McGregor, AleciaTosin-Oni, Motunrayo Damilola2026-06-0920262026-05-142026Tosin-Oni, Motunrayo Damilola. 2026. Place, Racism, and Place-based Policies: Essays on Structural Racism and Community-Level Health Inequities. Doctoral Dissertation, Harvard University Graduate School of Arts and Sciences.32702440https://dash.harvard.edu/handle/1/42740469Dissertation Abstract This three-paper dissertation explores the relationship between structural racism and neighborhood-level health inequities in the United States. The title, in which “race” is crossed out and replaced with “racism”, refers to the focus on racism, rather than race, as a determinant of health inequities. Examining the U.S. policy of redlining, papers 1 and 2 investigate the association between historical state-sanctioned racial residential segregation and present day statewide maternal and infant health outcomes. The first paper, Association between Historical Redlining and Severe Maternal Morbidity in New Jersey, examined the association between historical redlining and present-day severe maternal morbidity (SMM) rates in the state of New Jersey. Using hospital discharge data from New Jersey's State Inpatient Databases, redlining data from University of Richmond's Mapping Inequality Project, and neighborhood socioeconomic data from the American Community Survey, I estimated the effect of living in a redlined neighborhood (defined by ZCTAs) on risk of SMM. I found that compared to those who live in neighborhoods that received a historical grade of A or B, residents of C and D graded neighborhoods had 1.2 times and 1.4 times the odds of SMM, respectively. When controlling for neighborhood racial economic segregation, residents of D graded neighborhoods remained at greater odds (OR. = 1.12, 95% CI: 0.98, 1.23) of SMM than residents of A or B graded neighborhoods. In analyses stratified by race and ethnicity, residing in a D graded neighborhood was associated with higher odds of SMM for Black patients (OR: 1.22, 95% CI: 1.04, 1.44) giving birth in New Jersey hospitals than for those living in A or B graded neighborhoods. There was no observed association between HOLC grade and SMM odds for White and Hispanic populations. This study supports evidence of a strong relationship between historical systemic racism, as assessed through redlining in NJ, and racial and neighborhood level inequalities in SMM. Paper 2, Historical Redlining and Adverse Birth Outcomes in Massachusetts: 2016 to 2022, examines the relationship between historical redlining and present-day maternal and infant health inequities. Merging Massachusetts Department of Public Health’s Pregnancy to Early Life Longitudinal Data System (PELL) with Mapping Inequality shapefiles and American Community Survey neighborhood demographics data, I assessed the associations of historical HOLC grade with SMM, low birthweight, and preterm birth. I also conducted analyses stratified by race and ethnicity and the COVID-19 pandemic. I found that residents of MA neighborhoods historically graded C or D by HOLC were at increased odds of SMM (ORC =1.22, 95% CI: 1.14, 1.31; ORD= 1.30, 95% CI: 1.19, 1.42) compared to residents of AB-graded neighborhoods even after adjusting for individual characteristics and neighborhood deprivation. In race-stratified analyses, the highest rates of SMM was found among Black and API residents of D-graded neighborhoods, who had 41% (ORD= 1.41, 95% CI: 1.15, 1.71) and 42% (ORD= 1.42, 95% CI: 1.07, 1.87) greater odds of SMM, respectively, whereas White and Hispanic residents of D-graded neighborhood both had 23% (ORD= 1.23, 95% CI: 1.05, 1.44) greater odds of SMM. I found no statistically significant relationship between historical HOLC grade and preterm birthweight in the full population, but in race-stratified analyses, White residents of D-graded neighborhoods were at 11% (ORD= 1.11, 95% CI: 1.02, 1.20) higher odds of preterm birth and Black residents of D-graded neighborhoods were at lower odds (ORD= 0.90, 95% CI: 0.81, 1.00) of preterm birth, compared to their counterparts in AB-graded neighborhoods. In COVID-19-stratified analyses, I found that relative to pre-pandemic years, COVID-19 was associated with increased odds of SMM for those living in D-graded neighborhoods among the full population and within each racial and ethnic group. This study supports evidence that systemic racism continues to play a role in neighborhood-level maternal health disparities in MA, suggesting that neighborhood specific interventions and investments may be necessary to target neighborhood specific risk factors. The third paper is a qualitative study titled Examining Community Organizing for Health Equity using the Community Capitals Framework: A Qualitative Analysis of the Hyde Park Health and Wellness Steering Committee in Boston, Massachusetts. This community-engaged study aims to understand how disadvantaged communities organize at the grassroots level to address their community’s specific healthcare needs. Employing a Community Capitals Framework, I focused on a case study based in Boston, Massachusetts. This study examined how the Hyde Park Health and Wellness Steering Committee, a grassroots community health coalition in Boston’s Hyde Park neighborhood, is building and leveraging their community capitals in their mobilization for a community health center. I conducted 2 focus groups with 7 Steering Committee (SC) members and 14 semi-structured interviews with community members and political and healthcare stakeholders. The findings revealed that Hyde Park has a wealth of cultural, natural, and human capitals that create immense community pride that in turn has facilitated and sustained mobilizing effort for over 5 years. These capitals also help build community power and hold their elected officials accountable. Finally, I identified in the data that despite what appears to be strong political and social capital present in the neighborhood and within the SC, gaps remain in institutional linkage capital and financial capital necessary to accomplish the committee’s largest goal: establishing a community health and wellness center. This paper also sheds light on the roles health equity minded policymakers and institutional stakeholders can play in supporting grassroots organizing.  application/pdfencommunity health accessHealth Disparitiesmaternal and infant healthStructural racismPublic healthPublic policyThesis or Dissertation2026-06-090000-0001-9659-1527