The impact of redlining and place-based systemic racism on health inequalities at mid-life

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Understanding the social, economic, behavioral, and institutional factors that drive place-based differences in mid-life morbidity and mortality is critical to addressing health inequalities. Historic racist housing policies (e.g., federal redlining, restrictive deeds and covenants) influenced the physical, social and economic structure of places resulting in racial and socioeconomic residential segregation in the US. The systemic denial of homeownership opportunities through racist housing policies may be a key upstream source of mid-life health inequities observed across the US today through restrictions wealth and place-based investment over time. Our previous work has shown that Home Owners' Loan Corporation (HOLC) redlining from 1935-40 is associated with high minority, low socioeconomic neighborhoods with shorter average life expectancy, higher neighborhood prevalence of chronic diseases, and worse physical and mental health. However, few studies have investigated the mechanisms by which historic redlining, subsequent neighborhood trajectories of investment and disinvestment, and racial residential segregation over time have shaped place-based inequalities in `exposure' to harmful environments (e.g., industrial toxins) and `access' to health promoting resources (e.g., health care services) that impact individual-level morbidity and mortality. The proposed project will address this gap by, first, harmonizing siloed data sources to produce a national database of historical redlining, historic and current environmental hazards, housing investment, gentrification, and longitudinal neighborhood demographics and socioeconomics. Then, we will examine structural racism as it is embedded in neighborhoods with 1) the resulting inequalities in neighborhood `access and exposure' that drive health opportunities (Aim 2), and 2) disparities in morbidity and mortality risk beginning in mid-life in a nationally representative longitudinal study, the Health and Retirement Study (HRS) (Aim 3). We hypothesize that historically redlined areas will have greater proximity to present-day environmental hazards and reduced access to healthcare and health promoting resources, and that longitudinal neighborhood change associated with redlining will partially mediate these associations. We further hypothesize that HRS participants living in historically redlined areas will have greater risk of morbidity and mortality than HRS participants not living in redlined areas and that this association will vary by present-day intensity of racial residential segregation. This project will create actionable knowledge to address health inequities beginning in mid-life by uncovering how macrostructural factors, including historic, racist government policies result neighborhood and individual health disparities. Further, the data product generated in Aim 1 will be made publicly available to facilitate additional research on the impact of place in other longitudinal studies of health.