should be included as a consideration together with economic and efficiency principles when formulating and implementing public policy. Yet there has been limited empirical research that follows this premise. The three studies that comprise this dissertation are guided by one overarching research question: which socioeconomic characteristics at the community and individual levels, reflect social disparities, or need, and how policy decision making may account for them to reduce disparities in the context of public health emergency preparedness and health policy. Assuming that social economic disparities can be analyzed from different levels and multiple perspectives, this dissertation follows a mixed methods approach to analyze individual and community level data. Chapter 1 relies on quantitative methods to analyze national survey data on household disaster preparedness. Nine preparedness items are classified into resource or action-based preparedness indicators. Logistic and multinomial logit regressions test the association between households’ socio-economic characteristics and preparedness items and levels of overall resource and action-based preparedness. Chapter 2 presents an index of community resilience for New York State (NYS) and uses it as a metric of need for preparedness resources. By conducting a series of policy simulations, it presents alternative grant allocation formulas to the Public Health Emergency Preparedness cooperative agreement grant in NYS. Chapter 3 analyzes how first responders’ beliefs, experiences, and organizational context shape their decision-making processes, and how their actions may help reduce inequality in the access to basic medical care. Each chapter reflects a different perspective to consider social equity in the context of public health emergency preparedness policy: inequality and equity, proportionality equality, and bureaucratic discretion and compensatory opportunity.

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