slu_ahead.pdf

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1. Racism, Redlining, and Contemporary Mental Health in St. Louis Christopher Prener, Ph.D. Assistant Professor of Sociology Saint Louis University
2. Christopher Prener, Ph.D. Assistant Professor of Sociology Saint Louis University Racism, Redlining, and Contemporary Mental Health in St. Louis
3. Acknowledgments Saint Louis University AHEAD Especially Leslie Hinyard, PhD, Jeffrey Scherrer, PhD, and Katie Sniffen, MS Washington University in STL Institute of Clinical and Translational Sciences Institue for Public Health Especially Randi Foraker, PhD Department of Sociology Michael Esposito, PhD
4. AGENDA 1. Preface 2. Measuring Health and Place 3. Fundamental Causes & Racism 4. Considering Mental Health 5. Where We Go From Here 1. PREFACE
5. ▸ Medical and urban sociologist with an interest in spatial and computational methods ▸ Affiliations: • SLU’s Advanced HEAlth Data Research Institute • SLU’s Institute for Healing Justice and Equity • Northeastern University’s Institute for Health Equity and Social Justice Research 1. PREFACE “HI, I’M CHRIS”
6. 1. PREFACE INTELLECTUAL TRAJECTORY
7. 1. PREFACE “DETRIMENTAL INFLUENCES”
8. 1. PREFACE “DETRIMENTAL INFLUENCES” Language used to describe the people and social problems that were seen as tarnishing neighborhoods’ reputations. Forthcoming funding from ICTS via NIH CTSA UL1TR002345 NIMHD R01 currently under review; NSF under revision Subject of a book proposal currently under development What are early 20th century racism’s longterm consequences for contemporary urban life and health? Core motivation for research initiative that launches July ‘22
9. 1. PREFACE “DETRIMENTAL INFLUENCES” What are heart disease rates like right here? What about here?
10. 2 MEASURING HEALTH AND PLACE
12. 2. MEASURING HEALTH AND PLACE PULLING COVID DATA TOGETHER New York Times COVID-19 Database (via GitHub) County Public Health Zip Code Data (via scrapers+API calls) Missouri COVID Tracking Data Sets State of Missouri and Illinois (via scrapers) CMS Nursing Home Data & HHS Hospitalization Data (via API) Census Bureau (via API)
19. Limited updates - not only are there lags, but data sources are often limited in longitudinal scope or receive (at best) yearly updates Problematic areal units - ZIP codes remain too common despite the known drawbacks Announcement Text CHALLENGES 2. MEASURING HEALTH AND PLACE Recency of data - MOPHIMS is comically out of date, and other data sources often run a year or more behind
20. Data are isolated - Analyses look within a single hospital system or within a certain subset of payor sources CHALLENGES 2. MEASURING HEALTH AND PLACE Announcement Text Data accessibility - Just downloading and working with these data can be incredibly challenging Announcement Text Data costs - Significant barriers to entry mean that a limited subset of researchers can realistically access data that do exist
21. CHALLENGES 2. MEASURING HEALTH AND PLACE Announcement Text Data costs - Significant barriers to entry mean that a limited subset of researchers can realistically access data that do exist Who are we doing this work for?
22. 3 FUNDAMENTAL CAUSES & RACISM
23. 3. FUNDAMENTAL CAUSES & RACISM FUNDAMENTAL CAUSE THEORY segregation (Williams & Collins 2001 and Sewell 2016) structural racism (Gee & Ford 2011) systematic racism (Phelan & Link 2015) racial capitalism (Pirtle 2020)
24. FOR THE PROBLEM OF THE TWENTIETH CENTURY IS THE PROBLEM OF COLOR LINE W.E.B. Du Bois The Souls of Black Folk (1903) Wikimedia Commons
25. 3. FUNDAMENTAL CAUSES & RACISM FOCUSING ON SOUTHERN CITIES Urban sociology has focused on a relatively small number of cities, and we often view them as a research site rather than an institution. We need to broaden literatures into the literal and figurative American South and produce deeper literatures on specific cities.
26. A LABORATORY FOR RACISM INDIGENOUS EXPULSION THE MISSOURI COMPROMISE DRED SCOTT BLEEDING KANSAS Clockwise from Upper-left: Author’s Work; Smithsonian Institution; Wikipedia; Wikipedia
27. A LABORATORY FOR RACISM DEED COVENANTS EXCLUSIONARY ZONING “SLUM” CLEARANCE REDLINING Clockwise from Upper-left: Erenow; Google; Wikipedia; Missouri Bar Association
28. REDLINING A - “Best” B - “Still Desirable” C - “Definitely Declining” D - “Hazardous”
29. REDLINING A - “Best” B - “Still Desirable” C - “Definitely Declining” D - “Hazardous” “In St. Louis, the white middle class suburb of Ladue was colored green because…it had ’not a single foreigner or negro.’” (Rothstein 2017) Rothstein, Richard. 2017. The Color of Law. New York, NY: W.W. Norton & Co.
30. REDLINING A - “Best” B - “Still Desirable” D - “Hazardous” C - “Definitely Declining” “‘infiltration of a lower grade population’” (Hillier 2005:217) Hillier, Amy. 2005. “Residential Security Maps and Neighborhood Appraisals.” Social Science History 29(2):207-233.
