Understanding the role of structural racism and intergenerational wealth on obesity outcome

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PROJECT SUMMARY/ABSTRACT Obesity is a preventable cause of early mortality and poses a significant cost burden to public health and health care systems. Obesity increases risk for several chronic conditions including kidney disease, hypertension, diabetes, cardiovascular disease, osteoarthritis, stroke, and preventable cancers. Disparities in obesity by racialized groups are marked, yet only a small body of literature has interrogated the role of structural racism in the creation of obesity disparities. This research aims to determine the plausible causal role that one form of structural racism—“redlining”, or the process of categorizing neighborhoods into race-based credit risk levels instigating discriminatory mortgage lending practices–plays in creating wealth inequality and obesity disparities over the life course. Using the geographical nature of Home Owners’ Loan Corporation (HOLC) racialized mortgage credit risk categories (e.g., redlined areas) provides an opportunity for a good natural experiment to evaluate the plausible causal impacts of the manifestation of neighborhood-level structural racism and its long-term consequences. Our specific aims are: 1) To identify the impact of neighborhood-level structural racism and intergenerational wealth accumulation; 2) To test the effect of structural racism on obesity over multiple generations; and 3) To test the mediating role of intergenerational wealth on the causal relationship between structural racism and obesity outcomes in adults. Our overarching hypothesis is that federally supported racialized “redlining” policies effectively prohibited Black Americans from building wealth in their homes, leading to decades of divestment in predominately Black neighborhoods and contributing to the development of obesogenic environments, and ultimately obesity risk over the life course. We leverage the longitudinal nature of the Panel Study for Income Dynamics (PSID) to implement a life course approach for assessing generational wealth inequality and obesity disparities and use a quasi-experimental design which circumvents the use of random assignment of the exposure variable. Aims 1 and 2 will use the actual boundaries of the “redlined” neighborhoods to conduct a geographical regression discontinuity (GRD) which addresses endogeneity of neighborhood characteristics by specifying a spatial or geographical boundary split with a marked threshold. Aim 3 will investigate the indirect effects of each generation of wealth accumulation on neighborhood-level structural racism and body mass index (BMI) outcomes. Results will contribute to understanding why health disparities exist for racialized minority communities by identifying how specific pathways operate through structural racism to create racialized inequities in obesity outcomes. Implications from this research will help identify consequences of structural racism and can help to lead to full accounting of the impacts, as well as identify corrective economic and health policy interventions that address inequalities in wealth and obesity disparities in middle-aged adults.