User:Vidyabhargava/Redlining

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Redlining and Health Inequality

Health inequality in the United States persists today as a direct result of the effects of redlining. This is because health in America is synonymous with wealth, both of which minority groups have been denied as a result of discriminatory practices. Wealth affords the privilege of living in a neighborhood or community with clean air, pure water, outdoor spaces and places for recreation and exercise, safe streets during the day and night, infrastructure that supports the growth of intergenerational wealth through access to good schools, healthy food, public transportation, and opportunities to connect, belong, and contribute to the surrounding community. Wealth also provides stability of home as those with capital are not confined to the deteriorating housing stock that minority groups who were redlined were forced to try and rehabilitate without access to loans.[18][19][20][21][22]

In the case of retail businesses like supermarkets, the purposeful construction of stores impractically far away from targeted residents results in a redlining effect.[23] This has been referred to as supermarket redlining and has been proposed as a cause of lower access to supermarkets that is characteristic of some scholarly definitions of food deserts. The concept describes how large chain supermarkets tend to relocate out of or refrain from opening stores in inner-city areas or impoverished neighborhoods due to perceived urban and economic obstacles, decreasing certain communities' access to supermarkets.[24]

Cancer Outcomes
Another outcome associated with redlining is varying cancer outcomes. For example, a study published in the Journal of the American Medical Association found non-redlined areas to have more favorable breast cancer outcomes among non-Latina white women. A 2023 study published in the Journal of the American College of Surgeons found that, beyond cancer outcomes, redlining also contributes to lower cancer screening rates. . Specifically, the study found that, in redlined versus non-redlined neighborhoods, there were 24% lower odds of being screened for breast cancer, 64% lower odds for colorectal cancer, and 79% lower odds in cervical cancer. It is important that strategies to combat screening disparities be structurally competent and location-specific, as Amanda Harper, senior staff writer at Ohio State's Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute writes. For example, if transportation is a barrier, travel vouchers or mobile clinics should be employed. The health inequalities that arise from redlining manifest in many forms, and cancer outcomes and screening are two ways redlined communities present differences when compared to non-redlined communities.

Life Expectancy
Overall life expectancy has improved, but there are still discrepancies between the life expectancies of different racial groups. The concentration of disparities in minority neighborhoods, reinforced by redlining, has resulted in worse health outcomes and lower life expectancies in these neighborhoods. Continued economic isolation and property devaluation resulting from redlining have widened the differences in life expectancy between redlined communities and neighboring highly-rated communities. When comparing redlined neighborhoods to highly-graded neighborhoods by the Home Owners' Loan Corporation, life expectancy in redlined communities is on average 3.6 years lower. However, there is significant variation in this difference among different cities. In Baltimore, red or yellow rated communities, meaning "declining," or "risky for mortgage support," had a life expectancy five years shorter then communities rated green or blue, meaning "desirable." In Richmond, Virginia, one predominantly black neighborhood has a life expectancy of 21 years shorter than that of a nearby predominantly white neighborhood, which had been highly rated by the HOLC in the 1930s.

COVID-19
Redlining intentionally excluded black Americans from accumulating intergenerational wealth. The effects of this exclusion on black Americans' health continue to play out daily, generations later, in the same communities. This is evident currently in the disproportionate effects that COVID-19 has had on the same communities which the HOLC redlined in the 1930s. Research published in September 2020 overlaid maps of the highly affected COVID-19 areas with the HOLC maps, showing that those areas marked "risky" to lenders because they contained minority residents were the same neighborhoods most affected by COVID-19. The Centers for Disease Control (CDC) looks at inequities in the social determinants of health like concentrated poverty and healthcare access that are interrelated and influence health outcomes with regard to COVID-19 as well as quality of life in general for minority groups. The CDC points to discrimination within health care, education, criminal justice, housing, and finance, direct results of systematically subversive tactics like redlining which led to chronic and toxic stress that shaped social and economic factors for minority groups, increasing their risk for COVID-19. Healthcare access is similarly limited by factors like a lack of public transportation, child care, and communication and language barriers which result from the spatial and economic isolation of minority communities from redlining. Educational, income, and wealth gaps that result from this isolation mean that minority groups' limited access to the job market may force them to remain in fields that have a higher risk of exposure to the virus, without options to take time off. Finally, a direct result of redlining is the overcrowding of minority groups into neighborhoods that do not boast adequate housing to sustain burgeoning populations, leading to crowded conditions that make prevention strategies for COVID-19 nearly impossible to implement.[25][26][27][28][29][30][31]

After years of de facto discrimination achieved through redlining, a system of structural racism blocking the achievement of health equity for all Americans has developed. As a result, a de facto health narrative that does not inspire belonging, compel political participation, nor dictate strategic change towards the social justice model for health equity has matured. In order to eliminate health inequality in America, a new de facto health narrative needs to dictate strategy. The process for achieving health equity relies on healthcare leaders articulating, acting on, and building the vision into all decisions and structures that support equity. Sufficient resources must be allocated to establishing a governance structure that can oversee health equity work. This includes taking specific action to address the social determinants of building intergenerational wealth as well as confronting institutional racism within health systems themselves. Next, health systems need to address the socioeconomic determinants of health which disadvantage minority groups. Through training, education, support groups, housing support, improved transportation, resource assistance, and community health programs, health equity organizations can begin to break down the long-lasting barriers that tactics like redlining have imposed on achieving health equity. In addition to ensuring the equal health outcomes of patients, healthcare organizations can also utilize their position as employers to develop a more diverse workforce through improved hiring practices and ensuring living wages to minority employees.[32][33]

Strategies to reverse effects of redlining
Moreover, residents of historically redlined neighborhoods face risks for worse health outcomes and lower life expectancies. Healthcare professionals play a crucial role in efforts to reverse the impact of redlining on adverse health outcomes. Metzl and Hansen propose that the U.S. medical education system should train healthcare professionals to recognize the larger structural contexts and social and economic conditions that influence patient health outcomes, including the legacy of redlining. Infusing clinical training with structural awareness allows healthcare providers to consider the structural barriers that shape patients’ health and illness. The faculty at Wayne State University School of Medicine in Detroit, Michigan launched a course called “Healing Between the Lines” to teach medical students and residents about the effects of structural injustices on health, including historical redlining as a “critical driver” of the life expectancy gap of Detroit. From a healthcare policy perspective, Egede and other scholars recommend Medicaid expansion, Medicaid coverage mandatorily including Community Health Worker services, value-based health system payments, and federal incentives for expanding hospitals and clinics. Healthcare providers and individuals in the healthcare system are crucial in addressing the long-lasting health consequences of historical redlining.