An ecological analysis of the effects of political inputs on health outcomes: The case of the black-white infant mortality disparity.

Abstract

It has been well documented that the Black infant mortality rate in the U.S. is about twice the white rate. Previous research suggests support for an effect of a variety of political and social factors on the black/white infant mortality disparity. There is some evidence that government actions have helped to reduce the infant mortality rate over the last three decades. And, there is further evidence that blacks in political office tend to allocate resources in support of health care. However, research on the impact of these programs and the effect of increased funding to public health, on the black/white infant mortality differential is lacking. This dissertation analyzes 176 U.S. cities with a population of at least 50,000 in 1980 and at least ten percent black population. Structural equation modeling is used to conduct a systematic inquiry into three research questions which are of theoretical and substantive importance. (1) What has been the effect of greater black political control of municipal resources on the black/white differential in infant mortality? (2) Has increased black political control of municipalities had an effect on budgetary allocations to public health? (3) Have municipal budgetary allocations to public health had an effect on infant mortality rates in the municipality? Support was found for the hypothesis that Black political representation has reduced the Black/White infant mortality differential. This is, in cities with higher levels of Black political and community organization the racial infant mortality disparity is smaller. Cities in which the Black population is proportionally politically represented are more likely to have high municipal budgetary allocations to health care. Cities with Black mayors are not more likely than cities which do not have Black mayors to have budgetary allocations that are above the national average. However, cities with Black mayors and Black proportional representation on the city council have the highest health care budgetary allocations. Although municipal budgetary allocations to health care do not have a direct impact on the infant mortality race disparity, higher municipal health care allocations improve the impact of Black community organization on reducing the infant mortality disparity.