The Legacy of Redlining in the Effect of Foreclosures on Detroit Residents' Self-Rated Health

McClure, Elizabeth S.; Feinstein, Lydia; Cordoba, Evette; Douglas, Christian; Emch, Michael E.; Robinson, Whitney R.; Galea, Sandro; & Aiello, Allison E. (2019). The Legacy of Redlining in the Effect of Foreclosures on Detroit Residents' Self-Rated Health. Health & Place, 55, 9-19. PMCID: PMC6345551

McClure, Elizabeth S.; Feinstein, Lydia; Cordoba, Evette; Douglas, Christian; Emch, Michael E.; Robinson, Whitney R.; Galea, Sandro; & Aiello, Allison E. (2019). The Legacy of Redlining in the Effect of Foreclosures on Detroit Residents' Self-Rated Health. Health & Place, 55, 9-19. PMCID: PMC6345551

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Historical practices, such as housing discrimination in Detroit, have been shown to have lasting impacts on communities. Perhaps the most explicit example is the practice of redlining in the 1930s, whereby lenders outlined financially undesirable neighborhoods, populated by minority families, on maps and prevented residents from moving to better resourced neighborhoods. Awareness of historical housing discrimination may improve research assessing the impacts of current neighborhood characteristics on health. Using the Detroit Neighborhood Health Study (DNHS), we assessed the association between two-year changes in home foreclosure rates following the 2007-2008 Great Recession, and residents' five-year self-rated health trajectories (2008-2013); and estimated the confounding bias introduced by ignoring historical redlining practices in the city. We used both ecological and multilevel models to make inference about person- and community-level processes. In a neighborhood-level linear regression adjusted for confounders (including percent redlined); a 10%-point slower foreclosure rate recovery was associated with an increase in prevalence of poor self-rated health of 0.31 (95% CI:-0.02 to 0.64). At the individual level, it was associated with a within-person increase in probability of poor health of 0.45 (95% CI:0.15-0.72). Removing redlining from the model biased the estimated effect upward to 0.38 (95% CI:0.07-0.69) and 0.56 (95% CI:0.21-0.84) in the neighborhood and individual-level models, respectively. Stratum-specific foreclosure recovery effects indicate stronger influence in neighborhoods with a greater proportion of residents identifying as white and a greater degree of historic redlining. These findings support earlier theory suggesting a historical influence of structural discrimination on the association between current neighborhood characteristics and health, and suggests that historical redlining specifically may increase vulnerability to contemporary neighborhood foreclosures. Community interventions should consider historical discrimination in conjunction with current place-based indicators to more equitably improve population health.




JOUR



McClure, Elizabeth S.
Feinstein, Lydia
Cordoba, Evette
Douglas, Christian
Emch, Michael E.
Robinson, Whitney R.
Galea, Sandro
Aiello, Allison E.



2019

P2C-Yes. T32-Yes. "We acknowledge the generous funding sources that made this study possible. This research was supported in part by the Detroit Neighborhood Health Study grant (R01DA022720), the Carolina Population Center Grant (P2C HD050924) and Training Grant (T32 HD007168), and a training grant from the National Institute of Environmental Health Sciences (T32 ES007018). We also acknowledge Michael Dolan Fliss, Danielle Gartner, attendees of the Health Disparities session of the 2017 Society for Epidemiologic Research Annual Meeting, the Department of Epidemiology Social Epidemiology Seminar, and the Carolina Population Center Interdisciplinary Seminar for their thoughtful feedback on this study and manuscript."

Health & Place

55


9-19








PMC6345551


11681

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