The Impact of Redlining on Mental Health

OBJECTIVE: This study aimed to investigate the relationship between historical redlining-the discriminatory denial of financial services and investment in predominantly Black and minority neighborhoods-and contemporary mental health outcomes. METHODS: Data were combined from the Centers for Disease Control and Prevention's PLACES dataset, Agency for Healthcare Research and Quality's Social Determinants of Health dataset, and Centers for Medicare and Medicaid Services' Provider of Services File to construct a sample at the census tract level. The primary exposure was historical redlining, measured with the Home Owners' Loan Corporation (HOLC) grade for each census tract. Outcome measures included health care access indicators and prevalence of mental health problems. Ordinary least-squares regression was used to estimate the association between redlining and outcome measures. RESULTS: The sample consisted of 13,255 census tracts from 37 states. Mean±SD prevalence of depression was 21.71%±4.23%, of frequent mental distress was 18.08%±3.99%, and of social isolation was 35.56%+3.84%. All mental health measures were significantly associated with HOLC scores; historically redlined census tracts had, on average, higher prevalence of depression, mental distress, and social isolation than did census tracts historically graded as the "best" neighborhoods. Historically redlined areas had 5.5% higher prevalence of uninsured residents. CONCLUSIONS: These findings illustrate cross-sectional census tract-level correlations between structural racism and mental health, showing that historical redlining is associated with higher levels of depression, mental distress, and social isolation in contemporary communities. The authors identify key targets for policy and intervention development to address structural racism in population health.