Structural Racism, Historical Redlining and Current-Day Diabetes

New research investigating connections between structural racism and the high current-day prevalence of diabetes among racial and ethnic minority populations in the United States shows significant links and targets for policy and intervention.

In the study, researchers hypothesized that the adverse effects of historical redlining, a specific form of structural racism, put racial and ethnic minority populations on direct and indirect paths toward developing diabetes. Further, they theorized incarceration, poverty, discrimination, substance use, housing, education, unemployment, and food access are specific drivers.

Historical redlining, an outcome of structural racism, was a legal practice of systematically denying residents in economically disadvantaged areas access to credit and insurance, which led to structural exclusion from homeownership and wealth, according to researchers. Present-day poor health and mental health are examples of how redlining continues to impact racial and ethnic minority populations negatively. Researchers in the current study believe the high prevalence of diabetes is a specific example.

To test their hypothesis, the researchers analyzed U.S. Census data on diabetes prevalence for adults aged 18 years or older and historic Home Owners’ Loan Corporation (HOLC) maps along with rates of incarceration, poverty, discrimination, substance abuse (i.e., smoking, binge drinking), housing instability, education, unemployment, and food access. HOLC maps were developed in the 1950s to rate and color code neighborhoods based on their mortgage lending risk from A (best) to D (hazardous). Neighborhoods considered high risk or hazardous were “redlined” by lending institutions, and their residents were denied access to financial resources.

The data points investigated by the researchers resulted in an analytic sample of 11,375 U.S. census tracts. Results indicate an average diabetes prevalence of 11.8% across the census tracts, and that redlining is directly and indirectly associated with a higher diabetes prevalence via social factors such as incarceration, poverty, discrimination, housing, and unemployment. The findings are consistent with previous studies showing poverty to be a driver of structural racism, increasing diabetes prevalence.

Researchers in the current study emphasize the need for new policy and multifaceted interventions that address poverty, substance use, home ownership, home evictions, and education to ease the impact of structural racism on diabetes.

Citation:
Egede, L. E., Walker, R. J., Campbell, J. A., & Linde, S. (2024). Historic redlining and impact of structural racism on diabetes prevalence in a nationally representative sample of U.S. adults. Diabetes Care, 47(6), 964-969. https://doi:10.2337/dc23-2184.

Page published Sept. 30, 2024