Browsing by Subject "Public policy"

Between 1890 and 1965, the ideology of government responsibility for maternal and child health represented a continuous and central goal that fueled programs and institutional networks of progressive and liberal social policy advocates. Beginning in the settlement houses of the 1890s, a cadre of female bureaucrats, social reformers, and their political allies developed an array of federally based programs. Conservative stakeholders--among them anti-feminists, representatives of the medical industry, anti-communists, and white supremacists--strenuously opposed this vision of health justice, arguing that health was a personal responsibility in which government should play no part. Despite the achievements of government-based progressive reformers in instituting their vision in urban settlement houses, under the Sheppard-Towner Act of the mid-1920s and during the years of the New Deal and World War II, the Cold War's approach to domestic social policy after 1947 clamped down on their vision. After this conservative turn against social democratic solutions to welfare needs, these progressive advocates shifted their attention to the international health rights movement and to community-based maternal and child health activities.

My dissertation introduces the concept of health justice as an interpretive lens to trace the history of health policy progressives and their institutional networks. On the one hand, health justice reflects the communitarian premise that the health of all members of society is essential for the common good. On the other hand, health justice implies that health and health care are individual rights that government ought to protect. While communitarian arguments were often on the tip of the tongues of social reformers, a passionate belief in citizenship-based rights and redistributive and humanitarian ideas of social justice undergirded their policy ideas and became a more explicitly stated position during the New Deal and World War II. This justice-based approach to maternal and child health policy was consistently undermined by the prevailing counter-ideologies of individual responsibility for health, local control of public services, racial segregation in health services, and the commodification of health care.

My work relies on primary evidence collected from the personal papers of key protagonists, the administrative records of the Children's Bureau housed at the National Archives, oral histories, and the presidential papers of Harry S. Truman. Published primary materials have been culled from memoirs, professional public health and medical journals, as well as the popular press. I also draw from a body of historical and political science scholarship of the past twenty-five years to contextualize the narrative.

There have been few efforts to evaluate the actual and perceived effectiveness of environmental management programs created by consensus-based, multi-stakeholder negotiation or negotiated rulemaking. Previous evaluations have used perceived success among participants as a proxy for actual effectiveness, but seldom have investigated the ecological outcomes of these negotiations. Fewer still, if any, have compared the actual and perceived outcomes. Here I evaluate and compare the social and ecological outcomes of the negotiated rulemaking process of marine mammal take reduction planning. Take reduction planning is mandated by the U.S. Marine Mammal Protection Act (MMPA) to reduce the fisheries-related serious injuries and mortalities of marine mammals (bycatch) in U.S. waters to below statutory thresholds. Teams of fishermen, environmentalists, researchers, state and federal managers, and members of Regional Fisheries Management Councils and Commissions create consensus-based rules to mitigate bycatch, called Take Reduction Plans. There are six active Take Reduction Plans, one Take Reduction Strategy consisting of voluntary measures, and one plan that was never implemented. It has been 20 years since marine mammal take reduction planning was incorporated into the MMPA. Early evaluations were promising, but identified several challenges. In the past decade or more, the National Marine Fisheries Service (NMFS) has implemented measures to set up the teams for success.

I used data from formal Stock Assessment Reports to assess and rank the actual ecological success of five Take Reduction Plans (Harbor Porpoise, Bottlenose Dolphin, Atlantic Large Whale, Pelagic Longline, and Pacific Offshore Cetacean) in mitigating the bycatch of 17 marine mammal stocks. In addition, I employed social science data collection and analytical methods to evaluate Take Reduction Team participants' opinions of the take reduction negotiation process, outputs, and outcomes with respect to the ingredients required for successful multi-stakeholder, consensus-based negotiation (team membership, shared learning, repeated interactions, facilitated meetings, and consensus-based outputs). These methods included surveying and interviewing current and former Take Reduction Team participants; using Structural Equation Models (SEMs) and qualitative methods to characterize participant perceptions across teams and stakeholder groups; and identifying and exploring the reasons for similarities and differences among respondents, teams, and stakeholder groups. I also employed SEMs to quantitatively examine the relationship between actual and perceived ecological success, and contrasted actual and perceived outcomes by comparing their qualitative rankings.

