Redlining: Denial by Design

As stated by National Alliance’s study, “a key issue facing the American healthcare system is the impact of social needs, social risks, and social determinants of health (SDoH) on healthcare.” Social determinants of health include conditions in places where people live, work, and play. The Department of Health lists Neighborhood and Built Environment as a major domain of SDoH. For many people, redlining has predetermined where they live.

Redlining is a term related to discriminatory housing practices, often financial. The act of redlining started in the 1930s, but the term was not coined until the 1960s.

“Redlining was an intentional process that was used by the real estate industry and the financing industry to really color-code communities and steer where lending happened.”

It is crucial to acknowledge that these lending policies were a federal program produced by the government. Lenders utilized these maps to determine who got money and who did not, all based on the neighborhoods they lived in. When this practiced started, typically if it was a community of color, it was marked red.

Redlining is now illegal. But the influences of it are still felt today and impacts much more than just mortgages. It is so engrained in the system, the effects are felt in many fields of life, including health care, and frequently for those in communities of color.  A primary example of systemic racism.

Impacts of SDoH:


A2019 report proved that Pittsburgh is not America’s most livable city. It is “the nation’s least livable and unequal cities for Black Americans” all due to the “reluctant to acknowledge the consequences of their own institutionalized system of racial separation.” Pittsburgh is a “tale of two cities” that redlining put into place years ago.

Overall Health & Health Care Access

When redlining was put into place, the neighborhoods that were marked red were literally the most toxic areas to live in. For example, in Northern California, the neighborhoods within Berkley and Oakland that were redlined sit on land closer to manufacturing and major highways, creating unhealthy environments for those living there. The air quality is poisonous. These patterns are seen country wide, not just in a few cities here and there.

Residents of these toxic neighborhoods are likely to have shorter life spans than people living in other parts of the same city. Sometimes there is a 20-to-30-year difference! Redlining has a massive lingering impact in our country.

“(She says that) People often think of health as the result of individual choices. (But she says) The redlining study’s findings show how health is also a result of a lack of choices baked into the very fabric of American cities by racist policies made long ago.”

The forced residential segregation in turn has created hospital segregation. Hospitals in the redlined neighborhoods do not receive equal funding and the quality of care does not match those outside of these areas. All hospitals deserve equal support to provide the best quality of care to their patients. The unequal reimbursement system must end, “so that all hospitals are compensated equally for the patients they serve.”


School funding is based on property values, unjustly created by redlining, which also had in a hand in creating school district boundaries.

“The government and corporations then diverted money and other resources away from these siloed minority neighborhoods, which they had a hand in creating. This meant a lack of funding for public schools in high-needs neighborhoods primarily serving children of color. The denial was by design.”

Just like quality of care, every child deserves equitable access to a first-rate education.

Food deserts/Inequitable food access

The term food desert is contested because it ignores the true cause of the lack of access to food – systemic racism. “Food Apartheid” is said to be more accurate. It calls out the reason behind these areas with inequitable food access and limited options. People are not in these areas by chance. It’s the result of a purposeful plan. Grocery stores are more hesitant to open in these areas, adding another hurdle to creating equitable food access, and another component of a healthful lifestyle.  

“Food justice means racial justice, demanding a clear-eyed understanding of how white supremacy has shaped our food systems” and that “nutritious, affordable, and culturally relevant food is a universal human right.”

In an upcoming interview, hear from the Second Lady of PA, Gisele Fetterman, and her nonprofits focused on helping areas of food insecurity, including 412 Food Rescue.

By no means is this list all encompassing of the lifelong consequences that redlining has put into place. These are just some of the examples of systemic racism communities of color face. All started by a government policy. It has so many layers to peel back that these effects often get overlooked by those in places of privilege. Redlining, what it impacts, and other social determinants of health must be considered when employers are selecting the health care for their employees.

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