Racism, Racial Residential Segregation, and Health Inequities

Racial residential segregation is “the physical separation of the races in residential contexts” (Williams & Collins, 2001, p. 405). Explicit government policies through the first half of the 20^th century were designed to keep Black and white residents separate (Rothstein, 2017). Across the United States, patterns of Black-white residential segregation have remained etched in place for the past 80 years (Williams et al., 2019). Today, we see an inequitable distribution of risks (e.g., toxic waste, community stress, unhealthy food) and resources (e.g., parks, community resources, healthy food) across neighborhoods based on the racial makeup of residents, which drives health inequities.

Neighborhoods across the United States are highly segregated by race.

While residential segregation exists between multiple racial/ethnic groups, Black-white segregation is the most enduring, pronounced, and distinctive form of racial/ethnic segregation in the United States (Vock et al., 2019; Williams & Collins, 2001; Williams et al., 2019).

Racist government policies through the first half of the 20^th century created racial residential segregation and prevented Black families and other families of color from owning homes.

Explicit governmental policies and programs implemented in the 1930s were designed to keep racial groups separate in residential areas. As a part of the New Deal legislation, The Federal Housing Administration provided low-cost loans for working-class white families to move out of public housing and into all-white suburban neighborhoods while simultaneously denying Black families the same opportunities (Rothstein, 2017). Once white families moved out of public housing, Black families moved into the newly vacant units. Jobs and services left the areas surrounding the public housing units. The jobs moved into the suburbs, creating a lack of opportunities, high unemployment rates, and concentrated poverty in the now predominantly-Black neighborhoods.

At the same time, redlining ensured that Black families could not secure loans to purchase or improve homes in their communities. Throughout the 1940s and 1950s, the Home Owners’ Loan Corporation (HOLC) created “Residential Security” maps to guide lenders, appraisers, and real estate agents in evaluating investment risk. Based on the false claim that property values decreased with the presence of Black residents, HOLC codified investment risk based on the racial composition of neighborhoods. As the proportion of Black residents increased, so too did the purported level of risk, ranging from green = “best” to indicate mostly white neighborhoods, blue = “still desirable,” yellow = “definitely declining,” red = “hazardous” for predominantly Black and immigrant neighborhoods (hence the name, “redlining”). Consequently, many Black families could not secure the funds to purchase or repair homes in their communities, which became targets of continued disinvestment. There are many helpful resources for those interested in learning more about these policies:

• Housing Segregation Timeline, Legal Services of Central New York
• Interview with Richard Rothstein, author of The Color of Law, NPR
• Interview with Richard Rothstein, author of The Color of Law, Smithsonian
• Massey DS, Denton NA. American apartheid: Segregation and the making of the underclass. Harvard University Press; 1993.
• Segregation in the United States, History channel
• The Color of Law: A Forgotten History of How Our Government Segregated America, by Richard Rothstein

The legacy of racist housing policies drives health inequities to this day

Despite the outlawing of explicit, legally codified racial residential segregation in 1968, the consequences of historical redlining continue for racial inequality in health, wealth, and well-being (Rothstein, 2017).

Those in positions of power have continued to disinvest in communities of color, leading to a higher concentration of environmental and social risk factors, including:

• Toxic air and polluted water – toxic-waste producing facilities and other health-harming environmental hazards are disproportionately placed in low-income Black and Brown neighborhoods (Woo et al., 2018; Morello-Frosch & Lopez, 2006)
• Road noise and traffic density (Casey et al., 2017),
• Tobacco and liquor stores (Bower et al., 2014; Scott et at., 2020; Moore & Diez-Roux, 2006)
• Police presence and other chronic stressors (Siegel et al., 2019; Kent & Carmichael, 2013).

At the same time, decision-makers and businesses deprive these communities of crucial health-promoting resources and opportunities, such as:

• Quality education and employment opportunities (Denton, 1995; Frankenberg, 2013; Jargowsky, 2014; Institute for Research on Poverty, 2018; Turner, Cheshire et al., 2003; Dickerson 2008; Turner, 2008),
• Healthy and affordable food options (Bower et al., 2014; Moore & Diez-Roux, 2006),
• Greenspace, parks, and other recreational amenities (Nardone et al., 2021).

This inequitable distribution of risks and resources has caused strong associations between racial residential segregation and racial inequities across multiple health outcomes.

For example, researchers at UC Berkeley have shown how historically redlined areas have higher rates of adverse birth outcomes (A. L. Nardone et al., 2020) and emergency department visits for asthma (A. Nardone, J. A. Casey et al., 2020) in California. These and other studies (Beyer et al., 2016; Huggins, 2017; Krieger, Van Wye, et al., 2020; Krieger et al., 2020; McClure et al., 2019) demonstrate the lasting impacts of historical redlining on present-day health inequities including cancer, adverse birth outcomes, and poor self-rated health.

Additionally, discriminatory land-use zoning practices have created and maintained racial housing disparities (e.g., limiting dwelling construction to single-family or low-density housing rather than lower-rent multi-unit buildings) in predominantly white and wealthier neighborhoods; concentrating the zoning for undesirable uses (e.g., industrial) to communities of color and lower-income neighborhoods which can further erode property values and prevent wealth building (Swope & Hernández, 2019).

These health effects are caused by systemic disinvestment in communities of color, not by anything about the communities themselves (Keene & Padilla, 2014).

Racist housing policies excluded Black families from wealth-building opportunities.

Homeownership is a primary means of wealth accumulation in the United States. The government’s systematic exclusion of Black families from obtaining loans to purchase homes in white suburban communities (via racially-restrictive covenants) or their communities (via redlining) means many Black families have been deprived of a crucial mechanism for building intergenerational wealth (Rothstein, 2017; Williams & Collins, 2001). The entrenchment of racial segregation meant there were fewer investments in Black neighborhoods and a smaller tax base for schools which fostered poverty conditions perpetuated by Black Americans earning roughly 60 cents to the dollar that white Americans make, with only 10 cents to the dollar that white Americans have in wealth (Rothstein, 2017; Williams & Collins, 2001).

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