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

项目摘要/摘要 在经历了数十年的歧视性政策和经济适用房投资不足之后，120万人 居住在我国公共住房开发项目中的家庭往往居住在集中的条件下 贫穷、不健康和不稳定的住房和社区环境，以及受限的社会和经济 机会。这些健康的社会决定因素导致了与PH居民之间的巨大健康差距 在许多健康领域经历高水平的死亡率和发病率。作为回应，目前 政策努力寻求将PH重新开发为混合收入社区，以消除贫困，创造 更健康的居住环境，减少社区压力源，增加社区资源。它是 对于描述这些政策对健康差距的影响以及理解 潜在影响的机制。 该项目试图利用一个多臂的PH重建自然实验来评估 改善住房质量，限制外部流离失所，创造混合收入社区，改善 PH居民的身体、心理和行为健康，包括儿童、成年人和老年人。我们会 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。 这项研究将采用严格的混合方法设计，跟踪调查来自600个家庭的1068人 正在进行重建的波士顿PH社区。重建计划将以准随机方式进行。 居民亚群进入新的高质量PH，或将他们转移到异地，然后返回新的高质量 混合收入住房。我们将把这些居民与将留在原地的匹配控制组进行比较。 我们的跨学科团队将收集四波面对面调查、直接环境评估和 直接生理压力测量，以及年度地理编码管理数据和密集 对部分受访者进行定性访谈。这一创新的来源组合将提供以下数据 居民的身心健康和行为健康；生理应激；社会关系和集体效能； 住房质量和无序；邻里犯罪、污染、社会问题和资源。 意向治疗、差异差异和平均治疗效果模型将提供严格的证据 混合收入住房中的住房质量、居住位移和居住对居民健康的影响。 结构方程模型和定性分析将确定住房效应的潜在机制。我们的 结果，揭示健康差异背后的因果和动态过程，将提供创新的新 关于健康的社会决定因素的数据，以便为住房和社区重建模式提供信息 集中贫困的问题。

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.