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

红线和基于地方的系统性种族主义对中年健康不平等的影响

• 批准号: 10582012
• 负责人: Helen Carmon Spink Meier
• 金额: $ 63.85万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10582012
• 关键词: Address; Aging; Air Pollution; Alcohols; American; Area; Behavioral; Cardiovascular Diseases; Censuses; Centers for Disease Control and Prevention (U.S.); Chronic Disease; Cities; Data; Data Set; Data Sources; Databases; Diabetes Mellitus; Disclosure; Economics; Environment; Environmental Hazards; Exposure to; Federal Government; Fire - disasters; Fostering; Geography; Goals; Government; Green space; Grouping; Health; Health Promotion; Health and Retirement Study; Healthcare; High Prevalence; Home; Housing; Hypertension; Individual; Industrialization; Inequality; Institution; Institutional Racism; Insurance; Investments; Knowledge; Life Expectancy; Location; Longitudinal Studies; Maps; Measures; Mediating; Mental Health; Minority; Morbidity - disease rate; Neighborhoods; Outcome; Ownership; Participant; Policies; Population; Population Dynamics; Poverty; Prevalence; Production; Race; Research; Resources; Risk; Security; Shapes; Societal Factors; Source; Strategic Planning; Structural Racism; Structure; Supermarket; Time; Toxin; United States Environmental Protection Agency; United States National Institutes of Health; Work; demographics; density; disparities in morbidity; health care availability; health care service; health disparity; health inequalities; high risk; metropolitan; middle age; mortality; mortality risk; multiple chronic conditions; physical conditioning; residential segregation; social; socioeconomics; tobacco products

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.

了解导致地域差异的社会、经济、行为和制度因素 中年发病率和死亡率对于解决健康不平等问题至关重要。历史上的种族主义住房政策（例如， 联邦红线、限制性行为和契约）影响了自然、社会和经济结构 导致美国种族和社会经济居住隔离的地方。系统性的否认 通过种族主义住房政策获得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，当今美国各地出现了不平等现象。 我们之前的工作表明，自 1935-40 年以来，业主贷款公司 (HOLC) 的红线是 与高少数族裔、低社会经济社区相关，平均预期寿命较短、较高 邻里慢性病流行，身心健康状况恶化。但很少有研究 研究了历史红线、随后的邻里轨迹的机制 随着时间的推移，投资和撤资以及种族居住隔离塑造了基于地方的 “暴露”于有害环境（例如工业毒素）和“获得”健康促进方面的不平等 影响个人发病率和死亡率的资源（例如医疗保健服务）。 拟议的项目将通过首先协调孤立的数据源以产生国家数据来解决这一差距。 历史红线数据库、历史和当前环境危害、住房投资、高档化、 以及纵向邻里人口统计和社会经济学。然后，我们将研究结构性种族主义 它嵌入到社区中，1）由此产生的社区“进入和暴露”方面的不平等 推动健康机会（目标 2），以及 2）从中年开始的发病率和死亡风险差异 全国代表性纵向研究，健康与退休研究 (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的机会，以及相关的纵向邻里变化 红线将部分调解这些关联。我们进一步假设 HRS 参与者居住在 历史上红线划定的地区比不居住在该地区的 HRS 参与者有更大的发病和死亡风险 红线区域，并且这种关联将根据当前种族居住隔离的强度而变化。这 该项目将创造可操作的知识，通过揭示如何从中年开始解决健康不平等问题 宏观结构因素，包括历史性的种族主义政府政策，导致社区和个人健康 差异。此外，目标 1 中生成的数据产品将公开，以方便更多人使用 研究其他健康纵向研究中的地点影响。