A prescription for fair housing during the COVID-19 pandemic
Before the COVID-19 pandemic, the United States was already grappling with racial and economic disparities in affordable and safe housing for its people. There were large areas in cities with limited access to health care, neighborhoods with older housing that was decades old, low-income minority families living in nearby neighborhoods, and a growing homeless population. The pandemic has resulted in significant job losses, with loss of income and health insurance for many people, especially low-income, immigrant and minority families, with concerns of deportation in groups of people already faced with structural racism and poverty. Composed largely of essential workers, a combination of occupational hazards, residential overcrowding, and increased domestic care responsibilities have played a major role in increasing COVID-19 incidence rates (and mortality). Housing insecurity has been a crucial social determinant of health during this pandemic and offers lessons relevant to location-based discrimination for millions of Americans.
When assessing the origins of housing discrimination and residential segregation, historical redlining comes to mind. A striking example of de jure segregation, the federally funded Home Owners’ Loan Corporation in the 1930s produced maps that offered a color-coded scheme to subdivide American neighborhoods into a risk-based ranking for approvals. mortgage. These explicit racist policies have diverted investment from minority neighborhoods and forced black, low-income or immigrant residents to move to unsafe neighborhoods.
Since then, the ubiquitous red line effect has been noted elsewhere: increasing gun injury rates in Philadelphia, PA,
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clusters of alcohol outlets in Baltimore, Maryland,
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- Rossheim ME
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increased preterm births in New York, NY,
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asthma emergency room visits in San Francisco, California,
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and later stage cancer diagnosis in Massachusetts.
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The American influenza epidemic of 1918-1919.
Previously re-lined neighborhoods, where black families were more likely to own home, also experienced a 52% reduction in personal wealth generated by property values ââsince 1980 compared to a home in a leafy neighborhood.
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Testing locations at the start of the pandemic were disproportionately more available in predominantly white neighborhoods. Even initial vaccine deployment efforts were hampered, with most sites located in predominantly white neighborhoods.
County-level COVID-19 vaccine coverage and social vulnerability – United States, December 14, 2020 – March 1, 2021.
During the polar vortex in Texas in recent months, marginalized communities already hit hard by the pandemic were the first to face power outages. None of this should come as a surprise as historically marginalized areas also bear a substantial share of climatic and environmental burdens, including higher land surface temperatures, flooding, traffic and noise pollution, and proximity to landmarks. polluting industries.
Recognizing housing insecurity and its associated inequalities may seem well upstream of the practice of daily clinical care of our patients. However, its effects are insidious, accumulate over generations, and make our patients much more vulnerable to social, economic and health shocks. There is a need at several levels – local, state and federal – to tackle this problem. In the short term, solutions include economic stimulus payments to households, funds to local and state governments for rent relief, the moratorium on shutting down public services in some states, and the extension of the moratorium on evictions in as long as the US administration under President Biden and the Centers for Disease Control and Prevention have done so (which ends in June 2021). In the long run, however, it will take a concerted effort for more institutional-local partnerships between hospitals and the neighborhoods in which they provide care, and the expansion of local health services to fill data gaps in the area. measurement of health inequalities. These efforts must also include greater efforts at the political level in the fight against exclusionary zoning, the maintenance of the law on community reinvestment, the expansion of housing vouchers to promote social mobility and the repeal of protections. discriminatory measures to make housing more affordable. A prescription for fair housing could go much further than any new health care system we could offer at this time.
I do not declare any competitive interest.
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DOI: https://doi.org/10.1016/S1473-3099(21)00257-7
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