The Political Determinants of Puerto Rican Health Inequities

Whether living in the United States (US) or the US Commonwealth of Puerto Rico (PR), a colonial territory since 1898, Puerto Ricans experience inequities across an array of health conditions. Several studies have examined common public health explanatory variables, typically within the context of individual-level lifestyle choices, to understand the disparate health outcomes observed among Puerto Ricans living throughout the greater US, which includes individuals living in the 50 states and PR. However, few have assessed the impact of the Puerto Rican political context on health. This is a significant gap in the public health literature, as the health, well-being, and lived experiences of Puerto Ricans are fundamentally shaped by the colonial relationship that exists between the US and PR, regardless of geographic location. When studying Puerto Rican health, the permanence of this colonial context coupled with the persistence of health inequities, calls for special attention to the political determinants of health. These determinants, relating to political structures such as voting, government, and policies, influence the conditions under which communities live, work, and recreate. Therefore, this dissertation investigates how the political determinants of health affect the health outcomes of Puerto Ricans living in the greater US, including individuals living in the States and Puerto Rico. This is accomplished through three unique investigations, employing distinct methodologies, described across three separate empirical papers. The first two studies examine how these political structures manifest into political perceptions that have the potential to influence health outcomes among the Puerto Rican diaspora living in the States. The third study assesses how the political relationship between the US and PR produces conditions that result in the exclusion of PR from US-based public health systems. Within these three investigations, and throughout this dissertation, a political determinants of health approach is applied to the study of Puerto Rican health inequities to intentionally acknowledge and address the permanence of colonialism in PR and its impact on health. As a result, this dissertation contributes to a body of scholarship that serves to shift our collective gaze away from traditional approaches to public health research and towards addressing the political structures that produce health inequities among Puerto Ricans living in the greater US