A recipe for fair living during the COVID-19 pandemic

0


Before the COVID-19 pandemic, the US was already grappling with racial and economic disparities relating to affordable and safe housing for its population. There were large areas of cities with limited access to health care, neighborhoods with older homes that were decades old, low-income minority families living in confined spaces, and a growing homeless population. The pandemic has resulted in widespread job losses for many people, particularly low-income families, immigrants and minorities, resulting in loss of income and health insurance, with concerns about the eviction of groups of people already exposed to structural racism and poverty were. A combination of work-related hazards, housing overcrowding, and increased responsibility for home care, comprised mostly of key workers, has been instrumental in increasing the incidence (and mortality) rates of COVID-19. Housing insecurity was a key social determinant of health during this pandemic, providing relevant lessons on location-based discrimination to millions of Americans.

When assessing the causes of discrimination based on housing conditions and segregation in residential areas, historical redlining is considered. As a striking example of de jure segregation, the federally funded Home Owners’ Loan Corporation created cards in the 1930s that included a color-coded scheme to divide American neighborhoods into a risk-based ranking for mortgage approvals. Such racially explicit policies distracted investment from minority neighborhoods and resulted in black, low-income, or immigrant residents being restricted to dangerous neighborhoods.

The effects of housing discrimination were rapid and began quickly after such practices became national. Within 20 years after Austin, TX, USA passed a Home Owners’ Loan Corporation card to control lending in 1934, the incidence of tuberculosis cases was already linked to red-boxed neighborhoods with rundown houses.
1
A Cartographic Perspective on the Correlation Between Redlining and Public Health in Austin, Texas – 1951.

Since then, the ubiquitous effect of redlining has been noted elsewhere: increased firearm injury rates in Philadelphia, PA,

2
  • Jacoby SF
  • Dong B.
  • Bart JH
  • Wiebe DJ
  • Morrison CN
The continuing impact of historical and structural racism on urban violence in Philadelphia.

Alcohol outlet cluster in Baltimore, MD,

3
  • Trangenstein PJ
  • Gray C.
  • Rossheim ME
  • Sadler R.
  • Jernigan DH
Alcohol Outlet Clusters and Population Differences.

increased premature births in New York, NY,

4th
  • Warrior N.
  • Van Wye G.
  • Huynh M.
  • et al.
Structural Racism, Historical Redlining, and Premature Birth Risk, New York City, 2013–2017.

Asthma emergency rooms in San Francisco, CA

5
  • Nardone A.
  • Casey YES
  • Morello frog R.
  • Mujahid M.
  • Balmes JR
  • Thakur N.
Associations between historical redlining in residential areas and the current age-adjusted rate of emergency room visits due to asthma in eight California cities: an environmental study.

and later diagnosed with cancer in Massachusetts.

6th
  • Warrior N.
  • Wright E.
  • Chen JT
  • Waterman PD
  • Huntley ER
  • Arcaya M.
Cancer Stage at Diagnosis, Historical Redlining, and Current Neighborhood Features: Breast, Cervical, Lung, and Colon Cancer, Massachusetts, 2001-2015.

The history of housing discrimination is not limited to redlining, however. There had been a precedent before that. During the pandemic influenza in Baltimore in 1918, there was initially reluctance to impose restrictions on the public. Soon many key workers working as civil contract workers were infected. The immigrant population of the city in East Baltimore carried a major brunt of the pandemic due to overcrowded and unsanitary housing conditions, and while blacks found themselves in the same situation, they only had access to black-only hospitals and overcrowded cemeteries for their deceased.
7th
University of Michigan Center for the History of Medicine and Michigan Publishing
The American Influenza Epidemic of 1918-1919.

The height of racist mortgage lending policies in the last century has created striking inequalities between generations. Home ownership is an important predictor of wealth creation in the United States and played a major role in the rising wealth of the middle class that was observed after World War II. However, such increases have not been seen by the black population, who, due to a lack of affluence, access to credit and discrimination against minorities, have been prevented from buying homes, even in areas where they lived that have also been redefined. Today the national home ownership rate is 44% for black families and 73.7% for white families.
8th
Redlining’s legacy of inequality: $ 212,000 less home equity, low home ownership rates for black families.

Previously redesigned neighborhoods, in which black families were more likely to be homeowners, have seen a 52% decrease in personal wealth generated by real estate values ​​since 1980 compared to a house in a green-bordered neighborhood.

8th
Redlining’s legacy of inequality: $ 212,000 less home equity, low home ownership rates for black families.

