The Structural Determinants of Health: How Structural Racism Facilitates Community Violence in Washington, DC

Racism is deeply embedded in social determinants of health, establishing racial health inequities in populations of color. Recent measures have been taken to address this issue in Washington, DC including the 2020 Racial Equity Achieves Results (REACH) Amendment Act, which focuses on racial equity, social justice, and economic inclusion. To further these efforts, there is a need to understand the relationship between structural racism, unemployment, poverty, and violence. This research explores the correlation between historic racism, social determinants of health, housing policies, and community violence in Washington, DC. Methods include mapping racial covenants from 1940 to 2010, neighborhood displacement, and social determinants of health. Current mortgage lending in the neighborhoods across the city was used to measure the housing market and lending discrimination. Demographic data, drawn from various sources, were used to measure social determinants of health across statistical neighborhoods. Findings indicate Wards 5, 7 and 8, in South and Eastern parts of DC, have the highest rates of crime, unemployment and concentrated poverty, lowest house lending rates, and experienced the most housing displacement from 1940-2010. The district’s racial dissimilarity index of 70.9 indicates that the city is still highly segregated and that zip codes play a significant role in individual health and exposure to violence. To achieve health equity, measures must be taken to dismantle structural racism that include community based participatory research and policies that incorporate a historical context of the problem as well as voices of community members.

Hello, everyone. My name is Nadia Altaher. And today I’ll be discussing my research project on the structural determinants of health, specifically how systemic racism facilitates community violence in Washington, DC.

So what is structural racism? Why is it important? It is a product of history but has adapted its contexts over time to create conditions that allow for worse health outcomes in racially marginalized populations. And we still see these worse health outcomes and disparities today as we higher rates of maternal mortality, lower life expectancy, and worse mental health outcomes among racially marginalized populations. It permeates in the various social determinants of health which is the environment in which people live, work, and play. And determines a lot of out health outcomes. As you guys can see, health equity and health equality are completely different as health equity strives to provide greater resources and attention to disadvantaged populations. Structural racism is a driving force many of these health inequities we see today.

So why conduct this research? Well, previous research has shown that mental health problems are more prominent among populations experiencing racism or discrimination. While young individuals are disproportionately impacted by community violence, certain populations are more at risk than others, specifically those experiencing systemic racism, bias, discrimination – which all impact adverse childhood experiences and the environment in which they grow up in. So drivers for violence impact communities of color and place residents at greater risk for poor mental health outcomes, tying metnal health and community violence aspects and their social determinants together. So I wanted to look at this theoretical framework between historic racism, social determinants of health, as well as housing and lending policies in DC as they have affected gentrification, community demographics, as well as community displacement over time. I did this by measuring racial covenants from 1940 to 2010, looking at current and previous housing and lending policies, as well as demographic data from DC department of health.

So my results have found that Wards 5, 7, and 8 – historically black neighborhoods (according to the Racial Covenants) are characterized by the highest poverty rates, gross rent rates, and violence mortality rates. They also have the lowest life expectancy, educational attainment, and income levels.

They are coincidentally make up the majority of the Non-Hispanic Black community as 93.7% to 98% are located in Southeast and Northeast DC. While the non-Hispanic White population is about 61.1% to 72.8% in Northwest and Southwest DC. Ward 3, the highest percentage of White Americans has a higher life expectancy by 16 years compared to Ward 8 which also has a 6 times higher rate of infant mortality, which is also an indicator for systemic racism.

I also wanted to point out that the racial dissimilarity index in DC is 70.9, meaning that 70.9% of White residents would have to move to achieve complete White/Black integration in the city, concluding that the city continues to be highly segregated.

The DC homicide rate is 16.0 per 100,000. That might seem low, but it is three times higher than the national average of 5.3. 74% come from firearms and 26% from suicides. But the most important thing to look at is that 94% of the victims were Black and 88% were males living in Wards 5, 7, and 8. As you guys can see the browner the color, the higher the violence mortality rate.

So this is a table I created looking at the population make up of these wards and their current social determinants such as violence mortality rate, life expectancy, median income, and unemployment. And how they drastically change looking at the Wards 1-3 from Wards 5-8.

So I wanted to look at the DC housing and redlining policies as they have impacted the placement of housing that people currently have in the city. So historic redlining comes from the 1933 New Deal Project which used to further segregation efforts by refusing to lend mortgages in neighborhoods of color while ensuring mortgages and reinvestments in white neighborhoods. It led to lasting impacts of generational wealth and property ownership as Black individuals were less likely to own a property of value and live in disinvested communities that were deliberately maintained by racial segregation. According to a study done on DC Housing in 2005, less than 10% of lending applicants in underserved census tracts were denied loans inequitably. And many public housing projects have been slated for private redevelopment, adding to existing waitlists for rent vouchers to assist underserved populations for private housing.

So what does all this mean? Why is it important? Why should we address this? So drivers for structural determinants of health have a long-standing impact on community violence in Washington, DC. Community trauma from adverse childhood experiences stemming from concentrated poverty, low-quality housing, and community segregation from redlining practices during the Jim Crow Era play a significant role in perpetuating community violence to this day. It was found that the availability of affordable housing shapes families’ choices on where they live and has the potential to relocate low-income families to substandard housing in neighborhoods with higher rates of poverty and crime, and fewer health care services.

So my conclusion from this research project was to look more into the anti-racist housing policies to understand gentrification and violence in low-income DC neighborhood and understanding the historical contexts that allowed for current community demographics and individual displacement. I also wanted to look more into how we can prevent crime and invest in community safety – what changes must be made to community infrastructure involving diverse approaches with youth that are multi-sectoral, include public-private partnerships and have multiple stakeholders in the community.

Thank you for listening! I would like to acknowledge my mentor, Dr. Debora G. Goldberg. The college of public health, GMU undergraduate research scholars program, and the Office of Student Scholarships, Creative Activities, and Research for funding this project. Thank you everyone. I hope you have a great day.