Redlining: how do racially-biased financial practices affect health?

Talk like a nutrition epidemiologist

Body mass index (BMI) – a measurement used to assess if someone is a healthy weight, calculated by dividing body weight by height

Epidemiology – the study of health and disease within populations

Home Owners’ Loan Corporation (HOLC) – a US agency set up in the 1930s to refinance home mortgages

Obesity – a complex chronic disease defined by an excessive accumulation of body fat that poses risks to health

Mortgage – a loan for the purchase of property

Redlining – a discriminatory practice where neighbourhoods’ credit-worthiness ratings were conflated with race

Socioeconomic – related to social and economic factors

Throughout the 1930s, the US was wracked by economic hardship in the form of the Great Depression. Almost everybody in the country was affected and millions found themselves without income. In an attempt to help homeowners pay their mortgages, the government created the Home Owners’ Loan Corporation (HOLC), which offered financial relief to those unable to make payments through no fault of their own. “A few years later, HOLC produced maps that rated neighbourhoods based on how safe or risky they were for investment,” says Dr Andrea Richardson from the RAND Corporation. “The mapmakers factored in details such as the condition of houses but also the race and ethnic background of the people who lived there.”

These HOLC maps reflected decades of structural discrimination. At the bottom of their rating scale were the red-marked neighbourhoods – a practice that became known as redlining. “These neighbourhoods were often where Black families and immigrant communities lived,” says Andrea. “This reinforced racial and economic segregation, which went on to affect families for generations.” It is unknown if the maps had any influence on mortgage lending, but they mirror the racist attitudes entrenched in the real estate industry.

“Although the Civil Rights Act of 1968 formally prohibited redlining, informal practices of housing discrimination still persist today,” says Andrea. “People in formerly redlined neighbourhoods may still face discrimination when seeking investment and mortgages.” If someone is denied a mortgage by a lender, such as a bank, they become locked in to the expenses of renting, without the benefits of home ownership.

These biased mortgage practices mean that people living in historically redlined neighbourhoods may still experience the negative impacts of redlining, not just in terms of their ability to secure a mortgage or their financial security, but also in terms of their health. According to a growing body of research, this location-based housing discrimination can lead to poor health outcomes.

Redlining ramifications

Health is complicated; as well as your biology and lifestyle choices, it depends on your environment and the lifestyle opportunities available to you. Andrea suspected that redlining may be connected to health because of how it prevents investment in certain neighbourhoods, and there is plenty of evidence to support this theory. “For instance, in Chicago, it was found that Black women living in areas with a history of redlining were more likely to have premature births,” says Andrea. “Another study in Atlanta found higher rates of death from breast cancer in women from such neighbourhoods.”

In her current research, Andrea is focusing on obesity, characterised by high body mass index (BMI). While obesity is often thought of as an individual issue, the truth is far more complicated. “Obesity is influenced both by biology and environment,” says Andrea. “For instance, if a neighbourhood has fewer healthy grocery options and fewer safe places to exercise, the community may be more prone to obesity.” It is unclear how much historical redlining drove neighbourhood factors that increase today’s residents’ obesity risk.

Honing in on health

Andrea and her team used data from the Coronary Artery Risk Development Study (CARDIA), which tracked the health of over 5,000 people from 1985 to 2016. “The study followed Black and white adults who were 18-30 years old when the study started,” says Andrea. “The study collected detailed data on diet, medical health, physical activity, neighbourhood environments and social background.”

Participants were from four US cities heavily affected by redlining: Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California. “We used CARDIA data to see how past and current mortgage lending discrimination may influence BMI, diet and levels of physical activity,” says Andrea.

First of all, the team wanted to examine the link between historical redlining and neighbourhood economic conditions from 1985 onwards. “The results were clear,” says Andrea. “Neighbourhoods historically marked as ‘high-risk’ by the HOLC remained more socioeconomically deprived 55 years later than other areas.” This was one of the first pieces of evidence the team gathered about the far-reaching impacts of those red lines drawn many years ago.

When the team examined how these factors relate to health, things became more complicated – though the trends were clear. “This long-term disadvantage may have led to poorer diet quality for all groups,” says Andrea. “For white adults and men, living in historically redlined neighbourhoods was linked to higher BMI, but for women and Black adults, the relationships were more nuanced.” For all groups, the link between historical redlining and socioeconomic deprivation was present.

“These results highlight that the connections between redlining, neighbourhood environments, gender, race and BMI are complex and can differ across groups,” says Andrea. “Overall, the study suggests that the economic disadvantages created by housing discrimination many decades ago still affect health and body weight differences across race and gender today.”

Dr Andrea Richardson
Senior Policy Researcher, RAND; Professor, RAND School of Public Policy, USA

Fields of research: Nutrition epidemiology; health disparities; neighbourhoods and social equity

Research project: Investigating the impacts of racial disparities in mortgage lending on obesity

Funders: US National Institutes of Health (NIH)

Research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number R01HL155187. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.