U.S. redlining in the 1930s linked to poor health outcomes today

New research shows the connection between historical redlining and an increase in cardiometabolic health risk factors in patients today.

The study, published in the Journal of the American College of Cardiology, was conducted by researchers at University Hospitals (UH) Harrington Heart & Vascular Institute in Cleveland. According to the study’s authors, their research further proves that people living in areas that were subjected to housing discrimination decades ago now suffer from higher rates of poor health outcomes, such as heart disease, kidney failure, and diabetes.

According to the study, in the 1930s, the United States federal government created the Home Owners’ Loan Corporation (HOLC), in part to stabilize the housing market during the Great Depression, offer home mortgage refinance services to some homeowners in default, and expand home buying opportunities. The HOLC created maps of nearly 200 U.S. cities that color-coded neighborhoods to denote potential lending risk: A (“best” or green), B (“still desirable” or blue), C (“definitely declining” or yellow) and D (“hazardous” or red), with the latter deemed as a “redlined” neighborhood. A majority of Black neighborhoods were “redlined” into the hazardous category more frequently, meaning people living there were more likely to be denied a loan to buy or renovate a home. These housing practices were not outlawed until the 1960s.

In this study, the authors sought to examine the national relationship between redlined neighborhoods and cardiovascular diseases. It supports the results of previous related studies while additionally showing that historic redlining is associated with an increased risk of comorbidities and a lack of access to appropriate medical care today.

They investigated this by linking 1930s redlining maps with current neighborhood maps and examining the prevalence of cardiovascular risk factors and disease by neighborhood category (A through D, A=lowest risk to D=highest risk). They obtained the prevalence of cardiovascular disease from Centers for Disease Control and Prevention (CDC) data. The study spanned more than 11,000 HOLC-graded census tracts that included more than 38.5 million people across the country.

The study’s results revealed an overall increase in rates of obesity, diabetes, high blood pressure, and smoking across the grading spectrum from A to D. Nearly twice the amount of adults ages 18 to 64 years old were without health insurance in D-graded areas compared to those with an A. In addition, they discovered that neighborhoods with a better grade had more routine health visits and better cholesterol screening as compared to neighborhoods with a worse grade.

“Our group wanted to study redlining in this way to better understand the socio-environmental underpinning of health inequities,” said Sanjay Rajagopalan, MD, chief of the division of cardiovascular medicine and chief academic and scientific officer of UH Harrington Heart & Vascular Institute.

With the goal of helping to improve health for those in Northeast Ohio, ACHIEVE GreatER, is a $18.2 million initiative funded from the National Institutes of Health that was announced last year.. Through ACHIEVE GreatER, UH will provide cardiovascular care to people living in the Cuyahoga Metropolitan Housing Authority (CMHA). More than half of CMHA units fall into a previously redlined category. 

Community health workers, nurses, dieticians, and pharmacists will provide personalized diet and exercise advice and health services like screenings for blood pressure, cholesterol, and average blood sugar in the CMHA communities. The impact of these interventions will then be studied.