Social Determinants and International Comparisons of Health and Mortality

Despite substantial gains in population health over recent decades, the US faces a growing epidemic of obesity that threatens continued progress. This dissertation seeks a better understanding of this dire challenge through three chapters that explore obesity from distinct vantage points. The first chapter quantifies the extent to which greater obesity in the US contributes to its low life expectancy ranking with respect to 15 other developed countries. The principal finding is that the higher prevalence of overweight and obesity in the US may contribute between a fifth and a third of the longevity gap above age 50. The second chapter is an investigation of the mortality risks and population impact of obesity in the older adult population of the US. I propose an innovative measurement strategy using weight histories. My findings indicate that the prior literature may substantially underestimate the mortality risks of obesity by failing to fully account for confounding by illness. The third and final chapter investigates the social context of obesity through an examination of eating behaviors of adults in the US. I find that participation in the family dinner is associated with a significantly lower probability of being obese and that the association is robust to adjustment for multiple dimensions of socioeconomic status.