This amazing disinvestment in formerly discriminated neighborhoods has resulted in reduced infrastructure for education, nutrition, transportation and economic opportunities that are closely related to social mobility. There is a complex interplay between a patient’s health and those around them. This complexity became more apparent during the COVID-19 pandemic. Overcrowded homes and eviction moratoriums have been linked to an increased incidence of COVID-19.
9
  • Leifheit KM
  • Linton SL
  • Raifman J.
  • et al.
Expiring eviction moratoria as well as the incidence and mortality of Covid-19.

Test sites at the beginning of the pandemic were disproportionately available in districts with a white majority. Even the initial efforts to introduce vaccines were hampered as most of the sites were placed in white-majority neighborhoods.

10
Centers for Disease Control and Prevention
County-Level COVID-19 Immunization and Social Vulnerability – US December 14, 2020 – March 1, 2021.

During the polar vortex in Texas in recent months, marginalized communities already badly affected by the pandemic were the first to be hit by power outages. None of this should come as a surprise, as historically marginalized areas also bear a significant portion of the climate and environmental pressures, including higher land surface temperatures, flooding, traffic and noise pollution, and proximity to polluting industries.

Recognizing housing insecurity and the associated inequalities seems to be far ahead of the practice of daily clinical care for our patients. The effects are insidious, however, and accumulate over generations, making our patients all the more vulnerable to social, economic and health shocks. This problem needs to be addressed at several levels – local, state and federal. In the short term, the solutions included the stimulus payments to households, funding to local and state governments for rent relief, the moratorium on shutting down utilities in some states, and extending the eviction moratorium as President Biden’s U.S. government and the Centers for Disease Control and Prevention did ( which will end in June 2021). In the long term, however, a concerted effort needs to be made to foster more institutional-local partnerships between hospitals and the neighborhoods where they are served, and to expand the services of the local health ministry to fill data gaps in measuring persistent health inequalities. These efforts must also include greater political efforts to tackle exclusion zones, uphold the Community Reinvestment Act, expand housing vouchers to promote social mobility, and remove discriminatory housing affordability protections. A fair living recipe could go much further than any novel health care we could currently offer.

I am not declaring any competing interests.

References

  1. 1.

    A cartographic perspective on the correlation between redlining and public health in Austin, Texas – 1951.

    Cityscape. 2017; 19th:: 267-280

  2. 2.
    • Jacoby SF
    • Dong B.
    • Bart JH
    • Wiebe DJ
    • Morrison CN

    The continuing effects of historical and structural racism on urban violence in Philadelphia.

    Soc Sci Med. 2018; 199:: 87-95

  3. 3.
    • Trangenstein PJ
    • Gray C.
    • Rossheim ME
    • Sadler R.
    • Jernigan DH

    Alcohol Outlet Clusters and Population Differences.

    J City Health. 2020; 97:: 123-136

  4. 4th
    • Warrior N.
    • Van Wye G.
    • Huynh M.
    • et al.

    Structural Racism, Historical Redlining, and Premature Birth Risk, New York City, 2013–2017.

    Am J Public Health. 2020; 110:: 1046-1053

  5. 5.
    • Nardone A.
    • Casey YES
    • Morello frog R.
    • Mujahid M.
    • Balmes JR
    • Thakur N.

    Associations between historical redlining in residential areas and the current age-adjusted rate of emergency room visits due to asthma in eight California cities: an environmental study.

    Lancet Planet Health. 2020; 4th:: e24-e31

  6. 6th
    • Warrior N.
    • Wright E.
    • Chen JT
    • Waterman PD
    • Huntley ER
    • Arcaya M.

    Cancer Stage at Diagnosis, Historical Redlining, and Current Neighborhood Features: Breast, Cervical, Lung, and Colon Cancer, Massachusetts, 2001-2015.

    Am J Epidemiol. 2020; 189:: 1065-1075

  7. 7th
    • University of Michigan Center for the History of Medicine and Michigan Publishing

    The American Influenza Epidemic of 1918-1919.

  8. 8th.

    Redlining’s legacy of inequality: $ 212,000 less home equity, low home ownership rates for black families.

  9. 9.
    • Leifheit KM
    • Linton SL
    • Raifman J.
    • et al.

    Expiring eviction moratoria as well as the incidence and mortality of Covid-19.

    SSRN. 2020; ()

  10. 10.
    • Centers for Disease Control and Prevention

    County-Level COVID-19 Immunization and Social Vulnerability – US December 14, 2020 – March 1, 2021.



Source link

Share.

About Author

Comments are closed.