The impact of redlining and place-based systemic racism on health inequalities at mid-life

了解推动地区差异的社会、经济、行为和制度因素 中年发病率和死亡率是解决健康不平等问题的关键。历史上的种族主义住房政策(例如， 联邦红线、限制性契约和契约)影响了#年的物质、社会和经济结构。 在美国造成种族和社会经济隔离的地方。系统性的否认 通过种族主义住房政策拥有住房的机会可能是中年健康的关键上游来源 随着时间的推移，通过限制财富和基于地点的投资，如今美国各地都出现了不平等现象。 我们之前的工作表明，1935-40年间房主贷款公司(HOLC)的红线是 与少数族裔高、社会经济水平低的社区相关，平均预期寿命较短、较高 社区慢性病流行，身心健康状况较差。然而，很少有研究 已经调查了历史红线，随后的邻里轨迹 投资和撤资，以及随着时间推移的种族居住隔离，形成了以地点为基础的 “接触”有害环境(如工业毒素)和“获得”促进健康的不平等 影响个人发病率和死亡率的资源(如保健服务)。 拟议的项目将通过以下方式解决这一差距：首先，协调孤立的数据来源，以产生国家 历史红线数据库，历史和当前环境危害，住房投资，士绅化， 以及纵向社区的人口统计和社会经济学。然后，我们将考察结构性种族主义作为 它嵌入在邻里之间：1)邻里之间的不平等 促进健康机会(目标2)，以及2)从中年开始的发病率和死亡风险的差异 具有全国代表性的纵向研究，健康和退休研究(HRS)(目标3)。我们假设 历史上的红线区域将更接近当今的环境危害，并减少 获得医疗保健和健康促进资源，以及与此相关的纵向社区变化 使用红线标记将部分调解这些关联。我们进一步假设HRS参与者居住在 历史上有红线的地区比不居住的HRS参与者的发病率和死亡率更高 红线区域，这种联系将因当今种族居住隔离的强度而有所不同。这 该项目将创造可操作的知识，通过揭示如何在中年开始解决健康不平等问题 宏观结构因素，包括历史上的、种族主义的政府政策导致社区和个人健康 差距。此外，在AIM 1中生成的数据产品将公开提供，以便于 研究地点在其他健康纵向研究中的影响。

Understanding the social, economic, behavioral, and institutional factors that drive place-based differences in mid-life morbidity and mortality is critical to addressing health inequalities. Historic racist housing policies (e.g., federal redlining, restrictive deeds and covenants) influenced the physical, social and economic structure of places resulting in racial and socioeconomic residential segregation in the US. The systemic denial of homeownership opportunities through racist housing policies may be a key upstream source of mid-life health inequities observed across the US today through restrictions wealth and place-based investment over time. Our previous work has shown that Home Owners' Loan Corporation (HOLC) redlining from 1935-40 is associated with high minority, low socioeconomic neighborhoods with shorter average life expectancy, higher neighborhood prevalence of chronic diseases, and worse physical and mental health. However, few studies have investigated the mechanisms by which historic redlining, subsequent neighborhood trajectories of investment and disinvestment, and racial residential segregation over time have shaped place-based inequalities in `exposure' to harmful environments (e.g., industrial toxins) and `access' to health promoting resources (e.g., health care services) that impact individual-level morbidity and mortality. The proposed project will address this gap by, first, harmonizing siloed data sources to produce a national database of historical redlining, historic and current environmental hazards, housing investment, gentrification, and longitudinal neighborhood demographics and socioeconomics. Then, we will examine structural racism as it is embedded in neighborhoods with 1) the resulting inequalities in neighborhood `access and exposure' that drive health opportunities (Aim 2), and 2) disparities in morbidity and mortality risk beginning in mid-life in a nationally representative longitudinal study, the Health and Retirement Study (HRS) (Aim 3). We hypothesize that historically redlined areas will have greater proximity to present-day environmental hazards and reduced access to healthcare and health promoting resources, and that longitudinal neighborhood change associated with redlining will partially mediate these associations. We further hypothesize that HRS participants living in historically redlined areas will have greater risk of morbidity and mortality than HRS participants not living in redlined areas and that this association will vary by present-day intensity of racial residential segregation. This project will create actionable knowledge to address health inequities beginning in mid-life by uncovering how macrostructural factors, including historic, racist government policies result neighborhood and individual health disparities. Further, the data product generated in Aim 1 will be made publicly available to facilitate additional research on the impact of place in other longitudinal studies of health.