Redlining, a discriminatory practice that designated many inner-city, mostly Black neighborhoods as hazardous for housing investment, is linked to the incidence of stroke in certain communities, according to researchers from Montefiore Medical Center in New York. The study found that the impact of redlining on social determinants of health, such as educational attainment, poverty, language barriers, and provider workforce shortages, drives health outcomes. These findings highlight areas for tailored health and social welfare interventions.
Institutional racism and its impact on social determinants of health (SDOH) have been linked to the incidence of stroke in certain communities, according to researchers from Montefiore Medical Center in New York. The study found that redlining, a 20th-century practice that designated many inner-city, mostly Black neighborhoods as hazardous for housing investment, has led to residual effects that are additive to classic SDOH as defined by the Healthy People Framework. The study also highlighted the link between certain SDOHs, including educational attainment, poverty, language barriers, provider workforce shortages, and historically redlined neighborhoods.
Redlining is a discriminatory practice that was officially ended in 1968 with the passage of the Fair Housing Act. However, the socioeconomic impacts remain, and formerly redlined neighborhoods have less access to quality housing stock, transportation, schools, green space, sanitation services, and employment opportunities in the present day. The researchers used data from 2,117 census tracts in New York City and data about stroke prevalence from the CDC 500 Cities Project from between 2014 and 2018 to identify a clear link between redlining and stroke. A neighborhood’s historical redlining score, which the researchers called HRS, was independently linked with community-level stroke incidence.
The researchers acknowledged the plausibility of the weathering hypothesis, which states that the stress that compounds from exposure to interpersonal and structural racism can impact health outcomes, including risk for stroke. They also noted that the stress of living in a disinvested community may impact health outcomes.
Notably, the researchers observed a lower stroke prevalence among Black and Hispanic people after adjusting for risk factors, SDOH, and historical redline score. This indicates that race is not a biological indicator of health outcomes, but rather an “identifier of social position.”
The study adds to the growing body of literature about the impact redlining has had on health outcomes. Researchers have reported that historically redlined neighborhoods now see a higher level of cardiometabolic risk factors and a link between redlined districts and asthma.
While uncovering these links cannot undo the racist practices in America’s history, it can help identify areas for tailored health and social welfare interventions.
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