Children who were raised in areas negatively affected by a government housing policy from the 1930s known as ‘redlining’ are still paying a price in the form of higher risk of developing asthma, according to a study published in the American Journal of Respiratory and Critical Care Medicine.
‘Redlining’ once determined who was eligible to receive government-supported home refinancing based on the race, ethnicity, and immigration status of neighborhood residents.
Neighborhoods that were discriminated against, called ‘redlined areas,’ are known to have higher levels of air pollution from industry and vehicles, especially diesel-fueled trucks, buses and cars; low-quality housing in redlined neighborhoods can also be prone to asthma-aggravating mold and dander from cockroaches and rodents.
Researchers used incidence data from seven U.S. cities — Boston, Baltimore, New York, Nashville, St. Louis, Detroit and Madison, Wisconsin — to document how today’s ongoing neighborhood-level disparities in asthma outcomes are linked to the housing policy that was later outlawed by the Fair Housing Act of 1968.
“This study demonstrates just how important the environment in which you grow up is in determining your risk for developing diseases such as childhood asthma and how powerful local and federal policies are in shaping that environment,” said co-author Tina Hartert, MD, MPH, director of the Center for Asthma and Environmental Sciences Research at Vanderbilt University Medical Center and the Lulu H. Owen Professor of Medicine.
“It’s easy to see in Nashville, for example, how race and areas that were historically redlined explain which communities were forced to bear the burden of construction of urban interstates and major roadways that increased traffic-related pollution exposure for those living in these communities, a known risk factor for asthma,” she added.
Asthma is a condition that significantly disrupts normal activities and drives thousands of emergency hospital visits each year. It is responsible for over 3,500 deaths in the U.S. annually.
It is also the most common form of chronic childhood illness, affecting more than 4.6 million U.S. children. It is one of the most common reasons for children being hospitalized, resulting in 150 child deaths each year.
Using information from more than 4,800 children who participated in one of 10 study cohorts based in the seven cities, the team mapped family home locations against old redlining maps drawn in the 1930s and followed participants through childhood to identify which children developed asthma.
“We found that children who lived in neighborhoods that had been redlined were at increased risk for asthma. And much of this increased risk was related to higher rates of poverty and lower household income,” said co-lead author Patrick Ryan, PhD, an expert at Cincinnati Children’s Hospital who studies how environmental exposures affect pediatric respiratory health and brain development.
“The health disparities that exist today didn’t just happen — there are root causes. In this study, we show that a systemic racist policy implemented in the 1930s is directly related to asthma disparities today, in part, because it prevented those neighborhoods from developing through the years with healthy environments,” he said.
The study was conducted by members of the Children’s Respiratory and Environmental Workgroup (CREW) consortium, established through funding from the NIH’s Environment and Child Health Outcomes (ECHO) program to integrate more than a dozen birth cohort studies that have tracked groups of children to study the origins of asthma.
Data included the NIH-funded Vanderbilt INSPIRE study population led by Hartert, a birth cohort of nearly 2,000 children born between 2012-2014 who continue to be followed to understand the influence of the early life environment on child health and asthma.
“This study applied new technologies linking addresses to exposures to demonstrate just how important housing and economic factors are in determining the risk for developing childhood asthma,” said James Gern, MD, professor of Pediatrics at the University of Wisconsin School of Medicine and Public Health and principal investigator for the CREW consortium.
“Improving living conditions and addressing structural racism are likely to markedly reduce childhood asthma and have many other health benefits,” he said.
The study was funded by NIH grants (UH3OD023282, UM2AI117870, HHSN272201000052I, P01AI089473, UM1AI114271, UM1AI160040, and U19AI104317), the Harvard NIEHS Center Grant (P30ES000002), and Apple, Inc.