Redlining Continues To Impact Breast Cancer Outcomes Today

Where you live matters when it comes to your health. Unfortunately, due to a U.S. housing practice known as redlining, history has put certain communities at a disadvantage. 

Despite being outlawed in 1968, the effects of redlining continue to affect the health and wealth of communities across the country.

The term “redlining” was first used in the 1930s, at a time when unemployment rates were high and many people couldn’t afford their mortgages. To help people keep their homes, the federal government established the Home Owners Loan Corporation (HOLC). Its goal was to make it easier for people to pay their mortgages. They did this by replacing old loans with new ones that had better terms, like lower interest rates and longer repayment periods.

HOLC sent people to assess neighborhoods in cities across the U.S. to determine what loans they would guarantee. They documented the types of housing in neighborhoods, along with information about the people who lived there. They used racist descriptions like “infiltration of Negroes” and “mixed races” as characteristics considered to lower a neighborhood’s value.

HOLC made color-coded maps for almost 250 cities using the information it gathered. The colors on the maps represented how HOLC felt about investing in the neighborhoods through housing loans. Urban areas and communities with more racial and ethnic minorities including Black, Hispanic, and Asian people, were described by HOLC as “hazardous” and outlined in red.

Families living in non-redlined areas had an easier time obtaining a mortgage, which meant they could invest more in their neighborhoods, accumulate wealth, and pass that wealth down to future generations. But people who lived in redlined areas, which were predominantly Black or other communities of color, were unfairly kept from obtaining mortgages, investing in their neighborhoods, and passing down “generational wealth.” 

A project known as Mapping Inequality has digitized these maps and their related documents and made them publicly available. You can search by city, and see if you live in an area that was redlined.

To this day, people who identify as Black, Latine, Asian, and Native American face higher interest rates and higher denials on conventional mortgage loans than white people.

One 2021 study found that redlined communities today are more likely to have poorer air quality, poorer water quality, worse noise pollution, and less green space. 

People who live in historically redlined communities have higher rates of emergency department visits due to asthma; they also have higher rates of pre-term births and are at increased risk of diabetes, hypertension, and heart failure compared to people living in non-redlined areas.

In the last five to 10 years, several studies have revealed the impact that living in a historically redlined community has on a person’s breast cancer outcomes. 

A 2023 study was one of the first to show that people who live in historically redlined areas are less likely to be screened for breast cancer.

Adam Aponte, MD, MSc, works at a federally qualified health center called the Boriken Neighborhood Health Center in East Harlem, a historically redlined neighborhood. He says that many of the women he sees today can’t make it to screenings because of transportation issues, literacy issues, language barriers, or other reasons. 

Regardless of race, people living in historically redlined areas are often diagnosed with breast cancers that are harder to treat. A 2024 study led by molecular epidemiologist Jasmine Miller-Kleinhelz, PhD, MS, at the University of Mississippi, found that Black women living in historically redlined areas were more likely to be diagnosed with estrogen receptor-negative breast cancer than those in non-redlined areas. Miller-Kleinhelz also found that White women living in historically redlined areas were at increased risk of receiving a late-stage breast cancer diagnosis than those in non-redlined areas. 

The study shows that everybody who lives in these environments is harmed, she says. But redlining doesn’t explain all healthcare inequities for  Black women. Regardless of whether they live in a historically redlined area or not, they are more likely to have a late stage of diagnosis, a more aggressive disease, and are more likely to die from breast cancer, she says.

Jesse Placsak, PhD, MPH, an associate professor at Ohio State University who studies cancer disparities, made a similar finding. In his 2022 study in JAMA Network Open, he and his team found that living in non-redlined areas was associated with more favorable breast cancer outcomes, but only among non-Latina White women. Placsak believes these differences may be due to other groups experiencing racism. 

Miller-Kleinhelz’s 2024 study also found that non-Hispanic white women who lived in redlined areas are more likely to die from breast cancer compared with those who lived in non-redlined areas. Black women were more likely to die of breast cancer, no matter where they lived.

As history has shown, the effects of redlining nearly 100 years ago continue to impact communities across the U.S. But, with more research into the effects of discriminatory policies on people’s health comes more knowledge about how to support these communities. One way is to meet the communities where they are. 

The Mount Sinai Mobile Mammography Van, for example, travels to every borough in New York to provide accessible and affordable mammograms for people who might have a harder time traveling to the health system. Many of the communities it reaches are located in historically redlined areas. 

The van parks at trusted sites in the community, such as faith-based institutions and community centers. One of the centers they partner with is the Boriken Neighborhood Health Center. Federally qualified health centers like this one provide primary care and health services to underserved populations, regardless of their insurance status or ability to pay. 

Today, many communities surrounding the center experience poor housing conditions, high crime rates, and food insecurity, says Aponte, who is the CEO of the center. 

“This partnership has allowed us to have a significant impact on the community of East Harlem,” he says.