UC Davis

Government endorsed redlining practices carried out by the Home Owners’ Loan Corporation (HOLC) beginning in the mid-1930s have garnered attention in the population health literature over the last few years, with increased recognition of structural racism and de jure residential segregation as fundamental causes of racial/ethnic health disparities. HOLC’s appraisal process was carried out in cities with at least 40,000 residents and entailed the assignment of color-coded “risk grades” to residential properties in urban neighborhoods based on perceived risk for foreclosure. Neighborhoods with concentrations of Black and/or immigrant residents were systematically graded in the highest risk category and experienced subsequent declines in property values, private investment, and lending opportunities associated with the “hazardous” designation. Digitization of HOLC’s infamous “residential security maps” by the University of Richmond’s Mapping Inequality Project has enabled researchers to link historical redlining patterns to a range of contemporary social, economic and health outcomes, from birth outcomes to chronic disease. The connection between historical redlining practices and contemporary health outcomes may highlight an important pathway by which structural racism produces and reproduces racialized and place-based health inequities across generations.

Despite the recent profusion of evidence associating historical redlining and contemporary health outcomes, few studies have probed these relationships for heterogeneity across population groups or geographic areas, and few have examined the mechanisms by which historical redlining practices may impact contemporary neighborhood conditions and health. This dissertation links data from the Centers for Disease Control and Prevention (CDC) PLACES Project (2020 release), Historic Redlining Scores Project, American Community Survey 5-year estimates (2013-2017), and the Home Mortgage Disclosure Act database (2013-2017) to examine historical and contemporary forms of institutionalized racism in housing markets as drivers of neighborhood health inequities. In the first empirical chapter (Chapter 2), I examine whether and how associations between historical redlining patterns and neighborhood health – specifically, prevalence of poor mental health and diagnosed diabetes – are moderated by contemporary neighborhood racial/ethnic composition. The findings of this study may point to differential impacts of historical to contemporary structural racism across racial/ethnic groups. In the second empirical chapter (Chapter 3), I examine whether and to what extent features of contemporary housing markets explain the documented association between historical redlining patterns and neighborhood prevalence of poor mental health. As inequities within local housing markets have particularly affected Black communities, I also examine whether the effects of historical redlining patterns through features of contemporary housing markets are dependent on the relative size of the Black population within a neighborhood. The findings of this study suggest neighborhood property values, homeownership rates, and loan denial rates for home purchase explain a large share of the association between redlining patterns and poor mental health. Finally, in the third empirical chapter (Chapter 4), I examine whether and how associations between historical redlining patterns and neighborhood diabetes prevalence vary across metropolitan areas. Specifically, I examine a novel composite measure of institutionalized anti-Black racism in housing markets as a possible metropolitan/micropolitan area-level modifier of the relationship between historical redlining and neighborhood diabetes prevalence. This study suggests contemporary institutionalized racism in local housing markets may be perpetuating legacies of historical redlining practices and other exclusionary policies. Overall, these studies contribute to a burgeoning body of literature examining the roles of historical to contemporary forms of institutionalized racism in housing markets in the (re)production of racial/ethnic and place-based health inequities. This work is particularly timely as policymakers have garnered stronger interest in pursuing reparations for historical injustices imposed on Black communities, including use of the HOLC maps to prioritize neighborhoods for place-based investments.