# A Randomized Controlled Trial of Concentrated Investment in Black Neighborhoods to Address Structural Racism as a Fundamental Cause of Poor Health

> **NIH NIH U01** · UNIVERSITY OF PENNSYLVANIA · 2021 · $4,913,131

## Abstract

Project Summary. Black Americans in the US fare worse across nearly every health indicator compared to
White individuals. In Philadelphia, the location of this study, these health disparities culminate in a stark
longevity gap, with average life expectancies in poor, predominantly Black neighborhoods being 20 years lower
than in nearby affluent, predominantly White neighborhoods. The fundamental cause of these racial health
disparities is structural racism, which operates via interconnected, mutually reinforcing social and economic
pathways. Notably, long-standing, systematic disinvestment has resulted in highly segregated Black
neighborhoods with dilapidated environmental conditions and severe economic insecurity within Black
households, leading to a “feedback loop of concentrated racial disadvantage,” which is strongly tied to poor
health. To date, most interventions have focused on individual-level behaviors or single social determinants of
health. However, by failing to address the multiple mechanisms that generate persistent health disadvantages
for Black Americans, 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 Black Americans. This new approach is motivated
by the insight that overcoming centuries of structural racism will require significant concentrated investment in
the structures that have left Black people and their 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, organization, and individual/household levels that address the social determinants of racial health
disparities. At the community level, we address underinvestment in Black neighborhoods by implementing
vacant lot greening, abandoned house remediation, tree planting, and trash cleanup. At the organization
level, we partner with community-based financial empowerment providers to develop cross-organizational
infrastructure to increase reach and maximize efficiency. 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 Black neighborhoods, with a total of 720 adults. We hypothesize
that this “big push” intervention will have significant impact on overall health and wellbeing, blood pressure,
psychosocial distress, food insecurity, social connectedness, and violence. This proposal is innovative
because when implemented simultaneously in targeted geographic areas, the suite of interventions
will address the multiple mechanisms by which structural racism harms Black health. The positive
health impacts will be multiplied and longer-lasting what would be achieved by implementing any individual
component. The results of t...

## Key facts

- **NIH application ID:** 10413510
- **Project number:** 1U01OD033246-01
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** EUGENIA C SOUTH
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $4,913,131
- **Award type:** 1
- **Project period:** 2021-09-23 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10413510

## Citation

> US National Institutes of Health, RePORTER application 10413510, A Randomized Controlled Trial of Concentrated Investment in Black Neighborhoods to Address Structural Racism as a Fundamental Cause of Poor Health (1U01OD033246-01). Retrieved via AI Analytics 2026-05-29 from https://api.ai-analytics.org/grant/nih/10413510. Licensed CC0.

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