The American History of Housing Discrimination Still Linked to Heart Risks for Black Americans

Almost a century ago, it was legal for US banks to deny mortgages to people in predominantly black communities, a practice known as “redlining”. For several decades, this practice has been banned. But research suggests that this history of structural racism has a continuing negative effect on the heart health of black Americans.

A study published on December 21, 2021 in Proceedings of the National Academy of Sciences (PNAS) focused on the cardiovascular health of a multi-ethnic sample of 4,779 middle-aged people living in 949 neighborhoods in seven US cities: Los Angeles; New York; Chicago; Saint-Paul, Minnesota; Minneapolis; Winston-Salem, North Carolina; and Baltimore.

In the 1930s, maps used by the Federal Homeowners Loan Corporation (HOLC) ranked each of these neighborhoods based on discriminatory assessments of the risk it would be granting mortgages to potential buyers. , according to the study. On these maps, the most “dangerous” places to issue loans were colored red and had high proportions of black, low-income and immigrant residents; The predominantly white, affluent communities have been colored green to indicate the “safest” places for banks to offer mortgages.

Overall, about 19% of study participants lived in “dangerous” neighborhoods marked in red, while about 5% lived in “better” communities. Using these historic HOLC maps, researchers examined the cardiovascular health of modern residents in each neighborhood, using factors such as blood pressure, blood sugar, cholesterol, overweight and obesity, diet , physical activity and smoking.

Surprising discoveries

Based on these risk factors, blacks who lived in neighborhoods historically marked in red had much worse cardiovascular health than blacks living elsewhere. But that was not the case for the other three groups examined in the study: whites, Hispanics and Chinese.

“We were surprised by these results,” says the study’s lead author, Mahasin Mujahid, PhD, associate professor of epidemiology in the school of public health at the University of California at Berkeley. “We hypothesized that our results would be more pronounced among black participants, but that there would still be associations for other racialized groups.”

The study found that the health outcomes of blacks living in neighborhoods historically marked in red persisted for several different risk factors for poor heart health. For example, blacks in these neighborhoods were 78% less likely to have healthy blood pressure and 60% less likely to have a healthy body weight.

“Our findings are an important reminder that black people have a different history in this country, from slavery to Reconstruction, Jim Crow and the civil rights movement,” said Dr. Mujahid. “The effects of this unique story continue to shape the current reality of black Americans regarding health outcomes, particularly heart health.”

Limitations of the study

One of the limitations of the study is that factors not directly measured in the analysis, such as socioeconomic status, may have impacted black heart health. Neighborhoods marked in red often tended to be very poor communities, and unfair lending practices often coincided with discrimination in employment and other aspects of life that could also have a negative impact on health. noted the researchers.

On top of that, the red line prevented black families from passing on the accumulated wealth – in the form of a family home – to subsequent generations, Mujahid says. Homeownership is one of the most common ways for families in the United States to enter the middle class and enable their children to be more successful financially.

Although redlining may technically be a thing of the past, structural racism and discrimination persist and contribute to worsening black health problems, several studies suggest.

One study, published in October 2015 in the American Journal of Public Health, for example, found that people living in communities with higher levels of anti-black prejudice were 24% more likely to die prematurely than people living in more tolerant neighborhoods.

Another study looked at who in New York City receives care at academic medical centers that provide access to advanced treatments and technologies not available elsewhere. This study, published in February 2017 in the International Journal of Health Services, found that black patients were half as likely as white patients to receive care at academic medical centers, even after accounting for differences in health insurance.

Can moving help?

It’s also possible that moving from isolated communities to more diverse neighborhoods helps black people improve their heart health. A study published in July 2017 in JAMA Internal Medicine found significant improvements in blood pressure among blacks who moved to less segregated communities.

This is not a sure thing, however, because even if blacks who move away from communities historically marked in red improve their chances of upward mobility and higher incomes, they can also leave behind strong networks of social support. that can be beneficial to their health, Mujahid said.

Whether blacks stay in historically demarcated neighborhoods or relocate, they must be vigilant about the potential for their health to be shaped by where they were born and how generations of their families have lived, adds Mujahid.

“Clinicians and health care providers should recognize that many of their patients are in poor health because of the intergenerational effects of racist or discriminatory policies,” says Mujahid. “Redlining is just one example, but there are many more examples. “


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