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

项目摘要 在俄亥俄州哥伦布市的林登社区，一个历史上被隔离和取消投资的社区 受几十年歧视性种族政策的摧残，婴儿死亡率(IMR)超过20%。 1,000名活产儿(2%)，种族差距比率接近3。研究人员将婴儿死亡率与贫困联系在一起 产妇教育的出生结果、产妇经历的压力和歧视、贫穷、缺乏机会 缺乏健康食品，缺乏稳定的住房，以及无法获得产前/医疗护理。这些风险因素是 由于历史和当代政策和做法的根深蒂固，集中在多数少数民族社区 在结构性种族主义(例如，红线、限制性公约、不利的分区)中，将人与人隔离 社区内的资源。林登区以黑人为主(63%)，人口18万 居民，其中约45%的人生活在联邦贫困线以下。建立在全国儿童基金会的基础上 医院(NCH)通过其健康社区/健康社区进行住房和社区发展的历史 家庭社区伙伴关系在城市的南侧，NCH有针对性地在林登进行再投资 改善住房质量和负担能力、教育成果、获得医疗保健的机会、经济发展、 和居民的社会关系。在生命历程理论(LCT)的启发下，本提案的目标是 描述影响儿童生殖健康和其他妇幼保健经验的歧视性政策以及 几代黑人女性的结果，重要的是，展示了社区再投资如何 旨在针对和纠正历史和当代的结构性种族主义和歧视。具体来说， 我们的目标是：(1)考察多代黑人女性在结构性结构的交叉点上的经历 从历史和当代政策的角度看种族主义和生殖健康 社区；(2)明确地对目标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；以及(3)衡量短期婴儿的相对变化 以及目标社区的孕产妇健康差距和统计上匹配的比较地理位置。

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.