The Lingering Effects of Redlining
Historical redlining, a discriminatory housing practice, has been linked to an increased risk of heart failure among Black residents living in areas with socioeconomic distress. This finding is particularly significant as it reveals the long-lasting health impact of a practice that was officially outlawed nearly half a century ago. Redlining, as defined by the Federal Reserve’s Consumer Compliance Handbook, is the practice of denying a mortgage to an otherwise creditworthy and eligible applicant trying to buy a home in a certain neighborhood. The Fair Housing Act, enacted in 1968, made it illegal for lenders to deny such loans based on race, color, religion, national origin, sex, handicap, or familial status.
Despite these legal protections, the effects of redlining continue to reverberate in the health of Black communities. As Dr. Shreya Rao, a cardiologist and assistant professor in the Department of internal medicine at the University of Texas Health Science Center at San Antonio and University Hospital, explains, “Although discriminatory housing policies were effectively outlawed nearly a half-century ago, the relationship between historic redlining practices and people’s health today gives us unique insight into how historical policies may still be exerting their effects on the health of many communities.” This statement underscores the enduring impact of redlining, a practice that has left an indelible mark on the health of Black communities.
The Study and Its Findings
In a recent study published in Circulation, researchers identified more than 2.3 million self-reported white and Black beneficiaries from the Medicare Beneficiary Summary Files from 2014 to 2019. They linked patient data with 2,922 ZIP codes with available information on redlining using the Mapping Inequality Project. After stratifying patients into quartiles of historical redlining proportion, the researchers compared the risk for incident heart failure among Black and white Medicare beneficiaries.
The results were revealing. Black residents living in ZIP codes with the highest quartile of redlining proportion at Medicare enrollment experienced an 8% increased risk for incident heart failure compared with Black residents living in the lowest quartile of redlining. This association remained even after adjusting for area-level Social Deprivation Index (SDI), a measure of socioeconomic distress. In contrast, redlining was associated with a lower risk for incident heart failure among white residents.
These findings highlight the stark racial disparities in health outcomes that persist today. They underscore the urgent need for further research and policy interventions to address the enduring health impacts of redlining. As Dr. Amgad Mentias, an interventional cardiology fellow at Cleveland Clinic, said in the release, “Ultimately, we were most interested in assessing the difference in risk of heart failure between individuals from communities with the highest level of exposure to redlining and individuals from other communities.”
The Call for a Reparative Approach
The findings of this study underscore the urgent need for a reparative approach on the part of federal, state, and local governments. As Dr. Ambarish Pandey, a cardiologist and assistant professor in the Department of internal medicine at the University of Texas Southwestern Medical Center, points out, “These findings show us the harm that discriminatory and racist housing policies have had on generations of Black adults and suggest the long-term impact of such policies on cardiovascular health disparities.”
The study’s findings highlight the need for intervention and investment in redlined communities. It is a call to address the systemic issues that continue to impact the health of Black communities and a call to strive for health equity for all. The echoes of redlining still reverberate in the health disparities we see today, and it is incumbent upon us to address these systemic issues and strive for health equity for all.
The research findings also underscore the pivotal role housing plays as a social determinant of health. “Aggressive enforcement of anti-discrimination laws in housing and support for and pathways to homeownership for Black families are needed in order to begin to achieve equity in health,” Pandey said. This statement underscores the need for a comprehensive approach to health equity that includes not only medical interventions but also policy changes that address the root causes of health disparities
