Background: Gentrification, a macro-level factor in the San Francisco Bay Area, shapes the symbiotic relationship between context and composition in urban neighborhoods. Gentrification is a process in which formerly declining, under-resourced neighborhoods experience reinvestment an in-migration of increasingly affluent new residents. These processes can potentially diminish health protective mechanisms such as social networks, housing stability, and community resources. Conversely, it may enhance public services, sense of safety, and wealth.

Methods: The question framing this dissertation is: To what extent and under what circumstances does the macro-level process of gentrification exacerbate health inequities between existing low-income long-term residents and newer higher-income residents in gentrifying communities? To ground this study, Chapter 2 provides a mixed-methods systematic review of the literature analyzing the conceptual underpinnings of research on gentrification in relation to health and well-being, the mechanisms linking the exposure to health outcomes, and temporal and spatial considerations of both the exposure and etiology of the health outcome of interest. Chapter 3 uses all-cause mortality data from 2005 – 2013 in Alameda County to examine the association between preventable mortality, which is an indicator of health inequities, and gentrification in low-income and medium/high income census tracts, while accounting for lack of independence over time between both the exposure and outcome. In Chapter 4, to capture the potential heterogenous effects of gentrification and the importance of identifying mechanisms linking gentrification and preventable

mortality, we analyze qualitative data collected by in-depth interviews with long-term residents that have lived in two adjacent census tracts in the West Oakland neighborhood of Alameda County with distinct preventable mortality rates but similar stages of gentrification.

Discussion and Significance: Increasingly macrosocial approaches to public health are examining the health effects of resultant social structures and social systems that propel unequal power, relations, and resources. This dissertation uses the example of gentrification as case study to inform research trajectories, challenges, and points of innovation for future scholarship on macro-level factors. Research findings underscore the importance of examining macro-social factors as producers of spatially patterned health inequities in cities. An exclusive focus on individual and neighborhood level factors limits understanding on the forces producing health inequity. Grounding research with conceptual clarity, explicit use of theory, hypothesized mechanisms, and accounting for time and space can illuminate the role of gentrification and potential approaches to reduce inequities. Furthermore, discerning the complex synergistic roles of the life course of regions, neighborhoods and individuals and embracing rather than controlling for difference may help inform movements, policy and interventions toward reducing urban health inequities.