Structural Equation Models provided a valid framework in which to quantitatively examine social and ecological data, in which the actual ecological outcomes were used as independent predictors of the perceived outcomes. Actual improvements in marine mammal bycatch enhanced stakeholder opinions about the effectiveness of marine mammal Take Reduction Plans. The marine mammal take reduction planning process has all of the ingredients necessary for effective consensus-based, multi-stakeholder negotiations (Chapter 2). It is likely that the emphasis that the National Marine Fisheries Service places on empirical information and keeping stakeholders informed about bycatch, marine mammal stocks, and fisheries facilitated this relationship. Informed stakeholders also had relatively accurate perceptions of the actual ecological effectiveness of the Take Reduction Plans (Chapter 3). The long timeframes over which the teams have been meeting generally have increased cooperation. The professionally trained, neutral facilitators have produced fair negotiations, in which most individuals felt they had an opportunity to contribute. Participant views of fairness significantly influenced their satisfaction with Take Reduction Plans, which significantly affected their perceptions about the effectiveness of those plans (Chapter 2). The mandate to create a consensus-based output has, for the most part, minimized defections from the negotiations and facilitated stakeholder buy-in.

In general, marine mammal take reduction planning is a good negotiated rulemaking process, but has produced mixed results (Chapters 1 and 2). Successful plans were characterized by straightforward regulations and high rates of compliance. Unsuccessful plans had low compliance with complex regulations and sometimes focused on very small stocks. Large teams and those in the northeastern U.S. (Maine to North Carolina) were least successful at reducing bycatch, which was reflected in stakeholder views of the effectiveness of these teams. Take Reduction Team negotiations have not always produced practical or enforceable regulations. Implementation of take reduction regulations is critical in determining plan success and identifying effective mitigation measures, but because of a lack of monitoring, has not been characterized consistently across most teams. Additionally, elements like the "Other Special Measures Provision" in the Harbor Porpoise Take Reduction Plan have undermined the negotiation process by allowing the National Marine Fisheries Service to alter consensus-based elements without consensus from the team, which has led to hostility, mistrust, and frustration among stakeholders.

The final chapter of this dissertation provides recommendations to improve the outcomes and make them more consistent across teams. I based these recommendations on the information gathered and analyzed in the first three chapters. They are grouped into four broad categories - team membership, social capital, fairness, and plan implementation. If the National Marine Fisheries Service implements these suggestions, both perceived and actual ecological effectiveness of marine mammal Take Reduction Teams should improve, allowing these teams to fulfill their maximum potential.

In this dissertation, I seek to understand the power of legal actors in determining punitiveness in plea bargaining in criminal courts. Using a unique combination of administrative court data and qualitative interviews, I evaluate the influence of the chief elected prosecutor, line prosecutors, and defense attorneys on plea bargaining practices and punitiveness in case outcomes across multiple local court systems. Chapter 2 presents an analysis of the association between the elected chief prosecutor and prosecution and active sentence rates in four types of criminal cases in nine districts in North Carolina. The study finds that chief prosecutors influenced punitiveness, but their influence was not aligned with their political party. Although Democratic and Republican chief prosecutors did not differ in levels of punitiveness, the one progressive prosecutor in the sample reduced punitiveness across most crime types to the lowest levels out of all nine study districts. Chapter 3 examines how line prosecutors working in one progressive prosecutor’s office reduced punitiveness in case outcomes, mainly by dismissing weak and low-priority cases even before they reached the plea bargaining stage. Finally, Chapter 4 explores the power of the defense attorney in plea bargaining, and shows how the legal actors and context of the plea bargaining interaction impacted defense attorneys’ leverage and negotiation strategies. These chapters provide insights into current movements to reform prosecution and reduce mass incarceration in the United States, and shed light on how punitiveness may be impacted through the complex process of plea bargaining.

How households and individuals respond to adverse and unanticipated shocks is an important concern for both economists and policy makers. This is especially true in developing countries where poverty, weak infrastructure, and a lack of social safety nets often exacerbate the effects of adverse shocks on household welfare. My research addresses these issues in the context of three economic outcomes and behaviors - early life health and the accumulation of human capital, willingness to take on financial risk, and behavior in the labor market. The results of this research project both adds to our understanding of how life experiences shape individuals' well-being and behavior and how policy can help individuals achieve long-term improvements in the lives following adverse events.

My research focuses on households and individuals affected by a large-scale natural disaster, the 2004 Indian Ocean tsunami. I utilize data from the Study of the Tsunami Aftermath and Recovery (STAR), a unique longitudinal survey of individuals and households living in coastal communities in Aceh and North Sumatra, Indonesia, at the time of the tsunami. The STAR surveys were conducted annually for five years after the disaster and include a wide range of demographic, economic, and health measures.

