Addressing the Impacts of Structural Racism on Race Inequities in Health: A Focus on Mass Incarceration, Housing, and their Intersection

This multi-level mixed methods study will analyze the implications for racial health equity of policies that undergird structural racism (SR) in the domains of mass incarceration (MI) and housing; and will examine the potential for policy reforms in these domains to reduce inequities. We conceptualize the domains of MI and

housing as systems of exposure to SR that are given meaning by specific policies (as well as the legacies of past policies) and that dynamically intersect with one another in ways that shape their impacts on population and individual health. We will measure, in different ways, SR in, and at the intersection of, each of these

domains, at the national level and within the state of Connecticut (CT) and analyze their impacts on health and race inequities in health. Focusing on the national level, Aim 1 will use legal policy mapping techniques and factor analysis to develop quantitative indices of SR related to MI and housing and characterize state variation

in SR within and at their intersection. Using publicly available data sources, we will explore the association of these indices alone and together, with race inequities in various measures of population health. This aim will advance methods for measuring SR as codified in state polices and provide insights into potential policy

reforms for advancing racial health equity. Focusing on the state of CT for Aim 2, we will collaborate with DataHaven, a non-profit CT-based organization that runs a bi-annual community well-being survey (DCWS) conducted with a random sample of the population as part of its mission to empower people to create thriving

communities. We will add to the DCWS questions to capture in detail whether and how individuals have interacted with the systems of MI and housing. Using latent class analysis, we will develop measures of individuals’ exposure to these systems and with appropriate regression techniques analyze the impacts of

these different forms of exposure on their health and racial health equity. To understand whether and how policy reforms may promote greater health equity, for Aim 3 we will focus locally and conduct a qualitative analysis—using methods of critical policy ethnography—of the rollout and implementation of Clean Slate and

Right to Council policies recently passed in CT and with potential to address SR in the domains of MI and housing, respectively. For these purposes, we will work with Health Equity Solutions, a CT community-based non-profit organization focused on ensuring health equity is embedded in all policies, to analyze how a broad

range of policy implementers (including impacted individuals and communities) navigate, resist, and work to confront SR as these policies are implemented. And we will consider the implications of this for racial health equity. Together, these analyses will highlight how policies in the domains of MI and housing maintain SR and

produce race inequities in health, but also, how policy reforms in these domains may confront SR and represent interventions to advance racial health equity.