Targeted Investment and Meaningful Engagement to Improve MCH Outcomes and Rectify Historical Structural Racism: The TIME Study

项目摘要 在哥伦布俄亥俄州的林登社区，一个历史上隔离和撤资的社区， 由于几十年来基于种族的歧视性政策的破坏，婴儿死亡率（IMR）超过20人死亡。 1，000名活产婴儿（2%），种族差异比率接近3。研究人员将婴儿死亡率和贫困 生育结果与产妇教育、产妇的压力和歧视经历、贫穷、缺乏机会 健康食品、缺乏稳定的住房和缺乏产前/医疗保健。这些风险因素 由于历史和当代的政策和做法， 在结构性种族主义（例如，红线，限制性契约，不利的分区），隔离双方的人， 社区内的资源。林登是一个黑人占绝大多数（63%）的社区，人口18万 居民，其中约45%生活在联邦贫困线以下。建立在全国儿童 医院（NCH）通过其健康社区/健康社区的住房和社区发展历史 家庭社区伙伴关系在城市的南侧，NCH有针对性的再投资林登的目的是 提高住房质量和可负担性、教育成果、获得医疗保健、经济发展， 和居民的社会关系。根据生命历程理论（LCT），本提案的目标是 描述影响婴儿死亡率和其他妇幼保健经历的歧视性政策， 几代黑人妇女的成果，重要的是，展示了社区再投资如何能够 旨在针对和纠正历史上和当代的结构性种族主义和歧视。具体地说， 我们的目标是：（1）研究几代黑人妇女在结构性交叉点上的经历 从影响妇女、儿童和青少年生殖健康的历史和当代政策的透镜审视种族主义与生殖健康 （2）对有针对性的社区投资计划进行实时形成性评估， 了解社区结构性种族主义的历史;（3）测量短期婴儿的相对变化 目标社区和统计上匹配的比较地域的产妇保健差距。

Project Summary In Columbus Ohio’s Linden neighborhood, a historically segregated and disinvested community that has been devastated by decades of discriminatory race-based policies, infant mortality rates (IMR) are over 20 deaths per 1,000 live births (2%) with racial disparity ratios nearing three. Researchers have linked infant mortality and poor birth outcomes to maternal education, maternal experiences of stress and discrimination, pove rty, lack of access to healthy foods, lack of stable housing, and lack of access to prenatal/medical care. These risk factors are concentrated in majority minority neighborhoodsdue to historical and contemporary policies and practices rooted in structural racism (e.g., redlining, restrictive covenants, unfavorable zoning) that segregated both people and resources within communities. Linden is apredominately Black (63%) neighborhood with apopulation of 180,000 residents, of which approximately 45% live below the federal poverty level. Building on Nationwide Children’s Hospital’s (NCH) history of housing and community development through its Health Neighborhoods/Healthy Families community partnership on the city’s south side, NCH targeted re-investments in Linden are intended to improve housing quality and affordability, educational outcomes, access to healthcare, economic development, and social connections of residents. Informed by Life Course Theory (LCT), the objective of this proposal is to describe discriminatory policies influencing IMR and other maternal and child health experiences and outcomes across generations of Black women and importantly, demonstrate how community re-investment can be designed to target and rectify historic and contemporary structural racism and discrimination. Specifically, we aim to: (1) examine the experiences of multiple generations of Black women on the intersection of structural racism and reproductive health through the lens of historical and contemporary policies that effect communities; (2) conduct real-time formative evaluation of a targeted community investment initiative explicitly informed by the community’s history of structural racism; and (3) measure relative changes in short term infant and maternal health disparities in the target community and a statistically matched comparison geography.