Structural Racism and Disparities in Social Risk, Human Capital, Health Care Resources, and Health Outcomes: A Multi-level Analysis of Pathways and Policy Levers for Change

结构性种族主义和社会风险、人力资本、医疗保健资源和健康结果的差异：变革路径和政策杠杆的多层次分析

• 批准号: 10654440
• 负责人: Leonard E. Egede
• 金额: $ 63.95万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-13 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10654440
• 关键词: Address; Area; Charge; Code; Color; Communities; Complex; Data; Data Sources; Discrimination; Disparity; Ensure; Equation; Event; Exposure to; Federal Government; Fostering; Goals; Government; Health; Health Care Costs; Healthcare; Hispanic; Home; Hospital Closures; Housing; Individual; Inequity; Insurance; Investments; Knowledge; Legal; Link; Local Government; Maps; Measurement; Medicaid; Medical; Methods; Modeling; Neighborhoods; Outcome; Pathway Analysis; Pathway interactions; Police; Policies; Residual state; Resources; Risk; Risk Factors; Safety; Schools; Security; Societies; State Government; Statutes and Laws; Structural Racism; System; Time; Wages; cost; disparity gap; disparity reduction; economic disparity; economic need; ethnic disparity; ethnic minority; evidence base; food insecurity; health care service utilization; health disparity; health outcome disparity; housing instability; human capital; implementation strategy; improved; innovation; machine learning method; mortality; multilevel analysis; novel; poor health outcome; programs; racial disparity; racial minority population; skills; social; social health determinants; voucher

Project Summary/Abstract Structural racism, the ways in which societies foster discrimination through mutually reinforcing inequitable systems, has emerged as an important social risk factor and contributor to poor health outcomes for ethnic minorities (Egede 2020, Bailey 2017, Paradies 2015). An important component of structural racism that has been inadequately studied is historic redlining. Historic redlining refers to the previously legal practice (initiated in 1934 by the Federal Housing Administration) of systematically denying credit access and insurance for borrowers in neighborhoods that were economically disadvantaged and that were inhabited by primarily racial minority groups (Richardson 2020, Rothstein 2017). While explicit redlining is now prohibited under the Fair Housing Act of 1968, the residual effects of residential redlining ensures that the same areas with exposure to historic structural racism are to this day disproportionately inhabited by residents that are unduly subject to worse social risk factors (defined across: Housing Instability; Food Insecurity; Transport Needs; Economic Needs; and Safety), lower human capital (defined as the totality of individuals’ knowledge and skills), and lower health care resources (defined as the medical resource capabilities of areas which enable them to handle broad and complex medical events/cases) (Brillioux 2017, Bailey 2021, Hidalgo 2021); and that redlining may present an important link between historic structural racism and present day disparities in health outcomes (defined across: mortality, health care cost, health care utilization) (Egede 2020). The goal of this project is to inform our understanding of the pathways between structural racism (defined as historic redlining), social risk factors, human capital, health care resources and health outcomes; and to evaluate policies that can help reduce the impact of structural racism on health disparities. The present study will accomplish this objective by using recently developed causal and interpretable machine learning methods, structural equation modelling, counterfactual analysis, along with stakeholder engagement, to address four aims: 1) Examine the relationship between regional exposure to structural racism (defined as: historic redlining) and present-day social risk factors, human capital, and health care resources. 2) Examine the direct and indirect effects of regional exposure to structural racism on health outcomes via social risk, human capital, and healthcare resources. 3) Assess policy levers of federal, state, and regional governments that can be used to reduce area vulnerabilities to historic structural racism, and that can reduce present-day health outcomes disparities. 4) Engage a diverse set of key stakeholders to identify and prioritize strategies for mitigating social risk, building human capital, and improving health care resources and outcomes for regions exposed to structural racism through historical redlining. The study is innovative in: (i) its examination of the linkages between structural racism and health outcomes, (ii) in its measurement of health care resources, and (iii) in its emphasis on identifying policy channels for reducing the perpetual impact of structural racism.

项目概要/摘要 结构性种族主义，社会通过相互强化的不平等来助长歧视的方式 系统，已成为一个重要的社会风险因素，并导致少数民族健康状况不佳 少数群体（Egede 2020，Bailey 2017，Paradies 2015）。 历史红线是指以前的法律实践。 （由联邦住房管理局于 1934 年发起）系统性地拒绝信贷准入和保险 对于经济上处于不利地位且主要居住在社区的居民 少数族裔群体（Richardson 2020，Rothstein 2017）。 1968 年公平住房法，住宅红线的残余影响确保了相同的区域 迄今为止，遭受历史性结构性种族主义影响的居民中，不成比例地居住着不适当的人。 受到更严重的社会风险因素的影响（定义为：住房不稳定；粮食不安全；交通需求； 经济需求；和安全），较低的人力资本（定义为个人知识和技能的总和） 技能），以及较低的医疗保健资源（定义为能够实现的地区的医疗资源能力） 还有那个 红线可能表明历史结构性种族主义与当今健康差异之间的重要联系 结果（定义为：死亡率、医疗保健成本、医疗保健利用率）（Egede 2020）。 该项目的目标是让我们了解结构性种族主义之间的途径 （定义为历史红线）、社会风险因素、人力资本、医疗保健资源和健康结果； 并评估有助于减少结构性种族主义对健康差异影响的政策。 研究将通过使用最近开发的因果和可解释机器学习来实现这一目标 方法、结构方程建模、反事实分析以及利益相关者的参与， 解决四个目标： 1) 检查区域性结构性种族主义暴露之间的关系（定义为： 历史红线）和当前的社会风险因素、人力资本和医疗保健资源 2）检查。 区域结构性种族主义通过社会风险对健康结果产生直接和间接影响， 3) 评估联邦、州和地方政府的政策杠杆。 这可以用来减少该地区对历史性结构性种族主义的脆弱性，也可以减少当今的 4) 让不同的关键利益相关者参与进来，确定战略并确定其优先顺序。 减轻社会风险，建设人力资本，改善地区医疗保健资源和成果 通过历史红线暴露于结构性种族主义 该研究的创新之处在于：（i）对历史的审视。 结构性种族主义与健康结果之间的联系，(ii) 在衡量医疗保健资源方面，以及 (iii) 强调确定减少结构性种族主义永久影响的政策渠道。