Poor health outcomes linked to reduced access to healthy foods

Heart disease, Type 2 diabetes, high blood pressure and obesity were more common and linked to reduced access to healthy foods among people who live in neighborhoods previously subjected to redlining, according to results of a preliminary study led by a UB researcher.

Rebekah J. Walker, associate professor of medicine and chief of the Division of Population Health at the Jacobs School of Medicine and Biomedical Sciences at UB, will present the study this week at the American Heart Association’s Scientific Sessions 2024 meeting in Chicago.

“We know that redlining leads to poor health outcomes, and even though redlining has been outlawed, it is still having an impact,” Walker told UBNow before her presentation. “We looked at what can we do to stop that relationship from continuing to happen. Many cardiovascular outcomes are diet-sensitive. So we wanted to find out if changing access to healthy foods in these neighborhoods might change your cardiovascular outcomes.”

Redlining is the practice that was effectively legal in the U.S. from 1933-68 that limited homeownership based on a person’s race. In 1933, the Home Owners’ Loan Corporation (HOLC), a government agency created as part of The New Deal, began sponsoring low-interest mortgage loans to help people recover from the financial crisis of the Great Depression. The agency developed a color-coding system for neighborhoods across the country based on “risk for investment” criteria. Areas labeled as “hazardous” were coded red, hence the term redlining, and were deemed “too risky” to insure mortgages.

Residents of these redlined neighborhoods were denied home loans, which lowered tax revenues in these communities. This led to years of reduced investment in schools and government programs and services, creating numerous inequities for residents for multiple generations, despite the practice being outlawed by the Fair Housing Act of 1968.

Previous research by Leonard E. Egede, Charles and Mary Bauer Endowed Chair of Medicine in the Jacobs School, and researchers at Texas A&M University found that people living in redlined neighborhoods in 1940 didn’t live as long as those living in neighborhoods with access to credit and home loans. And that disparity continues today.

In the preliminary study led by Walker, researchers examined data from more than 11,000 U.S. Census tracts across 38 states to understand if access to healthy foods served as a pathway through which historical redlining leads to increased rates of heart disease, Type 2 diabetes and cardiovascular risk factors.

After controlling for population size, researchers found that neighborhoods that were redlined were more likely to have lower access to healthy foods and, in turn, higher rates of heart disease, high blood pressure, obesity and Type 2 diabetes.

Specifically, the analysis found:

• An average of 11.8% of people in redlined neighborhoods had Type 2 diabetes; an average of 31.9% had high blood pressure; an average of 6% had heart disease; and 31.8% had obesity.
• A direct association was found among communities that were affected by both redlining and reduced access to healthy food, resulting in higher rates of Type 2 diabetes, high blood pressure, obesity and coronary heart disease.
• An indirect association was found between redlining and Type 2 diabetes, high blood pressure, coronary heart disease and obesity due to reduced access to healthy food.

“The direct relationships we found were that redlining is associated with food access, and food access is associated with higher prevalence of disease,” Walker explained. “The indirect relationship was that redlining is associated with higher prevalence of disease via the pathway of food access.

“The impact that social factors, like access to healthy foods, have as a pathway through which structural racism impacts health is important to identify so health care professionals and policymakers are aware of the long-term impact of historical events on current living experiences affecting their patients’ health.”