In the first chapter, Child Height after a Natural Disaster, co-authored with Elizabeth Frankenberg, Duncan Thomas, and Jed Friedman, we investigate the immediate and long-run impacts on child health of in utero exposure to stress induced by the tsunami. We investigate whether in utero exposure to stress, as measured by tsunami-induced maternal posttraumatic stress, affected the growth of children born in the aftermath of the tsunami in the critical first five years of their lives. Although previous studies suggest that in utero exposure to stress is related to a number of adverse birth outcomes such as prematurity and lower birth weight, there is little evidence of the impact on linear growth, a strong correlate of later life income. We find evidence that children exposed to high levels of stress beginning in the second trimester experienced reduced growth in the first two years of their lives. We also find evidence that growth reductions largely disappear by age five. This suggests that significant catch-up growth is possible, particularly in the context of pronounced post-disaster reconstruction and economic rehabilitation.

In the second chapter, The Impact of a Natural Disaster on Observed Risk Aversion, I investigate the short and long-term impacts of the 2004 Indian Ocean tsunami on attitudes toward risk. Attitudes toward risk are important determinants of economic, demographic, and health-related behaviors, but how these attitudes evolve after an event like a natural disaster remains unclear because past research has been confounded by issues of selective exposure, mortality, and migration. My study is the first to directly address these problems by utilizing exogenous variation in exposure to a disruptive event in a sample of individuals that is representative of the population as it existed at the time of the event. In addition, intensive efforts were made to track migrants in the sample population, which is important for this study because migration is common following events like natural disasters and is likely related to attitudes toward risk. I find that physical exposure to the tsunami (e.g., seeing or hearing the tsunami or being caught up in the tsunami) causes significant short-term decreases in observed aversion to risk, especially for the poor, but few longer-term differences. This finding has important implications for the design of effective post-disaster assistance policies. In particular, it implies that post-disaster assistance programs should include aid that is consistent with the observed risk attitudes of the survivors such as job training and capital to start-up businesses.

In the last chapter, Labor Market Outcomes following the 2004 Indian Ocean Tsunami, I investigate how labor market outcomes changed in coastal communities in Aceh and North Sumatra following the tsunami and the post-disaster recovery efforts. Although restoring the livelihoods of survivors of adverse events is critical for their long-term recovery, there is little evidence from developing countries of how labor market outcomes change after such events. Using the STAR data, I find a significant and persistent increase in paid employment for younger women in urban communities. The increase occurred in communities that were heavily damaged by the tsunami and those that were not, suggesting that the impacts of the disaster on livelihoods are likely long-lasting and extend beyond the communities that were directly stuck by the disaster.

While there is a common understanding that artists find it hard to make a living through their artistic activities, research is silent on how artists view and understand their lived experiences. “Creative wealth”, which is accumulated through artistic activities, is part of an untapped, unmeasured, and invisible economy (Kabanda, 2018). This qualitative, exploratory study examines the complexities of creative wealth through the lens of fifteen African and Afro-descendant performance, visual, literary, digital, and applied artists. Using a thematic analysis of semi-structured interview data, I present two conceptual themes: artistic challenges and artistic opportunities. The challenges focus on (1a) the trade-offs involved in the production and distribution of one’s art, and (1b) the lack resources to produce art, lack ownership of art, and lack of avenues to display or investigate art. The opportunities focus on (2a) how artistic activity can foster innovation and (2b) how artistic activity can be used as an individual-level and a communal-level tool of expression or "exchange of experience". The findings of this study indicate that artists perceive their artistic endeavors to be simultaneously impeded and elevated by conditions of scarcity, and they understand that these conditions are unique to their African ancestral identity. Drawing on insights and recommendations from the artists themselves, this research sheds light on how creative wealth can improve lives – both monetarily and non-monetarily.

Despite the threats to morbidity, mortality, and human capital accumulation posed by environmental risks, investments in environmental health technologies remain low. This is especially evident in low- and middle-income countries, which disproportionately shoulder the burden of environmental risk exposure and consequence. Households face competing risks associated with poor air and water quality, necessitating choices about how to invest in technologies to reduce the consequences associated with their exposures. Yet, even in areas where access to environmental health technologies such as improved cookstoves, latrines, and insecticide-treated bednets has expanded and products are subsidized to make them more affordable, adoption and use of these technologies often lag. This dissertation examines some of the conditions that impact environmental health technology adoption and use decisions as well as the health implications of low investment.

