The Studies Of Health Geography Issues Based On Multilevel Models

To be healthy is a good pursue of all human history,is the fundamental human right,as well as the supreme form of freedom.We are in an age where the promoting and hazard factors of health coexist.On one hand,socioeconomic development has improved the aggregate level of human health;those traditionally infectious diseases that had jeopardized human health or human life have been effectively controlled;human foci on heath have been transformed from how to cure diseases to how to prevent ill health;the definition of health has also been changed from the absence of disease to "a state of complete physical,mental and social well-being".Whereas,on the other hand,the global climate changing,urbanization,environmental degradation,the change of life style as well as aging are also challenging human health and demanding more actions to take to keep healthy.Health is the common will of Chinese people of every ethnic group as well as the necessity of human development,is the fundamental requirement of socioeconomic development as well as a key issue which the party and the state have attached great importance to.The Plan of Healthy China 2030 set "Health for all and all for health" as its goal and requires various levels of the society to pay ample attention to control the ecological environmental factors and social factors of human health,to improve healthcare provision,and to develop healthy lifestyles.Researchers from the Geography field had paid attention to health issue for a quite long time.Moreover,Geography has contributed a lot to understand and solve health issues.Recent years,the foci of geographers on health have been transformed from the geography of diseases to the geography of health,the emphasis has been transformed from the impact of physical environment on health to the impact of socioeconomic factor,and the approaches has been transformed from positivist approaches to humanistic approaches.There is urgency for Geograpissues hy Sciences to probe for new thought and new methodology.The health geography have multilevel structures,just like other social science phenomenon.Besides,the common health policy of the party and the nation calls for multilevel participant in controlling the impacting factors of health.In addition,the application of multilevel analysis in international geographical health field is still limited and is rather rare in the field of Chinese Geographical research.Therefore,the aim of this research is to explore the multiple applications of multilevel models in geographical issues to fill the gaps abovementioned.In view of the multilevel,temporal and spatial autocorrelation of health geography issues,the research will study the application of multilevel logistic model,longitudinal multilevel model and spatial multilevel model progressively.To explore the application of multilevel regression models is the main line of this research.The research is consists of three major parts,which consists of the summary of the study context,the introduction of the theory and method and the demonstration of the application.The whole study contains eight chapters,whose contents are as follows:Chapter 1 focuses on the background and literature review of this research.The significance of applying multilevel models to solve health geography issues is stressed and the general frame of this study is also illustrated.Chapter 2 introduces the three typical categories of health geography issues,i.e.hierarchical health geography issues,hieararchical health geographical issues with time-lag and hierarchical health geography issues with spatial autocorrelation,followed by a detailed illustration of three-level logistic model,longitudinal multilevel models containing growth curve model and dynamic model,and spatial multilevel models,which include spatial lag multilevel model and spatial error multilevel model.Chapter 3 explores the application of multilevel logistic models in hierarchical health geography issues.Combines with factor analysis,this study investigates the impacts of socioeconomic and environmental factors on self-rated health status of the lower,the middle and the higher income groups.This study is conducted from individual,community and provincial levels.Chapter 4 explores the application of longitudinal multilevel models in hierarchical health geography issues with time-lag.By taking temporal lag and the variations of each variable from 2011 to 2015 into consideration,this study investigates the impacts of living environment to the body function limitation and mental health status of middle-aged and elderly Chinese populations.This study is conducted from individual and community levels.Chapter 5 explores the application of spatial multilevel models in hierarchical health geography issues with spatial autocorrelation.Combined with the results of geodetector analysis,this study investigates the impacts of socioeconomic and physical environmental factors on life expectancy from vector grid and county levels.Chapter 6 concludes the possible future study focus on the reflection of this research.The main conclusions of this research can be summarized into 8 points.First,health geography issues are hierarchical.Second,health geography issues could be categorized as hierarchical health geography health issues,hierarchical health geography issues with time-lag,and hierarchical health geography issues with spatial autocorrelation.Third,multilevel models could be applied to various kinds of health geography research.Fourth,multilevel models could be combined with other basic statistical research methods to explain health geography issues.Fifth,besides the unequal socioeconomic levels among the lower,the middle and the higher income groups,the environmental injustice among them is another key reason resulting to unequal health status.Sixth,both housing and community infrastructure have significant impacts on the health status of the middle-aged and elderly group,whereas,the effects of community socioeconomic conditions are weak or insignificant;the initial condition issue should be taken into account in conducting longitudinal analysis using dynamic model.Seventh,the distribution of county-level life expectancy shows certain spatial patterns.Furthermore,both socioeconomic and physical environmental factors can significantly affects life expectancy,although the effects of socioeconomic factors are stronger,compared to those of the physical environmental characteristics.In addition,spatial multilevel model could solve the autocorrelation problems of residuals encountered by ordinary multilevel models.Eighth,multilevel models offer a possibility to combine the ideology of positivist and humanist in health geography research.This study has the following merits:firstly,it establishes a multilevel theoretical framework to study health geography issues;secondly,it exemplifies the application of different multilevel models in typical health geography issues;lastly,it enriches the coverage of multilevel analysis in the field of the social sciences.