Authored by Danielle Smith
Art by Nava Lippman
The hidden boundaries of redlined communities, drawn decades ago, continue to mark the contours of health disparities in our modern society. Redlining, a historically discriminatory practice that models the structure of American cities, continues to cast a long shadow over public health outcomes in the era of COVID-19. Exploring the enduring link between redlining, health disparities, and their convergence during the pandemic offers critical lessons for informing future public health intervention strategies.
In the early 1930s, the government implemented redlining policies that institutionalized racial segregation within urban infrastructure. This practice, which endured until the 1960s, involved the systematic denial of mortgage loans and financial services to minority communities, particularly Black and Hispanic neighborhoods, based on racially discriminatory neighborhood risk assessments [1]. The Home Owner’s Loan Corporation (HOLC) divided neighborhoods into low-graded, "redlined" areas (characterized by high concentrations of racial minorities) and high-graded "greenlined" areas (predominantly white neighborhoods) [1]. As a result, residents in redlined areas were denied mortgage loans and structurally constrained from moving towards mixed-income regions, thus concentrating communities with limited prospects for social mobility.
Residential segregation profoundly influences community dynamics, impacting health outcomes at their core by stifling opportunities for financial and human capital growth, two major social drivers of health. The lingering effects of historical redlining have left many residentially segregated neighborhoods facing a complex web of challenges, including hospital closures, higher rates of mass incarceration, and limited access to healthy food options [2]. These factors collectively elevate the risk of poor health outcomes by perpetuating a cycle of disadvantage that constrains the ability of marginalized communities to address critical health concerns. In hindsight, the legacy of discriminatory redlining policy continues to underpin health inequity today, cementing neighborhood disparities in access to vital economic, medical, social, and environmental resources crucial for health management [3].
Environmental challenges stemming from residential segregation prove to have a direct impact on racial disparities in measurable health outcomes. For instance, one study by the David Geffen School of Medicine found that residential segregation is associated with a perceived White-Black gap in survival. For Black men and women in residentially segregated communities, their probability of survival between the ages of 35 to 75 is reduced by 14% and 9% respectively [3]. In the literature, residential segregation is strongly associated with higher mortality rates for Black individuals [3].
The COVID-19 pandemic has served as a stark reminder of the enduring impact of historical redlining policies and government-embedded residential segregation on public health outcomes. Vulnerable communities, predominantly Black and Hispanic populations living in historically redlined areas, have suffered disproportionately during the pandemic. A recent National Institute of Health (NIH) study on COVID-19 exposure in New York City has indicated that historically low-graded neighborhoods presently have higher risks of COVID-19 infection, even in communities that have experienced notable economic growth [1]. More specifically, amidst the pandemic, redlined communities have been met with intensified housing-related concerns, including inadequate infrastructure and poorer housing quality, reducing preventative health protections against COVID-19 transmission [1]. Health disparities in these neighborhoods continue to be perpetuated by the long-term consequences of historical disinvestment, limited healthcare access, and increased exposure to environmental hazards.
Similarly, research in other major cities like Chicago connects COVID-19 excess deaths to historically redlined communities. Data from Cook County, Chicago revealed that since June 2020, COVID-19-related deaths have been nearly 30% higher for Black residents [4]. Consequently, historically low-graded Cook County neighborhoods experienced a sharper increase in pandemic mortality rates, disproportionately higher in the Black population [4]. Redlined communities, already grappling with limited access to local healthcare facilities and socioeconomic resources, have disproportionately suffered the burden of the pandemic's impact. Investigations that connect redlining maps and pandemic-related health outcomes illustrate that COVID-19 has further exacerbated the health disparities that persist in redlined communities, underscoring the continued health consequences of structural discrimination.
To address these deeply rooted issues, recognizing the influence of systemic racism and redlining on public health is paramount. Addressing health inequities born from redlining demands a multifaceted, targeted approach. This encompasses increased investment in underserved communities characterized by residential segregation, including policy initiatives allocating federal funding to boost the number of local healthcare facilities, enhance the quality and availability of affordable housing, and increase financial investments in public school systems. It could also be advantageous to institute place-based measures focused on community investment, such as increasing minimum wage, expanding food stamp eligibility, improving public transport, and offering tax subsidies to attract new businesses and supermarkets [2]. Integrating research that validates the relieving effects of social resource intervention in residentially segregated communities can prove worthwhile in addressing racial inequities within the pandemic [5].
In conclusion, the clear relationship between redlining and COVID-19 health outcomes , accentuates the continued need for structural approaches to managing health inequities. The COVID-19 pandemic has underscored the urgency of addressing growing racial health disparities, highlighting the necessity for targeted interventions in disease prevention efforts. To build a healthier, more equitable society, rectifying the costs of historical injustices must be a core priority of the public health aim.
Works Cited
1. Li, M., Yuan, F. Historical Redlining and Resident Exposure to COVID-19: A Study of New York City. Race Soc Probl 14, 85–100 (2022). https://doi.org/10.1007/s12552-021-09338-z
2. Egede, L.E., Walker, R.J., Campbell, J.A. et al. Modern Day Consequences of Historic Redlining: Finding a Path Forward. J GEN INTERN MED 38, 1534–1537 (2023). https://doi.org/10.1007/s11606-023-08051-4
3. Popescu I, Duffy E, Mendelsohn J, Escarce JJ. Racial residential segregation, socioeconomic disparities, and the White-Black survival gap. PLoS ONE 13(2): e0193222 (2018). https://doi.org/10.1371/journal.pone.0193222
4. Bertocchi, G., Dimico, A. COVID-19, Race, and Redlining. IZA Institute of Labor Economics 1-5 (2020). https://doi.org/10.1101/2020.07.11.20148486
5. Borrell, N., White, K. Racial/ethnic residential segregation: Framing the context of health risk and health disparities. Health Place 17(2): 438–448. (2011) doi:10.1016/j.healthplace.2010.12.002.