In Chapter 1, I ask how air pollution exposure drives consumption behaviors and impacts health outcomes. I examine this question in the short term--asking how behavior and health respond to a large, yet transitory, spike in ambient air pollution--as well as over time--considering the responses to average ambient air pollution levels over a period of 19 years. I leverage variation in air pollution resulting from forest fire emissions in Indonesia between 1996 and 2015 to generate short-term exposure spikes and average exposures over time, and I combine these exposures with four waves household and individual-level survey data. I implement a cross-sectional, difference-in-difference analysis to estimate the immediate effects of an unexpectedly severe forest fire season in 2015, finding increased fuel demands among the most-exposed households as well as declines in lung capacity among emissions-affected children. I extend my analysis across the panel using an instrumental variables approach to estimate consequences of average exposure over time. I find that households facing higher average ambient air pollution exposures are more likely to utilize clean cooking fuels such as LPG. Even with these behavioral adjustments, more-exposed individuals face significant reductions in lung capacity. In line with existing literature, I find negative health implications resulting from short-term exposure shocks; however, my analysis demonstrates that these respiratory consequences are not fleeting, particularly in areas that experience elevated average ambient air pollution levels.

In Chapter 2, I turn to environmental risks posed by limited access to improved sanitation technologies to examine how social influences impact household sanitation decisions. Using three waves of data collected immediately before, a few months after, and a few years after a randomized latrine promotion campaign in rural Orissa, India, I evaluate the extent to which social influences impact sanitation choices. I find that a ten percentage point decrease in neighbors' open defecation reduces a household's likelihood of open defecation by 3-4 percentage points. The sanitation intervention decreased open defecation in the short term; however, this treatment was less effective in neighborhoods with higher rates of open defecation due to strong social effects. Disaggregating social effects by gender, I find that both women and men respond to sanitation behaviors among male neighbors in the short term and female neighbors in the longer term, perhaps because men have more control over initial latrine purchasing decisions while women are more influential in sustaining latrine use over time.

Finally, in Chapter 3, I expand on my analysis of social influences and sanitation practices and examine how households make decisions to contribute to collective action for sanitation. In this chapter, I analyze data from an experimental public goods game I designed and implemented among over 1500 households in rural Bihar and Orissa, India. I randomly assigned each of the 70 villages in the sample into groups that are either homogeneous or heterogeneous by gender for game play. In the context of rural India, individuals are more likely to frequently interact with and make decisions in front of others of the same gender. Thus, splitting the groups in this way provides a proxy for peer or social groups. Participants chose how much to contribute to improved sanitation by making decisions in the game that are associated with actual sanitation and hygiene choices they face every day. Payoffs were awarded after each round, and payoff amounts were dependent on both individual contributions and aggregated group contributions, generating a setting in which the benefits participants received were connected. Comparing the game behavior among participants in groups that were homogeneous and heterogeneous by gender, I find evidence that contributions to collective action for sanitation are higher in gender homogenous groups. Female participants drive this difference, and it is more distinct in the first round of game play. I also find evidence that preferences for improved sanitation as elicited during the experimental games are reflective of actual improved sanitation practices at the household level.

Nearly 60% of the US population experiencing posttraumatic stress disorder have not received a meaningful clinical response from traditional interventions (Akiki & Abdallah, 2018). Early research using psychedelics in tandem with psychotherapy may offer a more effective option (Feduccia et al., 2019) and has been shown to provide or contribute to long-term relief or remission from PTSD symptoms (in small samples). Funding for psychedelic-assisted therapy (PAT) clinical-trials has increased to nearly billions (Phelps et al., 2022) and while the research is propitious, it is far from complete. Concerns about safety and generalizability have begun to surface (Love, 2022), including recent allegations of abuse. Though abuse is an issue within all clinical practice, risk is amplified by the non-ordinary state of consciousness experienced in high-dose PAT trials. In the US, treatment models using mind-altering substances are shaped by FDA-approved clinical research trials, which in turn define ethical practices and standards of care. By examining how existing regulations recommend governance for the informed consent process and reviewing publicly available documents from PAT trials, I aim to: 1) illuminate how risk and accountability are currently communicated to PAT participants; and 2) suggest how existing research policy might be updated to make working with trauma patients under non-ordinary states of consciousness safer and more ethically robust.

