Targeting Health Disparities through Housing Redevelopment: A Natural Experiment of Housing Quality, Stability, and Economic Integration

项目总结/摘要 经过几十年的歧视性政策和对经济适用房的投资不足， 居住在我国公共住房（PH）开发区的家庭往往居住在集中的条件下， 贫困、不健康和不稳定的住房和社区环境，以及受限制的社会和经济 机会这些健康的社会决定因素导致了巨大的健康差距，PH居民 许多卫生领域的死亡率和发病率都在上升。作为回应，当前 政策努力寻求将PH重新发展为混合收入社区，以分散贫困，创造 更健康的居住环境，减少社区压力，增加社区资源。是 至关重要的是，要描述这些政策对健康差距的影响，并了解 影响的机制。 该项目旨在利用PH重建的多臂自然实验来评估是否 提高住房质量，限制外部流离失所，建立混合收入社区， PH居民的身体，精神和行为健康，包括儿童，成人和老年人。我们将 进一步评估这些影响背后的社会、环境和生理机制。最后我们 将讨论影响是否因居民年龄、性别和种族/民族而异。 该研究将采用严格的混合方法设计，跟踪来自600个家庭的1068名个体， 波士顿PH社区正在重建。重建计划将移动准随机选择 居民的子集进入新的高质量PH，或将他们转移到异地，然后返回到新的高质量PH 混合收入住房。我们将这些居民与一个匹配的对照组进行比较，对照组将留在原地。 我们的跨学科团队将收集四波现场调查，直接环境评估， 直接的生理压力测量，以及年度地理编码的行政数据和密集的 对一部分受访者进行定性访谈。这一创新性的来源组合将提供以下数据： 居民的身体、心理和行为健康;生理压力;社会联系和集体效能; 住房质量和混乱;邻里犯罪、污染、社会问题和资源。 意向治疗、差异中差异和平均治疗效应模型将提供以下方面的严格证据： 住房质量、居住迁移和居住在混合收入住房中如何影响居民健康。 结构方程模型和定性分析将确定住房影响的机制。我们 结果，揭示了健康差距背后的因果和动态过程，将提供创新的 关于健康的社会决定因素的数据，为住房和社区重建模式提供信息， 集中的贫困。

PROJECT SUMMARY/ABSTRACT Following decades of discriminatory policies and underinvestment in affordable housing, the 1.2 million households residing in our nation’s public housing (PH) developments often live in conditions of concentrated poverty, unhealthy and unstable housing and community contexts, and constrained social and economic opportunity. These social determinants of health drive substantial health disparities, with PH residents experiencing elevated levels of mortality and morbidity across numerous health domains. In response, current policy efforts seek to redevelop PH into mixed-income communities in order to deconcentrate poverty, create healthier housing environments, decrease community stressors, and enhance community resources. It is essential to delineate the repercussions of such policies on health disparities and to understand the mechanisms underlying effects. This project seeks to exploit a multi-arm natural experiment of PH redevelopment to evaluate whether improving housing quality, limiting external displacement, and creating mixed-income communities improve the physical, mental, and behavioral health of PH residents, including children, adults, and older adults. We will further assess the social, environmental, and physiological mechanisms underlying such effects. Finally, we will address whether effects vary across resident age, gender, and race/ethnicity. The study will employ a rigorous mixed-methods design to follow 1068 individuals from 600 households in a Boston PH community undergoing redevelopment. The redevelopment plan will move quasi-randomly selected subsets of residents into new high quality PH, or displace them offsite followed by a return into new high quality mixed-income housing. We will compare these residents to a matched control group who will remain in place. Our interdisciplinary team will collect four waves of in-person surveys, direct environmental assessments, and direct physiological stress measurements, as well as annual geocoded administrative data and intensive qualitative interviews with a subset of respondents. This innovative combination of sources will provide data on resident physical, mental and behavioral health; physiological stress; social connections and collective efficacy; housing quality and disorder; and neighborhood crime, pollution, social problems and resources. Intent-to-treat, difference-in-differences, and average treatment effect models will provide rigorous evidence of how housing quality, residential displacement, and residence in mixed-income housing affect resident health. Structural equation models and qualitative analyses will identify mechanisms underlying housing effects. Our results, unearthing causal and dynamic processes underlying health disparities, will provide innovative new data on social determinants of health to inform models of housing and community redevelopment in the context of concentrated poverty.