"Association of historic redlining and present-day health in Baltimore," by Huang SJ, & Sehgal NJ (2022). PLoS ONE 17(1): e0261028. https://doi.org/10.1371/journal.pone.0261028.
In the 1930s, the government-sponsored agency Home Owners’ Loan Corporation (HOLC) - created as part of the New Deal in 1933 - categorized neighborhoods by investment grade along racially discriminatory lines, a process known as redlining. Although other authors have found associations between HOLC categories and current impacts on racial segregation, analysis of current health impacts rarely use these maps.
A study released in 2018 found that 74% of neighborhoods that HOLC graded as high-risk or "hazardous" are low-to-moderate income neighborhoods today, while 64% of the neighborhoods graded "hazardous" are minority neighborhoods today. "It's as if some of these places have been trapped in the past, locking neighborhoods into concentrated poverty," said Jason Richardson, director of research at the National Community Reinvestment Corporation (NCRC), a consumer advocacy group.
Fifty-four present-day planning board-defined community statistical areas are assigned historical HOLC categories by area predominance. Categories are red (“hazardous”), yellow (”definitely declining”) with blue/green (“still desirable”/”best”) as the reference category. Community statistical area life expectancy is regressed against HOLC category, controlling for median household income and proportion of African American residents.
Red categorization is associated with 4.01 year reduction (95% CI: 1.47, 6.55) and yellow categorization is associated with 5.36 year reduction (95% CI: 3.02, 7.69) in community statistical area life expectancy at baseline. When controlling for median household income and proportion of African American residents, red is associated with 5.23 year reduction (95% CI: 3.49, 6.98) and yellow with 4.93 year reduction (95% CI: 3.22, 6.23).
The primary policy implication is that discriminatory public or social policy - whether or not such a policy is intentionally discriminatory - in a realm such as housing can potentially have long-lasting, disparate, and large impacts on health. Additionally, contemporary African American activists and organizations in the 1930s presciently recognized the discriminatory impacts of how HOLC made its policy decisions: members of marginalized and/or impacted communities should have control over every major policy-making process.
Since many of these issues are structural and historical, health interventions that do not focus on disparate health outcomes risk being “weighed down” by structural problems that predispose a population to worse health. If we take health equity and disparities research seriously, we should be examining the possibility of interventions that attempt to tackle some of these structural factors, including the possibility of reparations. What Link and Phelan propose as “fundamental causes” of health disparities - such as a lack of flexible resources of money, knowledge, social connections, and political power - may have even more fundamental causes rooted in power hierarchies such as racial, class, and gender subordination.
Results add support that historical redlining is associated with health today. Even time-limited urban changes can have long-lasting cumulative effects. Michaels and Rauch found that the differential collapse of Western Roman urbanization in Britain and France in the 6th century CE differentially impacted the spatial efficiency of urbanization even 1500 years later in the 21st century. Similarly, evidence supports that redlining still has cumulative impacts on various social factors today. Aaronson et al. found that living in close proximity on two sides of differently graded borders - as represented in the 1930s HOLC security maps - is strongly associated nation-wide with increased residential racial segregation from the 1930s to today. The effect on residential racial segregation was particularly strong from 1930-1970 and the effect size began to decrease after 1970. Aaronson et al. provide additional support that maps were likely drawn with race in mind: only areas marked category D had a primarily Black population in the 1930s. In addition to increased segregation, Aaronson et al. found support for reductions in home ownership, house values, and credit scores throughout the 20th century that are maintained even today nearly a century later. They also found evidence of “yellow-lining”: areas marked as category C also had disparate current outcomes when compared to higher rated areas. Using a different methodology, Appel & Nickerson found that redlined neighborhoods had lower home prices in 1990 compared to surrounding areas, and that these discriminatory effects remained even after nearly 60 years. The presence of these discriminatory effects can be compounded across time: Massey et al. found that Black residents of redlined neighborhoods face greater barriers to residential mobility than white residents that negatively impacts Black residents’ social and economic well-being.