Over the past decade, international nongovernmental organizations (INGOs) have become increasingly active in authoritarian regimes as they respond to emergencies, assist with development, or advocate for human rights. Though these services and advocacy can challenge the legitimacy and power of the regime, many autocratic states permit INGO activities, and INGOs continue to work in these countries despite heavy restrictions on their activities. In this dissertation, I theorize that the relationship between INGOs and autocrats creates a state of amicable contempt, where each party is aware that the other both threatens and supports their existence. After outlining the theory, I explore the factors that determine when autocracies will constrict the legal environment for INGOs through de jure anti-NGO laws and the discretionary implementation of those laws. I combine a set of statistical models run on a cross-sectional dataset of 100 autocracies between 1991–2014 with case studies of Egypt, Russia, and China to test the effect of internal risk, external threats, and reputational concerns on the de facto civil society regulatory environment. I find that autocracies constrict civil society regulations in response to domestic instability and as regimes become more stable and cohesive. I also find that autocracies constrict civil society regulations in response to external threats to the regime, including the pressures of globalization. I find no evidence of an effect from reputational concerns. I then use results from a global survey of 641 INGOs to test the determinants of international NGO behavior. I find that the conflict between principles and instrumental concerns shapes INGO behavior and influences its relationship to its host government. Finally, I combine the survey results with case studies of four INGOs—Article 19, AMERA International, Index on Censorship, and the International Republican Institute—to analyze how INGOs respond to two forms of government regulation. When facing gatekeeping restrictions designed limit access to the country, I find that INGOs rely on their programmatic flexibility to creatively work around those restrictions. When facing restrictions aimed at capturing INGO programs, organizations rely on their programmatic flexibility to protect against changes to their core principles and mission.

Neurosurgical and neurological conditions account for a significant disease burden worldwide, with low- and middle-income countries bearing more than 90% of the burden. Uganda is a low-income nation with a high demand for neuro care services but limited access, especially in rural and remote areas. Mobile health clinics, which have proven to be effective in other specialties, could be adapted to provide neurological care in such regions. The objective of this research was to establish the feasibility, appropriateness, and usability of mobile neuro clinics for providing neurological care to people in Uganda's rural and remote communities. Participants who met the inclusion criteria were invited to participate in an education session. Following the education session, the participants participated in an interview session to evaluate the feasibility, appropriateness, and usability of mobile neuro clinics. The education and interview tools were developed using the Consolidated Framework for Implementation Research (CFIR). To weight provider views, a sentiment weighted scale was used, with total aggregate sentiment scores greater than 42 in each CFIR domain indicating high feasibility, acceptability, and usability. All the assessed CFIR domains scored above sentiment score of 49. The implementation process domain (167) received the best overall sentiment score, followed by the implementation climate structure (141), inner setting domain (102), innovation domain (59), and outer setting domain (55). According to the findings of the research, mobile neuro clinics are feasible, appropriate, and usable in Uganda. To achieve the best results, however, careful planning and integration involving stakeholders from conceptualization to execution are required.

Children who appear as the main characters or primary consumers of YouTube content have been the focus of emerging academic literature and public debate (Feller & Burroughs, 2022; Ferguson, 2018; Kumar, 2021). Sharenting, or posting information, photos, or videos about one's children on social media, has also been a discussion and concern among researchers, legal scholars, and parents (Kumar, 2021). Sharenting has online and offline consequences. It exposes personal information, such as a child’s name and whereabouts, which may lead to unwanted attention or safety risks (Brosch, 2016; Blum-Ross, 2015). However, there is a significant subsection of YouTube media where children appear as integral supporting characters of an adult’s content that has yet to be meaningfully researched.The normalization of sharenting has coincided with an upsurge of influencers and influencer marketing (Abidin, 2018). The influencer marketing industry was estimated to be worth 16 billion dollars in 2022, projected to increase to 21 billion dollars in 2023 (Geyser, 2023). Influencers who involve their children in content position them, at times, as unintentional microcelebrities or brand assets (Abidin, 2015). When this happens, their appearance in user-generated content contributes to the premise and profitability of their parent’s brand. However, children who consistently contribute to their parent’s brand have no rights to the money their names, images, and likenesses generate. They have no working hours to abide by and no access to representation by a third party acting without a personal stake in their profitability (Geider, 2021). Children are unaware of the long-term consequences of exposure to a digital audience, including potential privacy violations, online harassment, or reputational harm. They may also not fully understand the implications of having a digital identity established for them before they can make decisions for themselves. While existing literature demonstrates that social media platforms, laws, and policies do not adequately regulate or protect the children of influencers, there has been no effort first to define the child of an influencer and, second, to identify at what point that regulation becomes necessary. In other words, when do influencer parents go beyond mere sharenting? This research project examines the complex interplay between the potential long-term impacts of children's involvement in influencer content and the gaps in regulations related to children’s work on social media. I aim to analyze the regulatory gray area children of influencers inhabit on YouTube and to identify salient features of influencer content which place children at disproportionate risk of undesirable exposure online. The present study scopes the value children provide to user-generated monetized content. It constructs a typology to describe the unique privacy and psychological risks they are exposed to when their parents' income involves their presence. It outlines common arguments influencer parents use to justify their children's use in content production and discusses the impossibility of informed consent for children in this context.

