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Primary Submission Category: Structural factors

“Everybody I know went to the doctor at 10 S. Kedzie”: Differential spatial racialization, medically underserved area designations, and the expansion of community health centers in Chicago, Post-ACA

Authors:  Natalie Bradford,

Presenting Author: Natalie Bradford*

Initially a program to improve access to care in segregated Black communities, today community health centers (CHCs) are legally required to serve federally designated medically underserved areas and populations (MUA/Ps). The Affordable Care Act included provisions to modify MUA/P designation criteria, but they have not been updated since 1975 and do not account for the affect racial residential segregation has on health care access. This study used Public Health Critical Race Praxis to center marginalized voices, challenge dominant conceptualizations of MUA/P designations, and reveal the centrality of racialization in MUA/P policy decisions. Guided by a personal narrative, the study examined associations between MUA/P eligibility and designation among Chicago neighborhoods (N = 793 census tracts) between 2010 and 2019 and whether the associations varied by redlining. MUA/P data were obtained from the Health Resources and Services Administration and linked to demographic and housing data from the American Community Survey and Home Mortgage Disclosure Act. Multilevel logistic regression was used to examine associations and assess whether redlining moderated those associations. Results indicate that nearly half of Chicago census tracts were designated MUAs, but 158 were ineligible. Another 179 tracts were eligible but undesignated MUAs. All 192 redlined census tracts were on the city’s West and South Sides. The West Side had the highest proportion of ineligible MUAs, and the South Side had the highest proportion of undesignated MUAs. Among redlined tracts, those that were ineligible for a MUA designation had higher odds of having a MUA designation than tracts that were eligible. This indicates a “MUA/P paradox” exists. Results also suggest redlined neighborhoods on Chicago’s West and South Sides are racialized in different ways and that differential spatial racialization produces racialized geographic inequities in MUA/P designation and thus access to CHCs.