Written by Shannon Markus
Spoon Feed
Redlining — a U.S. federal agency’s practice of denying loans to minority borrowers — has had lasting effects, including higher poverty, lower homeownership, and poorer health outcomes.
From maps to mortality – redlining’s lasting effects on lives
Many Americans remain unaware of redlining, a discriminatory practice by the federally funded Home Owners’ Loan Corporation (HOLC), which systematically denied mortgage loans in African American neighborhoods. This institutionalized racial bias limited Black homeownership and wealth accumulation, perpetuating intergenerational poverty and economic immobility in segregated areas. Research increasingly links historic redlining to present-day health and mortality disparities. This particular study examining 30 U.S. cities used census and mortality data to show an 8% higher mortality risk for each downgrade in HOLC area grades (e.g., A to B). Residents of neighborhoods graded as D (“most hazardous”) currently have 1.44 year lower life expectancy at age 65 compared to those in A. HOLC maps mirrored broader systemic racism that restricted resources, economic opportunities, and healthcare access — disparities still evident today. While findings highlight associations rather than causation, they underscore the lasting health impacts of structural inequities that continue to this day. Addressing these disparities through targeted policies is crucial to improving outcomes in marginalized communities.
How will this change my practice?
Information like this gets me reevaluating how I approach my patient encounters. Only 10-20% of health outcomes are tied to medical care, while ~80% stem from socioeconomic, environmental, genetic, and behavioral factors. It highlights how structural racism in HOLC practices entrenched health disparities in these communities. And it motivates me to do my best to address and mitigate the lingering effects of historical discrimination (even as a single healthcare provider) by asking about social needs like housing, food security, and employment, referring patients to community resources, collaborating with social workers, and advocating for policy changes to promote health equity.
Source
Individual-Level Exposure to Residential Redlining in 1940 and Mortality Risk. JAMA Intern Med. 2024 Nov 1;184(11):1324-1328. doi: 10.1001/jamainternmed.2024.4998. PMID: 39348152
Thank you for reviewing and promoting this article. I appreciate your “practice change” takeaways around thinking critically about the whole person care our patients get.