A Randomized Controlled Trial of Concentrated Investment in Black Neighborhoods to Address Structural Racism as a Fundamental Cause of Poor Health

集中投资黑人社区以解决结构性种族主义作为健康状况不佳的根本原因的随机对照试验

• 批准号: 10413510
• 负责人: EUGENIA C SOUTH
• 金额: $ 491.31万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-23 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10413510
• 关键词: Address; Adult; Affect; African American; Behavior; Birth; Blood Pressure; Chronic Disease; Cities; Communication; Communities; Community Health Systems; Counseling; Criminology; Diabetes Mellitus; Disadvantaged; Discrimination; Distress; Economic Conditions; Economics; Emergency Situation; Evaluation; Evidence based intervention; Exposure to; Feedback; Financial Hardship; Food; Geographic Locations; Health; Healthcare; Household; Hypertension; Individual; Infrastructure; Intervention; Investments; Lead; Left; Life Expectancy; Link; Location; Longevity; Low Birth Weight Infant; Malignant Neoplasms; Maternal Health; Measurable; Methods; Neighborhoods; Outcome; Pathway interactions; Pattern; Personal Satisfaction; Philadelphia; Plants; Policy Analysis; Policy Maker; Population; Premature Birth; Preparation; Provider; Public Health; Race; Randomized Controlled Trials; Research; Resources; Rewards; Risk; Security; Services; Shoulder; Social Conditions; Structural Racism; Structure; Taxes; Testing; Time; Toxic Environmental Substances; Translating; Trees; United States; Violence; Youth; adverse childhood events; base; behavioral outcome; community engagement; community organizations; data infrastructure; design; empowerment; food insecurity; health disparity; health equity; health inequalities; implementation science; improved; innovation; insight; novel; novel strategies; poverty alleviation; psychosocial; racial disparity; racial diversity; racial health disparity; remediation; social; social determinants; social health determinants; social stressor

Project Summary. Black Americans in the US fare worse across nearly every health indicator compared to White individuals. In Philadelphia, the location of this study, these health disparities culminate in a stark longevity gap, with average life expectancies in poor, predominantly Black neighborhoods being 20 years lower than in nearby affluent, predominantly White neighborhoods. The fundamental cause of these racial health disparities is structural racism, which operates via interconnected, mutually reinforcing social and economic pathways. Notably, long-standing, systematic disinvestment has resulted in highly segregated Black neighborhoods with dilapidated environmental conditions and severe economic insecurity within Black households, leading to a “feedback loop of concentrated racial disadvantage,” which is strongly tied to poor health. To date, most interventions have focused on individual-level behaviors or single social determinants of health. However, by failing to address the multiple mechanisms that generate persistent health disadvantages for Black Americans, existing interventions have had limited impact. We propose to develop and test a radically different approach in which we intervene on multiple upstream drivers of health in unison to more substantially and durably improve health among Black Americans. This new approach is motivated by the insight that overcoming centuries of structural racism will require significant concentrated investment in the structures that have left Black people and their neighborhoods in peril. Specifically, we will conduct a cluster randomized controlled trial (RCT) of a suite of place-based and financial-wellbeing interventions at the community, organization, and individual/household levels that address the social determinants of racial health disparities. At the community level, we address underinvestment in Black neighborhoods by implementing vacant lot greening, abandoned house remediation, tree planting, and trash cleanup. At the organization level, we partner with community-based financial empowerment providers to develop cross-organizational infrastructure to increase reach and maximize efficiency. At the individual/household levels, we increase access to public benefits, financial counseling and tax preparation services, and emergency cash assistance. We will test this “big push” intervention in 60 Black neighborhoods, with a total of 720 adults. We hypothesize that this “big push” intervention will have significant impact on overall health and wellbeing, blood pressure, psychosocial distress, food insecurity, social connectedness, and violence. This proposal is innovative because when implemented simultaneously in targeted geographic areas, the suite of interventions will address the multiple mechanisms by which structural racism harms Black health. The positive health impacts will be multiplied and longer-lasting what would be achieved by implementing any individual component. The results of the proposed research are expected to have significant public health impact as it will provide timely and scalable evidence of new strategies to more effectively reduce racial disparities in health.

项目摘要。美国黑人在几乎所有健康指标上的表现都比黑人差。 白色个体。在费城，这项研究的地点，这些健康差距达到了顶峰， 寿命差距，在贫穷的，主要是黑人社区的平均预期寿命低20年 比附近富裕的、以白色为主的社区要多。这些种族健康的根本原因 不平等是结构性种族主义，它通过相互关联，相互加强的社会和经济 路径。值得注意的是，长期的，系统的撤资导致了高度隔离的黑人 黑人社区内环境条件破旧，经济严重不安全， 家庭，导致“集中种族劣势的反馈回路”，这与贫困密切相关 健康到目前为止，大多数干预措施都集中在个人层面的行为或单一的社会决定因素， 健康然而，由于未能解决产生持续健康不利因素的多种机制， 对美国黑人来说，现有的干预措施影响有限。我们建议开发和测试一种 我们采取完全不同的方法，对健康的多个上游驱动因素进行干预， 更实质性和持久地改善美国黑人的健康状况。这种新方法的动机是 由于认识到，克服几个世纪的结构性种族主义将需要大量集中投资， 那些让黑人和他们的社区处于危险之中的结构。具体而言，我们将进行一项 一项关于一系列基于地点和财务健康干预措施的随机对照试验（RCT）， 社区、组织和个人/家庭层面，解决种族健康的社会决定因素 差距。在社区层面，我们通过实施以下措施来解决黑人社区的投资不足问题： 空地绿化、废弃房屋整治、植树、垃圾清理。在组织 在这一层面，我们与社区金融赋权提供者合作， 基础设施，以扩大覆盖面和最大限度地提高效率。在个人/家庭层面，我们增加了 获得公共福利、财务咨询和税务准备服务以及紧急现金援助。 我们将在60个黑人社区测试这种“大推动”干预，共有720名成年人。我们假设 这种“大推动”干预将对整体健康和福祉，血压， 社会心理压力、粮食不安全、社会联系和暴力。这一建议具有创新性 因为当在目标地理区域同时实施时， 将解决结构性种族主义损害黑人健康的多种机制。的积极 健康的影响将成倍增加，并将通过实施任何个人 成分拟议研究的结果预计将对公共卫生产生重大影响，因为它将 为更有效地减少健康方面的种族差异的新战略提供及时和可扩展的证据。