• Pre-Collegiate Global Health Review

Redlining in The United States: The Ghost of Jim Crow in Modern Health

By Juliet Fang, University High School, Fresno, California, USA

An old adage states that an individual’s life expectancy is dependent on his or her zip code. The consequences of redlining have made this notion especially clear.

When the federal Home Owners Loan Corporation (HOLC) attempted to control mortgage loaning by color-coding metropolitan areas of the United States by credit score, neighborhoods with a high population of African Americans and other minority groups were invariably deemed “hazardous” for issuing loans (Richardson et al., 2020). Rationale for these decisions included “infiltration of Negroes” amongst other racial motives (Hillier, 2003). This process, known as redlining, marked a structural shift in the environmental make-up of these communities. Without access to loans and left with dilapidated living conditions, poverty soared and health worsened. Indeed, the 1930s saw a period of federally sponsored segregation with profound implications on health that have extended into the era of COVID-19.

After communities were redlined, it became difficult for people to buy or repair houses. Falling property values welcomed industrial companies, leading to pollution and diminished green space. Retailers and services soon left, resulting in less access to healthy food and medical care (Richardson et al., 2020). And without mortgage loans, individuals became chained to these communities. Moving past the redline was financially impossible.

With the global pandemic exacerbating health disparities in low-income communities, the impacts of historical redlining have been brought to light once again. A recent study by the National Community Reinvestment Coalition (NCRC) analyzed redlining across 142 urban areas in the US and observed significant associations between redlining and pre-existing conditions for heightened risk of COVID-19, such as asthma, diabetes, and high cholesterol. Take the following US cities, for example:

Figure 1. COVID-19 cases per 100,000 residents, Los Angeles County. Los Angeles County Public Health Department, US Census Bureau, 2021.

Figure 2. Map of Los Angeles, California. HOLC, 1939.

Figure 3. COVID-19 cases per 100,000 residents, Richmond, Virginia. Virginia Department of Health, US Census Bureau, 2021.

Figure 4. Map of Richmond, Virginia. HOLC, 1939.

Figure 5. COVID-19 cases per 10,000 residents, Detroit, Michigan. City of Detroit Department of Public Health, US Census Bureau, 2021.

Figure 6. Map of Detroit, Michigan. HOLC, 1939.

The figures display the distribution of COVID-19 cases in Los Angeles, California; Richmond, Virginia; and Detroit, Michigan, with darker shading representing greater COVID-19 cases. Green areas represent first and second grade areas (areas deemed “safe” for mortgage lenders, i.e. Beverly Hills), and yellow and red areas represent third and fourth grade areas, such as Downtown Los Angeles (Hillier, 2003). Strikingly, many of the areas experiencing the highest rates of COVID-19 cases are classified as third and fourth grade (yellow and red colored) communities, reflecting the conclusions of the NCRC study.

An increased risk for underlying health conditions in these communities combined with crowded housing conditions, inadequate transportation, and restricted access to medical care are all key factors in these communities’ vulnerability to COVID-19 (Richardson et al., 2020). Essentially, redlining has determined the physical and socioeconomic conditions of these communities, driving disproportionate numbers of COVID-19 infections.

Redlining remains to be one of the most conspicuous acts of structural racism in the United States. Yet, its impact is akin to a snake wrapped around its prey—slow, steady, deadly. Because moving is not an option, restrictions placed on these communities create generational cycles of poverty, with each generation becoming more marginalized than the last. Even with the passage of the Fair Housing Act in 1968, little could be changed. Low-income families that could not afford to move out of their neighborhoods pre-redline were largely ill-equipped to do so in the 70s.

Redlining and its direct relationship with poor health outcomes reaffirms that health is not solely a result of poor individual choices. More so, poor health can result from the lack of individual choices—whether that be in the form of education, nutrition, or housing.

Eighty years seems like a long time ago. Since then, we’ve commercialized flying, discovered penicillin, and invented the chocolate chip cookie. Despite how far we’ve come, the ugly head of history rears high. It will take stringent, concentrated reform to overturn these deeply entrenched policies. To counteract the disinvestment imparted upon these communities, reinvestment is needed to build quality infrastructure, establish better schools, create more job opportunities, and improve health. Only combined with time, conversation, and understanding can we hope to repair the structural damage wrought onto minority communities so long ago.


City of Detroit Department of Public Health (2021, April 1). COVID-19 Cases per 10,000 residents. Retrieved April 19, 2021, from https://detroitmi.gov/departments/detroit-health-department/programs-and-services/communicable-disease/coronavirus-covid-19

Godoy, M. (2020, November 2019). In U.S. Cities, The Health Effects Of Past Housing Discrimination Are Plain To See. NPR. Retrieved March 28, 2021, from https://www.npr.org/sections/health-shots/2020/11/19/911909187/in-u-s-cities-the-health-effects-of-past-housing-discrimination-are-plain-to-see

Hillier, A. (2003). Redlining and the Homeowners' Loan Corporation. Departmental Papers. Retrieved March 28, 2021, from https://repository.upenn.edu/cgi/viewcontent.cgi?article=1002&context=cplan_papers

Home Owners Loan Corporation (1939). Central Los Angeles. Retrieved March 28, 2021, from https://ncrc.org/holc-health/

Home Owners Loan Corporation (1939). Detroit, Michigan. Retrieved April 19, 2021, from https://ncrc.org/holc-health/

Home Owners Loan Corporation (1939). Richmond, Virginia. Retrieved April 19, 2021, from https://ncrc.org/holc-health/

Los Angeles Department of Public Health (LADPH) (2021, April 1). COVID-19 Locations and Demographics. Retrieved April 1, 2021, from http://publichealth.lacounty.gov/media/coronavirus/locations.htm

Richardson, J., Mitchell, B., Meier, H., Lynch, E., & Edlebi, J. (2020). Redlining and Neighborhood Health. National Community Reinvestment Coalition. Retrieved March 30, 2021 from https://ncrc.org/holc-health/

Virginia Department of Public Health (VDH) (2020, April 1). COVID-19 Cases by Zipcode. Retrieved April 17, 2021, from https://www.vdh.virginia.gov/coronavirus/covid-19-data-insights/covid-19-case-and-testing-data-by-zip-code/