31. REDLINING A - “Best” B - “Still Desirable” C - “Definitely Declining” D - “Hazardous” Hillier, Amy. 2005. “Residential Security Maps and Neighborhood Appraisals.” Social Science History 29(2):207-233. “‘detrimental influences in a pronounced degree,’ and ‘undesirable population or an infiltration of it’” (Hillier 2005:217)
32. REDLINING A - “Best” B - “Still Desirable” C - “Definitely Declining” D - “Hazardous” Rothstein, Richard. 2017. The Color of Law. New York, NY: W.W. Norton & Co. “Lincoln Terrace was colored red because ‘it had little or no value today…due to the colored element now controlling the district’” (Rothstein 2017)
35. Relationship with Redlining: r = 0.750 (p < 0.001)
36. 3. FUNDAMENTAL CAUSES & RACISM MEASURING SEGREGATION The Index of Concentration at the Extremes (ICE) provides a sub-county measure of segregation that produces scores per feature from -1 (total segregation of the marginalized group) to 1 (total segregation of the privileged group). Formula: ICEi = (Ai - Pi )/Ti Where: Ai = Privileged [white] Pi = Marginalized [Black] Ti = Total Population Massey, Douglas. 2001. “The prodigal paradigm returns: ecology comes back to sociology.” Pp. 41-48 in Does It Take a Village? Community Effects on Children, Adolescents, and Families, edited by A. Booth and A. Crouter. Mahwah, NJ: Lawrence Erlbaum Associates. Krieger, Nancy, et al. 2017. "Measures of local segregation for monitoring health inequities by local health departments." American Journal of Public Health 107(6): 903-906.
37. No Population
38. 3. FUNDAMENTAL CAUSES & RACISM CORRELATIONS There is an “arc” over time in the strength of the relationship between increased percent redlined and ICE values (remember -1 is highest segregation for African Americans). Year Pearson’s r with Redlining 1940 -0.141* 1950 -0.235*** 1960 -0.468*** 1970 -0.573*** 1980 -0.565*** 1990 -0.566*** 2000 -0.555*** 2010 -0.475***
39. Relationship with Redlining: r = -0.525 (p < 0.001)
40. FOUR ‘PECULIAR’ INSTITUTIONS Instituion Form of Labor Core of Economy Dominant Social Type Slavey (1619-1865) Unfree fixed labor Plantation Slave Jim Crow (South,1865-1965) Free fixed labor Agrarian and extractive Sharecropper Ghetto (North, 1915-1968) Free mobile labor Industrial manufacturing Menial worker Hyperghetto and Prison (1968-) Fixed surplus labor Postindustrial services Welfare recipient and criminal Loïc Wacquant (2002) argues that there are four successive institutions - particular to the U.S. - that link slavery with contemporary racial inequality. Wacquant, Loïc. 2002. “From Slavery to Mass Incarceration.” New Left Review 13:41-60.
41. FOUR ‘PECULIAR’ INSTITUTIONS Instituion Form of Labor Core of Economy Dominant Social Type Slavey (1619-1865) Unfree fixed labor Plantation Slave Jim Crow (South,1865-1965) Free fixed labor Agrarian and extractive Sharecropper Ghetto (North, 1915-1968) Free mobile labor Industrial manufacturing Menial worker Hyperghetto and Prison (1968-) Fixed surplus labor Postindustrial services Welfare recipient and criminal Loïc Wacquant (2002) argues that there are four successive institutions - particular to the U.S. - that link slavery with contemporary racial inequality. Contemporary Disparities Wacquant, Loïc. 2002. “From Slavery to Mass Incarceration.” New Left Review 13:41-60.
42. These layers form the structure on which health disparities are built. Unsplash
43. 4 CONSIDERING MENTAL HEALTH
44. 4. CONSIDERING MENTAL HEALTH “DETRIMENTAL INFLUENCES” Is this neighborhood bad for residents’ mental health? Or are people with good mental health more likely to live here?
45. 4. CONSIDERING MENTAL HEALTH “DETRIMENTAL INFLUENCES” Is this neighborhood bad for residents’ mental health? Or are people with good mental health more likely to live here? Is redlining associated with compositional or contextual factors associated with poor mental health?
46. 4. CONSIDERING MENTAL HEALTH “DETRIMENTAL INFLUENCES” reliance on problematic 500 Cities data limited evidence of racial disparities in SPMH… … but also limited access (McGuire and Miranda 2008; Williams and Earl 2007)
47. 4. CONSIDERING MENTAL HEALTH “DETRIMENTAL INFLUENCES” What are early 20th century racism’s longterm consequences for contemporary urban life and health? Are historic racism and contemporary segregation associated with hospitalizations for (a) schizophrenia, (b) depression, and (c) anxiety disorders… Meditational and spatial modeling … after for multiple competing forms of bias?
48. DATA & METHODS 2015-19 MH Hospitalization Rates (MHA) 1940 HOLC Boundaries (Gordon 2009) 2015-19 ACS Demographic Data Data Sources Descriptive Mapping Analytical Steps Analysis Platform Local Spatial Autocorrelation (LISA) Correlations OLS Models Meditational and spatial modeling
49. 5 WHERE WE GO FROM HERE
50. How can the Missouri Hospital Association’s data be extended to help create small area estimates for disease? 4. CONSIDERING MENTAL HEALTH “DETRIMENTAL INFLUENCES” What are early 20th century racism’s longterm consequences for contemporary urban life and health? How can we scale this to produce small area estimates for disease burden elsewhere in Missouri?
51. How can we use these data to highlight disparities, engage community partners, and focus our attention on neighborhoods most harmed by structural racism? 4. CONSIDERING MENTAL HEALTH “DETRIMENTAL INFLUENCES” What are early 20th century racism’s longterm consequences for contemporary urban life and health? How can we translate this information into clinical practice?
52. Slides available via SpeakerDeck https://speakerdeck.com/chrisprener/slu-ahead chris.prener@slu.edu chris-prener.github.io LEARN MORE THANKS FOR COMING! @chrisprener chrisprener.substack.com