Essays on Health Economic Geography

Economic Geography (EG) offers an essential spatial lens to analyse how economic and social phenomena unfold across regions, providing a deep understanding of the distribution of economic ac- tivities (Combes and Overman, 2004[1]), the formation of core-periphery patterns (Krugman, 1991[2]), the role of transportation networks (Hall et al.,2006 [3]) and multi-location setups in shaping economic landscapes (Ascani et al.,2016[4]; Ramos et al.,2013[5]). Traditionally, the field has focused on eco- nomic issues, yet over time it has expanded to address a range of social phenomena such as culture (James et al., 2006[6]), politics (Green et al., 2024[7]; Broz et al., 2021[8]), institutions (Martin, 2005[9]), and human capital accumulation (Gagliardi, 2011[10]). This growing scope is crucial for examining contemporary global crises, including COVID-19, climate change, political instability, and violence, all of which have clear spatial dimensions that demand policy-relevant solutions. This thesis applies the lens of EG to explore how spatial factors influence health outcomes. It fo- cuses on how external shocks, such as the COVID-19 pandemic and violence, shape health, affecting socioeconomic structures and their geographic distribution. Therefore, this research highlights the importance of health as both a component of human capital and an input for generating other forms of human capital. The thesis comprises three chapters, each focusing on a different geographical setting—Italy, Spain, and Mexico. These case studies explore how shocks influence labour markets and health, contributing to both theoretical and policy debates within EG. One critical focus of this research is the intersection of health, gender, and space. Drawing from Fem- inist Economic Geography, the thesis explores how spatial and economic structures impact women differently. Recent scholarship, such as that of Nobel laureate Claudia Goldin, has highlighted per- sistent gender gaps in economic and health outcomes (Goldin, 1991[11]). This research builds on these insights by examining gender disparities in healthcare access during the pandemic in Spain and analysing the differentiated impacts of violence on prenatal health in Mexico. In methodological terms, my focus on exploring the effects of spatial factors on health and other economic outcomes emphasises geographic implications at the micro level, utilising a causal inference approach. Specifically, I apply various causal inference frameworks, including dose-response assess- ments (continuous treatment), difference-in-differences, and event-study models. This thesis aims to address not only underexplored topics but also populations that are often over- looked in the literature due to data limitations. To overcome these constraints, I leverage a variety of data sources, ranging from non-traditional datasets such as online job postings (Lightcast dataset) to measure labour demand, to geographic data like rasters containing nightlight data as a proxy of income or shapefiles to capture non-administrative boundaries and infrastructure. I also use extensive administrative datasets, including birth and mortality records and surveys. This diverse data allows ii for a more comprehensive analysis of how spatial dynamics and external shocks impact health out- comes across different contexts and demographics. The thesis is divided into three different chapters. The first chapter examines the effect of the COVID- 19 pandemic on labour demand in Italy. Using a dose-response framework and online job vacancy data, we investigate how different levels of exposure to COVID-19 affected the local labour market. The findings reveal a non-linear relationship: while the pandemic reduced overall labour demand, regions with higher COVID-19 exposure saw a shift in demand, particularly for essential jobs in the economically dynamic North. This analysis emphasises the uneven spatial impacts of the pandemic and offers valuable insights for policymakers, particularly in terms of targeting economic interventions to mitigate regional disparities. The second chapter focuses on Spain and investigates the pandemic’s effect on gender gaps in health, particularly in access to healthcare and non-COVID-19-related mortality. This study analyses health- care access data and administrative mortality records to demonstrate the disproportionate impact of health service suspensions on women. The findings indicate that, despite women historically utilising healthcare services more frequently than men, they experienced lower satisfaction with care and con- tinued to visit doctors less often, even two years after the emergency declaration. We also observe increased mortality gaps from non-COVID-19 causes, particularly in older age groups. This chapter highlights the gendered impact of health service disruptions, emphasising the need for policies aimed at restoring women’s access to healthcare as well as a possible increase in the incidence of certain diseases such as cancer. The third chapter focuses on Mexico and explores how exposure to violence, specifically linked to illegal fuel extraction, affects prenatal health outcomes. This chapter uses quasi-exogenous variation from a fuel price hike and pipeline geography to assess the long-term impacts of violence on foetal health. I find a 22%-38% increase in homicides in areas with pipelines following the price increase and a null effect on birth weight. The lack of significant results may indicate that the population has adapted to sustained exposure to high levels of violence over the past 20 years. Another mechanism at play is a possible income effect from involvement in or proximity to this illicit activity, which could mitigate the negative health impacts of stress. Both mechanisms were examined, with strong evidence found through stress-related hospital discharges among women and nightlight data used as a proxy for income. Overall, this thesis provides an EG approach to understanding how spatial dynamics shape health outcomes, offering policy-relevant insights into how regions can address health disparities exacerbated by external shocks. The findings underscore the need for targeted interventions that consider both geographic and gendered inequalities in health access and outcomes.