Table 4.

Neighborhood-Level Structural Domains Relevant for Chronic Disease Management Generated by Patients and Community Leaders

Structural racism“They're dumping waste and garbage… the city has allowed [this] to go on over here [when] they wouldn't allow [it] to go over in Marina Green… Why are you letting it happen here…? Because you figured…it's just poor Black people, why not…? [P]eople are dying, because [they are] right on top of a toxic waste bin.” Patient 7
“[T]his little five-year-old boy…he's having nightmares that he's going to be arrested by the police, at five. If our children are not even feeling not-surveilled at five years old, imagine the anxiety, the depression. Where is he going to feel welcome…?” Community leader 6
“[My two employees] went to the bank…these are black men, [and the bank] would not give them cash until they called for authorization… It's like you don't even have access to your money that you worked for.” Community leader 6
Transportation inequity“If you're an elderly person, you're probably still not going to sit [on the bus] and [you'll] get pushed on. Because of the homelessness issue, there's also the cleanliness issue and it smells… Even if you leave an hour ahead, the bus can totally throw your schedule off and it's also very expensive.” Community leader 5
“Is the [tram] stopping in our area today or is it just going straight through? [F]olks can't actually get here and folks can't get to work on time.” Community leader 6
Housing inequity“[It's the] housing situation, that's why you see a lot more veterans out here, mental health patients, and people that can't keep up paying for rent…you notice that most of the homeless [are] in this demographic area…it's like we're in concentration camp, so to speak.” Patient 4
Gentrification and displacement/residential segregation“But there are…all kinds of people living in all kinds of different neighborhoods that maybe don't have an effect on them. Like someone who's born in the Mission but goes to a private school and has millions of dollars, they don't live in the Mission necessarily the way that someone who was born here and doesn't have those resources.” Community leader 7
“The population of the Mission is probably around 40,000 to 45,000 people. In that 15-year period, the Mission lost 10,000 individuals who were displaced…The 8,000 of those 10,000 were Latinos… It felt like communities are under attack, and it was losing something…” Community leader 11
“I was born and raised here and [this] was a community that was multicultural… A lot of Black and brown families have had to move out due to the re-gentrification…the average income median is what, $140,000? It's a tragedy because [this city is] losing so much of the culture…which made the city unique.” Patient 7
Generational poverty“We may be able to help with barrier removal for a deposit [for housing] but the deposit is not going to do anything for your family…when the rent is 200% more than what you make in a whole month… We're talking about persons who have been impacted by generational poverty. They are already…set up to fail from the beginning.” Community leader 10
Neighborhood safety“This neighborhood is…not healthy… [T]he drug use surrenders on the street…I can hear the noise at night, the shouting and…drug dealing…it's very wearing to have to be constantly alert.” Patient 3