| This dissertation examines social and structural determinants of health in Mexico. Mexico provides a unique opportunity to study such determinants in the context of social and economic change that has influenced individuals and communities alike. At the individual level, I argue that socioeconomic status (SES) is likely to be inversely related to health given Mexico's relatively advanced stage of development, but that some associations may be weaker than is commonly observed in high income countries given that access to unhealthy lifestyles may not yet be widespread. At the community level, I test the hypothesis of differential risk of diabetes, hypertension, and obesity in more versus less developed communities, based on community type, regional location, and indigenous concentration. I also assess whether differences are explained by indicators of community development that may be conducive to unhealthy lifestyles. Further, I investigate whether SES-obesity associations depend on community development, as proxied by community type. The study uses data from the first wave of the Mexican Family Life Survey (2002) and includes a sample of 19577 adults aged 20 and older. The analysis utilizes single- and multilevel logistic regression models.;I find evidence of inverse associations between multiple measures of SES and health, particularly for poorer general health status. Weaker inverse, absent, or direct associations are observed for chronic conditions. Lack of access to unhealthy lifestyles may play a role in the latter patterns, in that obesity risk is similarly distributed. Gender-related mechanisms may also be important, given that associations between some measures of SES, chronic conditions, and obesity differ for men and women.;Living in smaller urban versus rural communities in Mexico carries excess risk of diabetes, hypertension, and obesity. Obesity risk is highest in the more developed north versus the less developed south and central regions. In contrast, diabetes and obesity risk reduce with higher community indigenous concentration. Accounting for indicators of community development largely explains differential risk by community type and location, but not indigenous concentration, despite lower levels of development in high indigenous communities. Education disparities in obesity are stronger among women in more versus less urban or rural communities. Among men, obesity risk increases sharply with household economic status in rural areas, but this pattern is attenuated in urban communities. Efforts to avoid obesity among higher SES individuals in large urban communities may explain the similar risk of diabetes, hypertension, and obesity in these communities and rural areas. |
