Concentrated Investment for Health Disparities in Black Neighborhoods

Overseen By Evan Spencer, MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Pennsylvania

Disqualifiers: Moving, Unable to consent

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

571 Participants Needed

Trial Summary

What is the purpose of this trial?

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 investigators 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, the investigators address underinvestment in Black neighborhoods by implementing vacant lot greening, abandoned house remediation, tree planting, and trash cleanup. At the organization level, the investigators partner with community-based financial empowerment providers to develop cross-organizational infrastructure to increase reach and maximize efficiency. At the individual/household levels, the investigators increase access to public benefits, financial counseling and tax preparation services, and emergency cash assistance. The investigators will test this "big push" intervention in 60 Black neighborhood microclusters, with a total of 720 adults. The investigators hypothesize that this "big push" intervention will have significant impact on overall health and wellbeing.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Financial Well-being Interventions, Place-based Interventions for health disparities in Black neighborhoods?

Research shows that financial stress is a major cause of poor health outcomes, and Medical-Financial Partnerships (MFPs) that provide financial services like coaching and debt reduction can improve both finances and health. Additionally, place-based interventions targeting social and medical factors can help reduce the burden of diseases like diabetes and heart disease in Black communities. ^{1 2 3 4 5}

Is the treatment generally safe for humans?

The research does not provide specific safety data for the treatment, but it discusses interventions that address social determinants of health, which are generally considered safe as they focus on improving living conditions, education, and income. ^{5 6 7 8 9}

How does the treatment 'Financial Well-being Interventions, Place-based Interventions' differ from other treatments for health disparities in Black neighborhoods?

This treatment is unique because it focuses on improving health by addressing social and economic factors in Black neighborhoods, such as housing, employment, and access to resources, rather than traditional medical approaches. It uses community-based strategies to tackle structural issues like racism and economic inequality, aiming for long-term improvements in health and well-being. ^{9 10 11 12 13}

Eligibility Criteria

This trial is for Black Americans at least 18 years old living in certain Philadelphia neighborhoods. Participants must be able to text, speak English, reside permanently in their homes, and understand their household finances. Those planning to move soon or unable to consent are excluded.

Inclusion Criteria

Have knowledge of their household finances

A permanent resident of the home where they are to be enrolled

I am 18 years old or older.

Exclusion Criteria

I am unable to fully understand or agree to the study on my own.

Individuals who plan to move out of the study microcluster within 6 months

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive place-based and financial well-being interventions, including tax preparation, access to public benefits, financial counseling, microgrants, abandoned house remediation, trash cleanup, vacant lot greening, and tree planting

24 months

Follow-up

Participants are monitored for changes in health and well-being, including overall health index, psychological distress, and participation in public benefit programs

12 months

Treatment Details

Interventions

• Financial Well-being Interventions
• Place-based Interventions

Trial Overview The study tests a 'big push' intervention aimed at improving health by enhancing financial well-being and investing in neighborhood environments. It includes greening lots, fixing houses, planting trees, cleaning trash, financial counseling, tax help, and emergency cash aid.

Participant Groups

Group I: Intervention Experimental Treatment 2 Interventions

At the individual level, participants in the intervention arm receive place-based and financial well-being interventions. These include, at the individual level: * Tax preparation * Access to public benefits * Financial counseling and microgrants At the neighborhood level: * Abandoned house remediation * Trash cleanup * Vacant lot greening * Tree planting

Group II: Control Active Control 1 Intervention

Participants in the control arm will not receive any of the listed interventions.

Who Is Running the Clinical Trial?

University of Pennsylvania

Lead Sponsor

Trials

2,118

Recruited

45,270,000+

Findings from Research

Patients with low financial status (7467 individuals) reported 10% to 30% lower satisfaction with healthcare services and collaborative care compared to those with adequate financial status (43,701 individuals).

Markers of disease management and prevention were also significantly lower (7% to 18%) in patients with low financial status, highlighting that financial disparities negatively impact health outcomes and access to quality care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Postscript: health disparity and collaborative care. Wasson, JH., Benjamin, R.[2019]

Medical-Financial Partnerships (MFPs) are innovative collaborations between healthcare systems and financial organizations aimed at reducing financial stress in low-income families, which can lead to improved health outcomes.

MFPs provide a range of financial services, such as coaching and tax preparation, and have shown promise in enhancing both financial stability and health, addressing the link between financial circumstances and health in marginalized communities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Medical-Financial Partnerships: Cross-Sector Collaborations Between Medical and Financial Services to Improve Health. Bell, ON., Hole, MK., Johnson, K., et al.[2023]

Cardiometabolic diseases, such as diabetes and heart disease, lead to significant health disparities among Black adults in the U.S., with 12 million years of life lost annually, particularly in low socio-economic neighborhoods.

Interventions targeting social determinants of health, including access to medical care and adherence to treatment, are essential to improve cardiometabolic health equity and reduce the higher prevalence of diseases and complications in Black communities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Social and Medical Determinants of Cardiometabolic Health: The Big Picture. Puckrein, GA., Egan, BM., Howard, G.[2022]

References

1. United States pubmed.ncbi.nlm.nih.gov

Postscript: health disparity and collaborative care. [2019]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Analysis of racial differences in hospital stays in the presence of geographic confounding. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Identifying High-Cost Medicare Beneficiaries: Impact of Neighborhood Socioeconomic Disadvantage. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Medical-Financial Partnerships: Cross-Sector Collaborations Between Medical and Financial Services to Improve Health. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

Social and Medical Determinants of Cardiometabolic Health: The Big Picture. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Race differentials in obesity: the impact of place. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Measuring The Enduring Imprint Of Structural Racism On American Neighborhoods. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Can you party your way to better health? A propensity score analysis of block parties and health. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health. [2022]

10. Netherlands pubmed.ncbi.nlm.nih.gov

Community Investments and Diet-related Outcomes: A longitudinal study of residents of two urban neighborhoods. [2023]

11. Switzerland pubmed.ncbi.nlm.nih.gov

A Novel Framework to Address the Complexities of Housing Insecurity and Its Associated Health Outcomes and Inequities: "Give, Partner, Invest". [2023]

12. United States pubmed.ncbi.nlm.nih.gov

Using geographic information systems to inform the public health response to COVID-19 and structural racism: The role of place-based initiatives. [2022]

13. England pubmed.ncbi.nlm.nih.gov

Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review. [2023]