Studies on the effect of regime type on public goods provision have tended to take a quantitative, cross-national approach to examining the relationship between regime type and access to public goods, and have demonstrated that democracies produce better public goods outcomes than non-democracies for a variety of theoretical reasons, including politics being more competitive in democracies, democracies needing to appease a greater proportion of their population, and re-election incentives. Such studies, however, have not aimed to understand which segments of the population receive access to benefits and the literature examining this question has tended to focus on the distribution of benefits in democracies. As such, little is known about how authoritarianism itself affects the distribution of public services.

This dissertation examines how inequalities in access to drinking water and wastewater services arise in authoritarian regimes. In examining Egypt during the period of 1882 to 2015, and using archival documents, census data, electoral returns, and interviews, I find that the groups that are prioritized for receiving access to drinking water and wastewater services differ across the different regimes within this time period, as they are a product of the goals that leaders are seeking to achieve and the structure of the authoritarian political system that is implemented, which affects elite composition, the degree of influence that leaders have over policymaking, and the regime’s relationship with the mass public.

I also find that in the aftermath of the Arab Uprisings, self-undermining policy feedbacks, which occur when those who are not benefitting from government policy that is currently in place push for significant changes in policy, can affect the state’s response to expressed discontent regarding the state of public services, but that democratization is not necessarily correlated with greater investment in public services.

Overall, the findings emphasize that political will plays an important role in affecting the distribution of public services in an authoritarian setting.

People buy many goods produced in ways that appear to call for a remedy or a reaction from actors in developed countries: these are goods which appear to have “grave flaws” in the upstream supply chain. For example, one can buy products produced by firms which routinely clear-cut forests, employ child or forced labor, defy domestic health-and-safety laws, intimidate labor organizers, and so on. On the other hand, many of the global poor rely on the employment opportunities that global production networks create, and developing countries tend to see their low production costs as their comparative advantage to attract foreign investment and upgrade to higher stages of development. In this dissertation, I explore different aspects of the moral, political and social philosophy surrounding grave flaws, particularly what they entail for consumers in affluent countries. Chapters 1-3 concern the appropriate role of consumers and those who would mobilize them to remedy grave flaws. In Chapter 1, I survey the kinds of moral relationship that consumers might have to the grave flaws. I then ask under what conditions an individual consumer has strong moral reasons to react to grave flaws by practicing selective purchasing. I conclude that the deep epistemic difficulties surrounding recognising each good’s connection with a grave flaw, and the effects of switching to apparently better products, mean consumers do not typically have strong moral reasons to practice conscientious consumption. Chapters 2 and 3 turn to consider what I call political consumerism, practiced by consumers as an aggregate group, mobilized by those who aim to remedy some of the grave flaws. In Chapter 2 I raise concerns about the necessity, effectiveness, and risks of political consumerism, and argue that it might be an effective and appropriate means to remedy grave flaws in global supply chains only in rather specific circumstances. Furthermore, in Chapter 3, I argue that because political consumerism threatens several liberal-democratic values, the mobilizers of political consumerism should attempt to apply more deliberative and democratic elements to their campaigns. Finally, in Chapter 4, I turn to the question of which flaws in supply chains are actually grave. I use the apparel industry as an example, and argue that, apart from outright fraud and coercion, cases of firms trying to undermine or ignore attempts to collectively overcome systemic market failures in the supply chain are the grave flaws we in affluent countries should be most concerned about.

Young people living with HIV (YPLWH) constitute a growing proportion of the global population of people living with HIV but have less access to HIV testing, diagnosis, treatment, and face heightened mental health challenges. To address these challenges, targeted mental health and medication adherence interventions have been developed, including in Tanzania, which is home to 6% of the world's YPLWH. This study proposes a mathematical model to estimate the health and economic outcomes of mental health HIV adherence interventions targeting YPLWH in Tanzania.We developed a Markov model to predict the long-term health (Disability-Adjusted Life Years (DALY)) and economic outcomes (Value of a Statistical Life Year (VLSY)) of mental health HIV adherence interventions targeting YPLWH. We parameterized the model using outcomes data from the 2016-2020 Sauti ya Vijana randomized control trial (RCT) conducted in Moshi, Tanzania. Cost data were retrieved from a cost analysis of the same RCT and supplemented with data from published literature. The study is conducted from a health payer’s perspective, and the Willingness-To-Pay (WTP) per DALY averted was set to the 2021 Tanzanian GDP per capita (USD 1099.3). Costs and outcomes were modeled for ten years and discounted at an annual rate of 3%. The findings suggest that the Sauti ya Vijana intervention modeled in this study is cost-effective at a WTP of USD 1099.3. The Incremental cost-effectiveness ratio for the intervention compared to the standard of care was USD 637.06 per DALY averted at a 3% discount rate. The benefit-to-cost ratio of the intervention was USD 26.54 in economic productivity for the intervention arm for every dollar spent on the intervention, and the net economic productivity benefit was USD 17,174.74 over a decade. Mental health adherence interventions hold the promise of improving health outcomes amongst YPLWH. The mathematical model developed in this study is a valuable decision-making tool for policymakers regarding mental health adherence interventions targeting YPLWH in Tanzania. The model contributes to the global goal of achieving the UNAIDS 95-95-95 targets for YPLWH.

