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Scholarly Works (5 results)

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UC Berkeley Electronic Theses and Dissertations (2024)

Abstract

Ethnic Enclaves and Severe Maternal Morbidity: Investigating the Impact of Neighborhood Dynamics and Structural Disinvestment in California

BackgroundCalifornia's diverse neighborhoods, such as Koreatown in Los Angeles, Chinatown in San Francisco, and Little India in Artesia, are rich cultural hubs that reflect the unique social and structural elements of ethnic communities. These areas, known as ethnic enclaves, influence health outcomes through the distribution of resources and exposure to disadvantages while also offering protective elements like social support and cultural cohesion. Maternal and child health, particularly severe maternal morbidity (SMM), is significantly impacted by these neighborhood factors. SMM includes serious health complications and is more common among racial and ethnic minoritized groups. This dissertation explores the role of neighborhood environments in SMM, the varied conceptualizations of ethnic enclaves and segregated neighborhoods, and the historical context of structural racism and disinvestment.

MethodsWe first summarize the existing conceptualization and measurement of ethnic enclaves and racial segregation through a systematic review of the literature over the previous twenty years. We then examine the impact of living in ethnic enclaves on severe maternal morbidity through three quantitative measurements of ethnic enclaves among Latine, Asian, and Black-birthing people in California. Finally, we construct twenty-year poverty histories to examine the geospatial patterns of long-term neighborhood disinvestment in racial/ethnic minoritized communities. Data for this study are from all hospital live births in California from 1997 to 2018, obtained from the California Department of Health Care Access and Information, formerly the Office of Statewide Health Planning and Development, which has linked hospital discharge records with birth certificates. The State of California Committee approved the study protocol for the Protection of Human Subjects, as did the institutional review boards of Stanford University and the University of California, Berkeley.

SignificanceUnderstanding the influence of ethnic enclaves and neighborhood poverty on SMM is crucial for developing targeted public health interventions. This study clarifies how these factors impact health outcomes across generations by clarifying the complex neighborhood processes and structural forces, including the historical context of racial segregation and disinvestment. Developing and assessing refined measures that capture these structural determinants will inform the design of effective policies and practices to reduce health inequities and improve maternal and infant health outcomes. This research contributes to a more comprehensive understanding and intervention framework for addressing the historical and structural forces shaping neighborhood conditions and health equity.

    • Article
    • Peer Reviewed
    UC Berkeley Previously Published Works (2019)
    In Minneapolis-St Paul, Minnesota, factors such as cultural and linguistic diversity make it difficult for public health agencies to reach immigrant and racial/ethnic minority populations with health initiatives. Founded in 2006, the Minnesota Immunization Networking Initiative (MINI) is a community project that has provided more than 80 000 free influenza vaccinations to vulnerable populations, including immigrants and racial/ethnic minority groups. MINI administered 5910 vaccinations through 99 community-based vaccination clinics during the 2017-2018 influenza season and surveyed the clients in their own language about influenza vaccination knowledge and practices. Among those surveyed, 2545 (43.1%) were uninsured and 408 (6.9%) received a first-time influenza vaccination at the MINI clinic. A total of 2893 (49.0%) respondents heard about the clinic through their faith community. Lessons learned included the importance of building relationships with community leaders and involving them as full partners, holding clinics in community-based settings to bring vaccinations to clients, and reporting outcomes to partners.
      Cover page: Engaging Communities to Reach Immigrant and Minority Populations: The Minnesota Immunization Networking Initiative (MINI), 2006-2017
      • Article
      • Peer Reviewed
      UC Berkeley Previously Published Works (2022)
      In the United States, racial disparities in adverse maternal health outcomes remain a pressing issue, with Black women experiencing a 3-4 times higher risk of maternal mortality and a 2-3 times higher risk of severe maternal morbidity. Despite recent encouraging efforts, fundamental determinants of these alarming inequities (e.g. structural racism) remain understudied. Approaches that address these structural drivers are needed to then intervene upon root causes of adverse maternal outcomes and their disparities and to ultimately improve maternal health across the U.S. In this paper, we offer a conceptual framework for studies of structural racism and maternal health disparities and systematically synthesize the current empirical epidemiologic literature on the links between structural racism measures and adverse maternal health outcomes. For the systematic review, we searched electronic databases (Pubmed, Web of Science, and EMBASE) to identify peer-reviewed U.S. based quantitative articles published between 1990 and 2021 that assessed the link between measures of structural racism and indicators of maternal morbidity/mortality. Our search yielded 2394 studies and after removing duplicates, 1408 were included in the title and abstract screening, of which 18 were included in the full text screening. Only 6 studies met all the specified inclusion criteria for this review. Results revealed that depending on population sub-group analyzed, measures used, and covariates considered, there was evidence that structural racism may increase the risk of adverse maternal health outcomes. This review also highlighted several areas for methodological and theoretical development in this body of work. Future work should more comprehensively assess structural racism in a way that informs policy and interventions, which can ameliorate its negative consequences on racial/ethnic disparities in maternal morbidity/mortality.
        Cover page: Structural racism and adverse maternal health outcomes: A systematic review.
        • Article
        • Peer Reviewed
        UC Berkeley Previously Published Works (2023)
        Neighborhood environments significantly influence the development of diabetes risk factors, morbidity, and mortality throughout an individuals life. The social, economic, and physical environments of a neighborhood all affect the health risks of individuals and communities and also affect population health inequities. Factors such as access to healthy food, green spaces, safe housing, and transportation options can impact the health outcomes of residents. Social factors, including social cohesion and neighborhood safety, also play an important role in shaping neighborhood environments and can influence the development of diabetes. Therefore, understanding the complex relationships between neighborhood environments and diabetes is crucial for developing effective strategies to address health disparities and promote health equity. This review presents landmark findings from studies that examined associations between neighborhood socioeconomic, built and physical, and social environmental factors and diabetes-related risk and outcomes. Our framework emphasizes the historical context and structural and institutional racism as the key drivers of neighborhood environments that ultimately shape diabetes risk and outcomes. To address health inequities in diabetes, we propose future research areas that incorporate health equity principles and place-based interventions.
          Cover page: The Impact of Neighborhoods on Diabetes Risk and Outcomes: Centering Health Equity.
          • Article
          • Peer Reviewed
          UC Berkeley Previously Published Works (2023)
          A transformative change grounded in a commitment to antiracism and racial and health equity is underway at the University of California, Berkeley, School of Public Health. Responding to a confluence of national, state, and local circumstances, bold leadership, and a moral and disciplinary imperative to name and address racism as a root cause of health inequities, our community united around a common vision of becoming an antiracist institution. Berkeley Public Health has a long history of efforts supporting diversity, equity, inclusion, belonging, and justice. Building upon those efforts, we pursued an institution-wide initiative, one that creates a more equitable and inclusive school of public health that models and supports the development of future public health leaders, practitioners, scholars, and educators. Grounded in the principles of cultural humility, we recognized that our vision was a journey, not a destination. This article describes our efforts from June 2020 through June 2022 in developing and implementing ARC4JSTC (Anti-racist Community for Justice and Social Transformative Change), a comprehensive, multiyear antiracist change initiative encompassing faculty and workforce development, student experience, curriculum and pedagogy, community engagement outreach, and business processes. Our work is data informed, grounded in principles of change management, and focused on building internal capacity to promote long-term change. Our discussion of lessons learned and next steps helps to inform our ongoing work and antiracist institutional change efforts at other schools and programs of public health.
            Cover page: Leading Change at Berkeley Public Health: Building the Anti-racist Community for Justice and Social Transformative Change
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