Randomized Controlled Trial of Concentrated Investment in Low-Income Neighborhoods to Improve Health

University Of Pennsylvania, Philadelphia PA

Investigators

Abstract

Grant #U01ES036367 Americans living in low-income neighborhoods in the US fare worse across nearly every health indicator compared to Americans living in higher-income neighborhoods. In Philadelphia, the location of this study, these differences culminate in a stark longevity gap, with average life expectancies in low-income neighborhoods being 20 years lower than in nearby affluent neighborhoods. The fundamental cause of poor health in low-income neighborhoods is a constellation of reduced economic opportunities, financial insecurity, and adverse environmental conditions, which act in mutually reinforcing ways to harm health across generations. To date, most interventions targeting low-income neighborhoods have focused on changing behaviors for individuals living within them or single neighborhood-wide factors that impact health. However, by failing to address the multiple, reinforcing mechanisms that generate persistent health disadvantages for Americans living in low-income neighborhoods, existing interventions have had limited impact. We propose to develop and test a radically different approach in which we intervene on multiple upstream drivers of health in unison to more substantially and durably improve health among Americans in low-income neighborhoods. This new approach is motivated by the insight that overcoming multiple, reinforcing threats to health will require significant concentrated investment in the structures that have left these neighborhoods in peril. Specifically, we will conduct a cluster randomized controlled trial (RCT) of a suite of place-based and financial-wellbeing interventions at the community and individual/household levels that address health. At the community level, we address underinvestment in low-income neighborhoods by implementing vacant lot greening, tree planting, and trash cleanup. At the individual/household levels, we increase access to public benefits, financial counseling and tax preparation services, and emergency cash assistance. We will test this “big push” intervention in 60 neighborhoods low-income neighborhoods, with up to a total of 720 adults. We hypothesize that this “big push” intervention will have significant impact on overall health and wellbeing, psychosocial distress, food insecurity, social connectedness, and crime. This proposal is innovative because when implemented simultaneously in targeted geographic areas, the suite of interventions will address the multiple mechanisms by which living in low-income neighborhoods harms health. The positive health impacts will be multiplied and longer-lasting what would be achieved by implementing any individual component. The results of the proposed research are expected to have significant public health impact as it will provide timely and scalable evidence of new strategies to more effectively promote health in low-income neighborhoods.