The legacy of structural racism: Associations between historic redlining, current mortgage lending, and health

Abstract

Structural racism, which is embedded in past and present operations of the U.S. housing market, is a fundamental cause of racial health inequities. We conducted an ecologic study to 1) examine historic redlining in relation to current neighborhood lending discrimination and three key indicators of societal health (mental health, physical health, and infant mortality rate (IMR)) and 2) investigate sustained lending disinvestment as a determinant of current neighborhood health in one of the most hypersegregated metropolitan areas in the United States, Milwaukee, Wisconsin. We calculated weighted historic redlining scores from the proportion of 1930s Home Owners' Loan Corporation residential security grades contained within 2010 census tract boundaries. We combined two lending indicators from 2018 Home Mortgage Disclosure Act data to capture current neighborhood lending discrimination: low lending occurrence and high cost loans (measured via loan rate spread). Using historic redlining score and current lending discrimination, we created a 4-level hierarchical measure of lending trajectory. In Milwaukee neighborhoods, greater historic redlining was associated with current lending discrimination (OR = 1.73, 95%CI: 1.16, 2.58) and increased prevalence of poor physical health (β = 1.34, 95%CI: 0.40, 2.28) and poor mental health (β = 1.26, 95%CI: 0.51, 2.01). Historic redlining was not associated with neighborhood IMR (β = −0.48, 95%CI: −2.12, 1.15). A graded association was observed between lending trajectory and health: neighborhoods with high sustained disinvestment had worse physical and mental health than neighborhoods with high investment (poor physical health: β = 5.33, 95%CI: 3.05, 7.61; poor mental health: β = 4.32, 95%CI: 2.44, 6.20). IMR was highest in ‘disinvested’ neighborhoods (β = 5.87, 95%CI: 0.52, 11.22). Our findings illustrate ongoing legacies of government sponsored historic redlining. Structural racism, as manifested in historic and current forms of lending disinvestment, predicts poor health in Milwaukee's hypersegregated neighborhoods. We endorse equity focused policies that dismantle and repair the ways racism is entrenched in America's social fabric.

Association of historic redlining and present-day health in Baltimore

“…While we found no association with infant mortality, Lynch et al [ 27 ] noted that current investment patterns in census tracts interact with redlining and population displacement of Black residents by white residents that may drive infant mortality more than historical redlining patterns alone. This may suggest similar patterns for other maternal and child health outcomes.…”

“…The potential pathways for redlining’s impact on health reflect those found in residential segregation [ 23 ] and fall across the entirety of the life course [ 9 , 23 – 40 ]. Proposed pathways span both differential exposures to environmental and social hazards (including both the proximity and imposition of hazards and the reduced presence of mitigatory systems such as reduced access to health services [ 23 , 27 ]) and possibly the concentration of populations that have previously suffered such hazards [ 25 , 29 ]. Lynch et al [ 27 ] find that historical redlining was associated with sustained disinvestment and lending discrimination in Milwaukee neighborhoods, as well as poorer present day physical and mental health.…”

“…Proposed pathways span both differential exposures to environmental and social hazards (including both the proximity and imposition of hazards and the reduced presence of mitigatory systems such as reduced access to health services [ 23 , 27 ]) and possibly the concentration of populations that have previously suffered such hazards [ 25 , 29 ]. Lynch et al [ 27 ] find that historical redlining was associated with sustained disinvestment and lending discrimination in Milwaukee neighborhoods, as well as poorer present day physical and mental health. Similarly, neighborhood quality is thought to affect environmental health and reduce access to resources that enable protective behaviors [ 28 – 31 ].…”

“…Adding measures of community composition changes could be a way to account for these changes [ 50 ]. Additionally, adding analysis of current investment patterns [ 27 ] may help elucidate the ways that redlining interacted with population displacement.…”

“…Potential pathways from redlining through sustained disinvestment leading to exposure to hazards have been both theorized [ 9 , 23 ] and in some cases explored [ 27 , 28 ]. Future studies could look more closely at neighborhood factors like documented environmental hazards, exposure to policing, healthcare utilization, or mobility patterns to clarify potential causal pathways, including specifically in Baltimore.…”