Urban HEART Detroit: a Tool To Better Understand and Address Health Equity Gaps in the City

Does the built environment of settlements affect our sentiments? A multi-level and non-linear analysis of Xiamen, China, using social media data

Introduction

Humans spend most of their time in settlements, and the built environment of settlements may affect the residents' sentiments. Research in this field is interdisciplinary, integrating urban planning and public health. However, it has been limited by the difficulty of quantifying subjective sentiments and the small sample size.

Methods

This study uses 147,613 Weibo text check-ins in Xiamen from 2017 to quantify residents' sentiments in 1,096 neighborhoods in the city. A multilevel regression model and gradient boosting decision tree (GBDT) model are used to investigate the multilevel and nonlinear effects of the built environment of neighborhoods and subdistricts on residents' sentiments.

Results

The results show the following: (1) The multilevel regression model indicates that at the neighborhood level, a high land value, low plot ratio, low population density, and neighborhoods close to water are more likely to improve the residents' sentiments. At the subdistrict level, more green space and commercial land, less industry, higher building density and road density, and a smaller migrant population are more likely to promote positive sentiments. Approximately 19% of the total variance in the sentiments occurred among subdistricts. (2) The proportion of green space and commercial land, and the density of buildings and roads are linearly correlated with residents' sentiments. The land value is a basic need and exhibits a nonlinear correlation with sentiments. The plot ratio, population density, and the proportions of industrial land and the migrant population are advanced needs and are nonlinearly correlated with sentiments.

Discussion

The quantitative analysis of sentiments enables setting a threshold of the influence of the built environment on residents' sentiments in neighborhoods and surrounding areas. Our results provide data support for urban planning and implementing targeted measures to improve the living environment of residents.

Historic Redlining Practices and Contemporary Determinants of Health in the Detroit Metropolitan Area

Objectives. To examine how redlining, a historical racially discriminatory housing policy implemented by the Home Owners' Loan Corporation (HOLC), is associated with current neighborhood determinants of health in the Detroit Metropolitan Area. Methods. We analyzed associations between census tract‒level HOLC color grades (red = "hazardous"; yellow = "declining"; blue = "desirable"; and green = "best") and a developed neighborhood determinants of health index (DOHI) consisting of 8 indicators of economic, social, governance, and physical environment characteristics using spatial regression analysis and controlling for change in the census tract's percentage of White residents. Results. A total of 484 Detroit Metropolitan Area census tracts had HOLC grades. The mean redlining score across all census tracts was 3.02 (min = 1.0; max = 4.0). The mean contemporary DOHI was 19.11 (min = 8.0; max = 36.0). Regression models show significantly higher DOHI scores in yellowlined (b = 2.71; 95% confidence interval [CI] = 1.52, 3.91), bluelined (b = 5.33; 95% CI = 3.65, 7.01), and greenlined (b = 9.25; 95% CI = 6.86, 11.64) neighborhoods compared with redlined neighborhoods. Conclusions. Historical redlined neighborhoods experience contemporary determinants of health conditions that are less conducive to health compared with those in nonredlined neighborhoods. These differences also reflect the accumulation of resources essential for health in greenlined neighborhoods. Public Health Implications. Neighborhood development initiatives should consider the impacts of historical redlining on contemporary neighborhood conditions. (Am J Public Health. 2023;113(S1): S49-S57. https://doi.org/10.2105/AJPH.2022.307162).

Bringing Sectors Together in Da Nang, Vietnam: Participatory Systems Mapping

The USAID-funded Building Healthy Cities (BHC) work in Da Nang, Vietnam, engaged 108 multi-sector stakeholders to gather qualitative data across two workshops and three citizen town halls from 2019 to 2021. These data were synthesized with the results from BHC's seven other activities in Da Nang to build systems maps. Contextual findings showed that multi-sector, multi-level participation and collaboration have been the key to moving the city toward their smart and livable city goals. Currently, citizen, nongovernmental organization, and private sector collaboration are low for many government sectors, which results in policy and programs that are mismatched to actual needs and therefore have less powerful impacts. When these policies and programs are implemented, they struggle to demonstrate strong benefits to these stakeholder groups, further decreasing participation. This is central to the systems map that BHC developed, and is expanded upon through additional patterns that fall within four main areas: management quality; vision and leadership; workforce capacity; and community engagement. Stakeholders found four key leverage points within this context that, if included in every action, could help overcome barriers. These leverage opportunities are: (1) investing at all levels; (2) improving function and innovation of information technology; (3) increasing participation and feedback; and (4) creating more responsive policy. As BHC concludes activities in Da Nang, local university students will be trained on systems mapping techniques to embed systems thinking skills into the next generation of workforce, and a set of recommendations will be developed to share with the government to act on these findings.

