Image from “Mapping Inequality,” American Panorama, ed. Robert K. Nelson and Edward L. Ayers.
By Courtney Anderson
Only 10-20% of health outcomes are attributed to health care. Social, economic, and environmental factors thus account for the vast majority of population and individual health outcomes. And housing encompasses many of these factors, as it largely determines the built environment and exposure to stressors.
Section 801 of the Fair Housing Act declares, “It is the policy of the United States to provide, within constitutional limitations, for fair housing throughout the United States.” This Act was the culmination of racial justice protests, resistance to discrimination and violence, and other aspects of the civil rights movement. Despite the stated intention of this Act, housing remains unequal across the nation.
Decades ago, the federal government issued maps which gave low ratings to Black neighborhoods, prohibiting many of these families from receiving government-backed home loans. This process is commonly known as redlining.
Even after redlining and other practices, such as restrictive covenants, were deemed unlawful, the federal government built public housing for Black people in segregated areas and the Supreme Court affirmed the practice of exclusionary zoning. The Fair Housing Act, designed to create “truly integrated living patterns,” continues to be lackluster in its proactive enforcement mechanisms.
Further, the current administration stripped the Act of regulations that would have given cities and states the tools to understand the impact of segregation on health and housing quality, as well as the ability to create more equitable neighborhoods.
The intentional seclusion of people of color results in these populations living in neighborhoods that experience environmental hazards at disproportionately high rates. African Americans who live in highly segregated areas have higher mortality rates than those living in moderately segregated areas. Economic disinvestment comes with segregation, further creating unhealthy environments. White buyers are reluctant to buy in predominately Black neighborhoods, which lowers the home values in these areas. The inability to optimize equity in this major asset makes it harder to end generational poverty, which is a factor in high infant mortality rates and other poor health outcomes.
The United States only has enough affordable housing to allow 52% of American renters to spend less than 30% of their income on housing. The other 48% must choose between basic needs and housing, or face the consequences of being homeless, which include high rates of chronic illness and infectious disease, such as hypertension, substance use disorder, and HIV.
People experiencing homelessness are at a higher risk for a number of physical and mental illnesses by virtue of their living conditions. Existing health conditions often go untreated, which increases the chance that injuries or minor conditions develop into serious health threats, contributing to the shorter lifespan of people who are unhoused.
There is a positive correlation between a lack of affordable housing and food insecurity. Faced with the choice between paying for housing or other expenditures, necessities such as food and medicine are often foregone. Nutritional deficiency especially affects children, and the harm is multiplied when housing is unstable. Children living in cost-burdened households have disproportionately lower reading and math skills, and without proper nutrition, academic achievement suffers more.
Reliance on residential property taxes for the majority of public school funding also preserves the cyclical nature of white supremacy. Black communities have higher instances of vacant homes and commercial properties, resulting in a lower tax base. These communities can become distressed, resulting in the decimation of local economies, and negatively affecting employment opportunities, infrastructure, and other neighborhood assets. Vacant structures create a myriad of health issues. These structures are prone to the presence of mold and allergens, which can cause respiratory illnesses and other conditions. Instances of suicide and crime are also higher in areas with more abandoned buildings.
The rotation of white people fleeing neighborhoods as Black families move in, only to reclaim these spaces during gentrification processes, displacing people of color, is well-documented. White flight brings severe health consequences for Black families. The displacement resulting from gentrification is also problematic, as mobility is associated with a range of physical and mental health issues.
Racism continues to exist in the face of laws and policies purporting to end discrimination because white supremacy is a significant component of our structural systems. The structure of the housing system exemplifies this principle, and, as a result, communities of color experience adverse health effects. Understanding how racism creates socioeconomic determinants of health in the housing context is a first step towards dismantling the harmful components of the housing system, thus mitigating health disparities.
Courtney Anderson is an associate professor of law at Georgia State University College of Law.