This dissertation encompasses three essays which examine the development of obesity in black and white girls and its responses to interventions.

The first chapter asks the question, how does obesity develop in girls? Using the National Growth and Health Study (NGHS), a longitudinal study of 2400 girls from age 9 to age 18, this chapter aims to address gaps in knowledge about the development and persistence of obesity in girls. Analyses using multivariate regression and growth-mixture modeling describe trajectories of body mass change in children and their correlates. Results suggest that obesity in children begins early and persists in most cases--BMI at age 17 is, on average, 1.3 times BMI at age 9. However, change does occur; 0.8 percent of the sample move from being obese at age 9 to healthy weight at age 17, and 2.2 percent of the sample make the reverse journey from healthy weight to obese. Where change occurs, it is most commonly seen among those who socio-demographically were anomalies among their body mass cohort at age 9. These results emphasize the importance of early interventions as well as the need for more study into body mass mutability in population subsamples.

The second chapter investigates 1) what motivates children to pursue weight loss; and 2) what aspects of interventions may most effectively support healthy child motivations and program success. These questions are qualitatively studied among a sample of 45 obese girls aged 9 to 13 girls participating in a behavior modification intervention. In total, 106 interviews were conducted. All of the girls in the study were interested in losing weight, most commonly in order to fit in (n=11), reduce teasing (n=10), or express particular social identities (n=6). However, not all of the girls were able to translate this desire to lose weight into a healthy and effective lifestyle change motivation. Several factors were associated with adopting healthy motivation and behavior, including familial involvement, self-regulation skills, non-social weight desires, realistic weight loss goals, and clear messages about body ideals. Other program protocols also supported motivation during difficult periods for those who adopted healthy motivation, including nutrition information, incentives, lack of physician judgment, and patient autonomy. Finally, two other potential program protocols were mentioned by girls in the study as useful aids. More support services, particularly during the summer, and more information on the expected course of weight loss could, these girls argued, help sustain motivation. Together, these findings suggest a role for self-regulation theory in the design of lifestyle change motivation and for more directly addressing expectations in weight loss treatment.

The third chapter investigates the relationship between self-worth and obesity among girls, again using the National Growth and Health Study. Results indicate a negative relationship between self-worth and obesity across all participants. However, this relationship only has predictive power from early body mass to later self-worth and self-worth trajectories. That is, higher body mass at age 9 predicts lower self-worth at age 17 and decreases in self-worth from age 9 to age 17. The effect is larger for Caucasians and for those in young adolescence but persists across the sample. Mechanisms for this relationship are also investigated, and some support found for stigma. Analyses using self-worth components suggest most of the self-worth effects are driven by social concerns, while mediational analyses suggest social body image pressures explain the relationship between global self-worth and body mass. Overall, the findings suggest a complex interrelation between self-worth and body mass in girls, meriting further investigation as well as a more nuanced discussion in the public realm.

The West African coast is prey to an erosion washing away communities’ houses, livelihoods, and ancestral temples. By studying locals’ lived experiences and state resilience efforts my research investigates environmental and social issues and possibilities emerging from this climate disaster. I focus on Aneho, a historic town and former site of transcontinental commerce during the precolonial period, and a center of the famous African Print Textile trade since the early colonial period—which today risks disappearing into the sea. While the situation is dire, Aneho has a long history of survival and resilience to, among others, local wars, the slave trade, and colonialism. Reproduced through collective festivals and rituals, these traits are deployed today in their fight against coastal erosion. The ontological turn shows how native knowledge in the Amazonia and beyond offer alternative ways of being and knowing; however, this literature fails to answer the fundamental question of how this form of knowledge can influence our collective response to the current global climate crisis and change our ways of living. By analyzing Aneho’s biopolitical terrain where both scientific and ontological knowledge intersect, my work addresses this question through the examination of power relations underlying the way policymakers and traditional leaders address coastal erosion. The intersections I am exploring generate new possibilities for local agency and innovation in the face of climate catastrophe while also enabling my work to address the uncanny absence of West Africa’s rich cosmology in the canon of ontological literature. My research essentially pushes environmental anthropology beyond its theoretical limits by engaging the field in a pragmatic conversation with public policy on resilient development.

