This is the fourth chapter in a series of research articles on racial inequities in US housing produced by the Chandan Economics Research Team. Other posts in this series can be found here: 1. Racial Inequities in Household Wealth. ; 2. Racial Inequities in Housing Affordability ; 3. Racial Inequities in Access to Credit ; 5. Racial Inequities in Housing: Policy Considerations.
In the previous chapters of our series on racial inequities in US housing, we discussed how historic racial segregation helped facilitate today's wealth and upward mobility disparities. In this installment, the Chandan Economic Research Team will explore the origins of similar inequities observed in housing and environmental quality.
Defining Housing Quality
When housing quality is mentioned, one's first thought may go toward the quality of home construction, utility efficiency, or resources that impact safety and security. While evaluating such variations are essential, our analysis focuses on “quality of life” measurements and how housing disparities may affect them.
As covered in our most recent chapter, redlining in appraisals by the new-deal era Homeowners Loan Corporation (HOLC) reinforced de-facto racial segregation in the United States and curtailed economic development in minority-majority neighborhoods. Further, research has shown that measures of environmental quality and public health are significantly more negative in historically redlined zones.
In a study of redlining’s environmental effects in Indianapolis, using a geographic information system, researchers found evidence of more high-intensity development, low green space, and a disproportionate concentration of brownfield sites in formerly redlined areas. Superfund sites, industrial waste sites, and interstate highways were also more prevalent in formerly redlined areas than in other parts of Indianapolis.
Outside the borders of Indianapolis, the effects of HOLC’s redlining stretch across several US cities. According to an analysis by Indiana University-Purdue University Indianapolis, HOLC scores alone account for 31% of the variation in tree canopy across US cities today.
Redlining's environmental legacy appears to have a tangible impact on health outcomes, with HOLC scores predicting 91% of the variation in cancer risk from air pollution.
Epidemiology studies have probed this further. According to a 2020 study by researchers at the Huntsman Cancer Institute using Georgia Cancer Registry data, residing in redlined census tracts coincided with a 1.60-fold increase in breast cancer mortality. Contextualizing the potential reach of this issue, the Huntsman study utilized Home Mortgage Disclosure Act data to extrapolate population totals and demographic information for the geographies in focus. It found that roughly 80% of non-Hispanic Black women and 20% of non-Hispanic White women reside in areas with significant lending bias, proving that redlining contributed to both a racial and gender health gap.
While less green space and a higher prevalence of environmental hazards help explain variations in health outcomes, hospital quality may also play a role.
While US hospitals were formally desegregated in 1965 following the creation of Medicare (equal access was a requirement for new federal funding), remnants of segregation persist in patient demographics and results. A key reason for this is the prevalence of patients with public or no health insurance in minority-majority communities and the downstream effect this has on hospital quality.
Hospitals that serve large portions of uninsured or Medicaid patients are paid significantly less than those that serve higher proportions of privately insured patients. How medical facilities are reimbursed for their costs ultimately impacts staffing, operations, and quality of care.
Evidence of such poorer hospital quality and its impacts surfaced during the COVID-19 pandemic. According to research from the University of Pennsylvania analyzing data from 44,000 patience across 1000 US hospitals, Black patients with COVID-19 had an 11% greater risk of mortality or discharge to hospice compared to White patients. Furthermore, while the racial disparities held when controlling for sociodemographic characteristics, they dissipated when controlling for differences in hospital quality.
Often when highlighting racial inequities in the US economy, a common misconception derived from research is that outward racial discrimination is the catalyst to outcomes. While modern social and racial bias likely plays some role, the more pertinent theme arising from our analysis is the prevalence of historic structural racism in US policy and commerce and its long-lasting effects.
How to best narrow these widespread disparities are debatable. We will cover some of these ideas during the next chapter of the series on racial inequities in housing focused on public policy considerations, set for release on Tuesday, February 21st. Below is the full release schedule of our 2023 series.
Other posts in the 2023 series can be found here:
 Defined as property not-in use due to potential presence of contaminants, pollutants, or environmental hazards.  Defined as polluted locations that require a long-term response in order to clean up hazardous material.  After 30-days of impatient care.