Background: Community-level disinvestment and de facto segregation rooted in decades of discriminatory race-based policies and racism has resulted in unacceptably large infant mortality rates (IMR) in minoritized neighborhoods across the US. Most community development and housing work is designed to address current challenges in the condition of neighborhoods without explicitly centering structural racism and discrimination (SRD). Informed by Life Course Theory (LCT), the objective of the NIH-funded Targeted Investment and Meaningful Engagement (TIME) Study is to richly describe the history of discriminatory policies that has shaped one neighborhood and influenced maternal and child health across generations of Black birthing people. The study will also demonstrate how community re-investment can be designed to target and rectify historic and contemporary SRD.

Methods: This mixed-method study focuses on Columbus, Ohio’s Linden neighborhood, a predominately Black (64%) neighborhood with a population of 19,000 residents, of which approximately 45% live below the federal poverty level. Building on Nationwide Children’s Hospital’s (NCH) history of housing and community development, NCH’s targeted re -investments in Linden are intended to improve housing quality and affordability, educational outcomes, access to healthcare, economic development, and social connections of residents. The TIME study uses information gathered through an extensive SRD policy inventory of the neighborhood and qualitative interviews with Black birthing residents to understand the “why” of the neighborhood deprivation that imperils birth outcomes for Black infants to tailor future investment strategies. Using community-based system dynamics modeling, we will translate qualitative data into quantitative policy simulations to identify interventions that could have the greatest impact on birth outcomes and guide the design and implementation of re-investment activities. Finally, we will conduct real-time formative evaluation of a targeted community investment initiative explicitly informed by the community’s history of SRD and measure relative changes in short term infant and maternal health disparities in Linden and a statistically matched comparison neighborhood.

Results: Policy inventories and qualitative interviews are underway. Early findings depict the neighborhood’s complex, intertwined history of disinvestment, white-flight, and failing health.

Discussion: Further findings from this project will illuminate how structural racism drove systemic disinvestment in an urban neighborhood that has impacted health outcomes over the past several decades. Importantly, beyond describing the problem, we explore a solution, SRD informed strategic community re-investment.

Public Health Implications: This study will create the evidence base proving that SRD informed community re-investment can work which can facilitate adoption in other communities and hopefully yield lasting change.