The literature on clientelism has extensively covered the direct exchange of private goods for political support between voters and politicians. Yet, patronage does not end with the distribution of food, medicine or public employment. In poor informal settlements, access to a sanitation system or clean drinking water is often mediated by local politicians.Therefore, the interaction between slum politics and the provision of Local Public Goods (LPG) is quite relevant and requires further study.

This dissertation explains the variation in infrastructure and public services in shantytowns as a function of social capital. Well-connected communities --with stronger ties among its members-- solve collective action problems, improving slum dwellers' quality of life. The linking mechanism between social capital and LPG is electoral coordination (bloc-voting). Neighbors agree for a common electoral strategy at the slum-level, which translates into an effective mechanism to demand for improvements in their locality (``good-type partisan homogeneity'').

Alternatively, isolation among slum dwellers deteriorate their access to and quality of LPG. Under the absence of social capital, when slum-level electoral behavior appears to be homogenous, it is likely signaling political clientelism and not community-led coordination. Ultimately the ``bad-type partisan homogeneity'' represents the inability of slum dwellers to enforce electoral accountability and sanction unresponsive governments. I test my hypotheses with survey data from Udaipur (India) and eight provinces in Argentina.

Scholars and practitioners recognize the importance of coordination in mitigating the costs of aid proliferation and improving the effectiveness of foreign aid. However, low levels of donor coordination persist. In this dissertation, I address this donor coordination puzzle. I offer a novel theory of coordination called Constrained Coordination, in which I posit that two key factors that play a crucial role in shaping coordination. First, I argue that donors strategic interests are a damper on coordination – the greater the strategic political, economic, and security interests of a donor government in a recipient country, the less coordination its aid agency will engage in. Second, I argue that aid agency autonomy is positively associated with coordination – the greater the level of autonomy – or freedom – that an aid agency has from its home government, the more that aid agency will coordinate. In order to test my Constrained Coordination theory, the dissertation uses mix-methods, and includes a quantitative analysis of hundreds of donor agencies coordination. I also leverage over one hundred extensive interviews with key stakeholders to present two qualitative case studies of donor coordination in Nigeria and Zambia. Finally, I use qualitative evidence to look at the coordination of South-South donors, a group of donors growing in importance. I find that a donor government’s strategic interests have a significant impact on whether its aid agency will coordinate within recipient countries. Similarly, when a recipient is strategic to a large number of countries, donors will not be well coordinated. Second, I find that aid agencies with greater levels of autonomy from their home governments coordinate more. And finally, I find that these effects amplify one another – a high autonomy donor working in a low priority country coordinates more than any other combination of strategic interests and autonomy.

High levels of partisan polarization on environmental policies, and on climate change in particular, have led to policy gridlock in the United States. While most Americans rely on their partisan identities to guide their policy preferences on highly polarizing issues, other non-partisan identities may also be relevant in informing environmental policy attitudes. This dissertation investigates the role that partisan and non-partisan identities play in driving attitudes on climate change and environmental policies broadly. In a first paper, I use a survey experiment to test how identity salience influences the effectiveness of a persuasive message about climate change. I find that priming a non-partisan (parental) identity decreases partisan polarization on climate change policy support, while priming a partisan identity increases polarization. In a second paper, I use focus groups, participant observation, and interviews to identify four strategies that individuals use to reconcile conflicting identities and form attitudes on climate change. In a third paper, I use focus groups with rural voters in North Carolina to understand how rural identities inform unique environmental policy preferences. Each of these studies contributes to the broader understanding of the role that non-partisan identities play in driving environmental attitudes and offers a potential way to build more bipartisan agreement in this policy area.

The main research question of this thesis is how do grand strategies form. Grand strategy is defined as a state's coherent and consistent pattern of behavior over a long period of time in search of an overarching goal. The political science literature usually explains the formation of grand strategies by using a planning (or design) model. In this dissertation, I use primary sources, interviews with former government officials, and historical scholarship to show that the formation of grand strategy is better understood using a model of emergent learning imported from the business world. My two case studies examine the formation of American grand strategy during the Cold War and the post-Cold War eras. The dissertation concludes that in both these strategic eras the dominating grand strategies were formed primarily by emergent learning rather than flowing from advanced designs.