Redlining and contemporary health effects in Birmingham neighborhoods: paying the price for past policies

Abstract Redlining supported an ecosystem of racialized norms that often excluded black residents from homeownership in high growth neighborhoods. Exacerbated by suburbanization, redlined residents were isolated in low-growth neighborhoods where, over time, disorder and accumulated disadvantage led to unfavorable conditions for health optimization. No study has examined these effects in Birmingham, a city whose segregation policies coexisted with redlining and suburbanization. We examine the association of adverse health rates with residence in Birmingham’s redlined neighborhoods. Comparisons are made with green/blue and yellow coded neighborhoods. Additionally, redlined neighborhoods are compared to the high growth suburban neighborhoods that emerged with white and black outmigration. Census Tract-level health data were derived from the CDC PLACES data set. We analyzed adverse health rates using composite scores of 5 health categories (health-related social needs, prevention, health risk behavior, disability, and health outcomes/status). Adverse health rates under the category for Health Risk Behaviors reported the largest effect size between green/blue and redlined neighborhoods (-1.95, CI -2.62 -1.26). Adverse health rates under the category for Health Related Social Needs reported the largest effect size between suburban and redlined neighborhoods (-2.70, CI -3.31 -2.09). Odds ratio analyses revealed that residents in redlined neighborhoods were 27.63 times more likely than their green/blue counterparts and 113.33 times their suburban counterparts to live in a neighborhood with high adverse health. However, findings reveal that residents in redlined neighborhoods had high rates of screenings. Future interventions should leverage this tendency toward prevention to decrease health risk behaviors and meet health related social needs.