Urban HEART Detroit: the Application of a Health Equity Assessment Tool

The Urban Health Assessment Response Tool (Urban HEART) was developed by the World Health Organization. In 2016, the Urban HEART was adapted and used by the Healthy Environments Partnership, a long-standing community-based participatory research partnership focused on addressing social determinants of health in Detroit, Michigan, to identify health equity gaps in the city. This paper uses the tool to: (1) examine the geographic distributions of key determinants of health in Detroit, across the five Urban HEART specified domains: physical environment and infrastructure, social and human development, economics, governance, and population health, and (2) determine whether these indicators are associated with the population health indicators at the neighborhood level. In addition to the Urban HEART matrix, we developed various tools including graphs and maps to further examine Detroit's health equity gaps. Although not required by Urban HEART, we statistically analyzed the associations between each indicator with the health outcomes. Our results showed that all the domains contained one or more indicators associated with one or more health outcomes, making this an effective tool to study health equity in Detroit. The Urban HEART Detroit project comes at a critical time where the nation is focusing on health equity and understanding underlying determinants of health inequities in urban areas. A tool like Urban HEART can help identify these areas for rapid intervention to prevent unnecessary burden from disease. We recommend the application of the Urban HEART, in active dialog with community groups, organizations, and leaders, to promote health equity.

Residential Racial and Socioeconomic Segregation as Predictors of Housing Discrimination in Detroit Metropolitan Area

This study examined neighborhood racial and socioeconomic characteristics associated with housing discrimination (HD) in the Detroit Metropolitan Area, Michigan. Using novel neighborhood level data from the Fair Housing Center of Metropolitan Detroit in combination with the American Community Survey, incidence rate ratios (IRRs) were derived to examine associations between HD cases and percentage of homeowners, non-Hispanic White (NHW) residents, and median income. Models were stratified to examine these associations for race-, disability- and rent-related HD outcomes. Between 2008–2017, 988 HD incidents were reported. Independently, neighborhood proportion NHW, income, and homeownership were inversely associated with all-types of HD. Jointly, the neighborhood predictors remained significant indicators. Similar patterns were observed in race-, disability- and rent-related HD when neighborhood predictors were examined independently. In the joint models, household income no longer predicted race-related HD, while proportion NHW no longer predicted disability- and rent-related HD. Results suggest HD may be more frequent in neighborhoods with greater proportions of NHB or Hispanic residents, those with lower incomes, and greater proportion of rental households. These findings have great social and health implications and warrant further exploration of how HD contributes to social and health inequities in lower income, predominantly NHB and Hispanic neighborhoods and those with more renters.

Insuring Good Health: Outcomes and Acceptability of a Participatory Health Insurance Literacy Intervention in Diverse Urban Communities

BACKGROUND

The U.S. uninsured rate has dropped significantly since the passage of the Affordable Care Act (ACA), yet insurance coverage remains lower in historically marginalized communities than in the overall population. New consumer engagement approaches that involve these populations are needed. The purpose of this study was to evaluate the effectiveness of the Insuring Good Health Intervention, a website and video series designed to improve engagement with health insurance and ACA reforms. The study was designed and implemented using a community-based participatory research approach.

METHOD

We conducted a lagged-control cluster randomized controlled trial to evaluate Insuring Good Health with racially and ethnically diverse adults seeking services in medically underserved areas within the Detroit, Michigan metropolitan area. Outcomes were assessed at baseline and at 6 and 9 months postintervention, and including self-efficacy, knowledge, beliefs, and intention to seek help with insurance navigation and care.

RESULTS

Among 243 participants, mean age was 43.4 ( SD = 13) years, and all participants met federal guidelines for poverty. The study had an 86% response rate at 9-month follow-up ( n = 209). Compared with the lagged-control group, intervention participants had more positive beliefs concerning preventive care (estimate 0.51, standard error 0.16; p < .01), and intention to seek help with insurance navigation and care (estimate 0.43, standard error 0.17; p < .001) at 9-month follow-up. Hispanic participants benefitted the most from the intervention, including improved knowledge of health insurance eligibility over 9 months compared with other racial/ethnic groups (estimate -0.97, standard error 0.40, p < .01).

DISCUSSION

Insuring Good Health was associated with increased intention to seek help with insurance navigation and care, and improved beliefs around preventive care.

CONCLUSIONS

Insuring Good Health has the potential to be an important consumer engagement tool to reduce disparities in health insurance coverage and care seeking.

Prioritizing Racial Equity: How Efforts to Advance Racial Equity Helped Shape the W.K. Kellogg Food & Fitness Initiative

Racial equity is closely linked to principles of fairness and justice. It is distinct from the concept of racial equality. Community engaged strategies aimed at creating racial equity have generated effective ways to dismantle structural racism-the racialized policies and practices that have shaped economic and social institutions in the United States throughout its history. In crafting the Food & Fitness Initiative, the W.K. Kellogg Foundation made advancing racial equity a top priority. By doing so, it encouraged the community partnerships funded under the initiative to apply theories of expanding equity to real-world situations in order to reduce racial disparities in their neighborhoods. This article reviews the methods that were employed over the course of the initiative to support the partnerships with their efforts. It highlights three key components: (1) being intentional about maintaining a focus on racial equity, (2) concentrating on changing policies and systems, and (3) consistently incorporating meaningful and authentic community engagement into the work. The importance of making the concept of equity concrete and measurable is explored. Furthermore, the article discusses strategies that strengthened the capacity of the partnerships to navigate the policy-making process and to build leadership and shift power to community residents. The article concludes by detailing measures that could guide future efforts to make racial equity a priority and emphasizes that doing so is crucial given the rapid demographic shifts underway across the country.