Redlining Linked to Worse Cardiovascular Health Among U.S. Veterans
A new study published in JAMA Network Open has revealed that redlining, a historical housing discrimination practice, continues to have a detrimental impact on the cardiovascular health of U.S. veterans. The research utilized data from the Home Owners’ Loan Corporation (HOLC), a New Deal program established in the 1930s to make homeownership more accessible during the Great Depression.
Unfortunately, the program ended up making it harder for many Americans, particularly racial, ethnic, and religious minorities, to obtain mortgages. HOLC classified neighborhoods with large minority populations as high-risk and marked them on maps with the color red, hence giving rise to the term “redlining.”
Although the mapping practice was discontinued by HOLC in the 1940s, racist housing policies persisted for several decades. Redlining was formally prohibited by the 1968 Fair Housing Act; however, it has long been associated with increased disease risk, limited access to healthcare, and other adverse health outcomes.
For this study, researchers analyzed historic HOLC and census data, as well as medical data from Veterans Affairs patients, to examine the cardiovascular health of 79,997 veterans with atherosclerotic diseases like coronary artery disease. They also considered factors such as median household income, education levels, and other indicators of neighborhood prosperity.
The analysis included patients from 81.5 percent of the tracts graded by HOLC. The findings showed that patients residing in areas that HOLC once classified as the highest risk were more likely to be White and had lower rates of cardiovascular risk factors such as smoking, chronic kidney disease, high blood pressure, and obesity. On the other hand, those risk factors were more prevalent in neighborhoods that were formerly redlined. For instance, 31.1 percent of veterans living in once-redlined neighborhoods were smokers, compared to 27.2 percent in neighborhoods graded as the lowest risk.
Furthermore, patients residing in neighborhoods that were previously redlined had a greater likelihood of being diagnosed with chronic kidney disease, heart failure, diabetes, and chronic obstructive pulmonary disease. They also faced a nearly 13 percent higher mortality risk and a 14 percent higher risk of experiencing a major cardiovascular event, like a stroke or heart attack, compared to their counterparts in other neighborhoods.
The researchers suggest that these elevated risks are likely a result of multiple factors. Formerly redlined neighborhoods tend to have worse air quality and higher levels of noise pollution, both of which have been linked to adverse health outcomes. Additionally, individuals whose ancestors faced racism and discrimination may have inherited genetic factors that impact cardiovascular health.
The study emphasizes the significant impact of one’s surrounding environment on their health, even though almost a century has passed since HOLC introduced redlining. The findings call for public health experts to consider neighborhoods when assessing cardiovascular risk and suggest further research to inform policies concerning issues ranging from food accessibility to tobacco sales.
In conclusion, this research sheds light on the persistent consequences of redlining and highlights the need for addressing systemic housing discrimination and its impact on health outcomes. It serves as a reminder that the effects of discriminatory practices can last for generations, underscoring the importance of creating equitable and inclusive communities for all.