In an unprecedented effort to address the harmful effects of structural racism on health, 60 predominantly Black neighborhoods in Philadelphia will be part of an ambitious study to assess the impact of a multi-component intervention addressing both environmental and economic injustice on health and well-being, led by Penn Medicine researchers Eugenia C. South, MD, MHSP, and Atheendar Venkataramani, MD, PhD.
At the community level, the study includes tree planting, vacant lot greening, trash cleanup, and rehabilitation of dilapidated, abandoned houses. For households, the study will help connect participants to local, state, and federal social and economic benefits, including food, unemployment, and prescription drug assistance, provide financial counseling and tax preparation services, and offer emergency cash assistance.
This randomized controlled trial (RCT), is funded by a nearly $10 million dollar grant (1-U01OD033246-01) from the National Institutes of Health (NIH), awarded to researchers at the Perelman School of Medicine at the University of Pennsylvania through the NIH Common Fund's Transformative Research to Address Health Disparities and Advance Health Equity initiative, the NIH announced 11 grants totaling $58 million over five years for highly innovative health disparities research across the U.S.
Previous efforts to reduce racial health disparities have been less impactful than we would like because they often only address a small number of the many mechanisms by which structural racism harms health. Our multi-component intervention is designed to address these multiple mechanisms all at once."
Atheendar Venkataramani, Assistant Professor of Medical Ethics and Health Policy and Director of the Opportunity for Health Lab
Recent research illustrates that the roots of poor health in Black neighborhoods are structural, resulting from decades of disinvestment and neglect. The impacts of structural racism are evident from neighborhood-level factors such as crumbling houses, lack of greenspace, trash build-up, and declining economic opportunity. The impact on the health of individuals living in those communities is profound, and includes increased rates of depression, post-traumatic stress disorder and heart disease compared to their White counterparts.
The researchers also aim to make it easier for individuals to navigate the process of determining their eligibility and getting help from multiple providers through development of a platform that makes collaboration between community financial service agencies simpler and more efficient. Community partners, including the Pennsylvania Horticultural Society, Campaign for Working Families, Benefits Data Trust, and Clarifi will implement the interventions.
"Black communities are centered in this proposal," said Eugenia South, MD, MSHP, an assistant professor of Emergency Medicine, and faculty director of the Penn Urban Health Lab. "Collectively, our team has spent a significant amount of time talking and working with leaders and community groups in Black Philadelphia neighborhoods and with this study we are committed to being responsive to the economic and environmental needs they have identified. We will also be hiring four full-time community members to the Penn Medicine team to advise on the entire process and lead recruitment."
The researchers will enroll 720 predominantly Black adults across the 60 study neighborhoods, half of whom will receive the proposed interventions. The study will meet participants where they are via door-to-door recruitment, rather than relying on clinic referrals or responses to flyers, which may exclude the most vulnerable adults. Investigators will use standardized surveys to evaluate the overall health and wellbeing of participants at multiple times over the course of the trial. They will also evaluate the impact on violent crime.
The overall goal is to show that deeply entrenched racial health disparities can be closed by concentrated investment in Black neighborhoods. Researchers are hopeful their interventions will be successful improving the health not just of participants in the study, but other members of the household and of the whole community. The findings of this bold project could serve as evidence to policymakers that these sweeping, "big push" interventions work, and should be implemented broadly.
Co-investigators on the study are: George Dalembert, MD MSHP, an assistant professor of Clinical Pediatrics, Courtney Boen, PhD MPH, an assistant professor of Sociology, Meghan Lane-Fall, MD MSHP, an associate professor of Anesthesiology and Critical Care, and Epidemiology in Biostatistics, and Epidemiology, and the Director of Acute Care Implementation Research at the Penn Implementation Science Center, Kristin Linn, PhD, an assistant professor of Biostatistics, John MacDonald, PhD, a professor of Criminology and Sociology, Christina Roberto, PhD, an assistant professor of Medical Ethics and Health Policy, and Charles Branas, PhD, an Adjunct Professor of Epidemiology in Biostatistics and Epidemiology.