Nearly a century ago, it was legal for U.S. banks to refuse mortgages to people in predominantly Black communities, a practice known as “redlining.” For the past several decades, that practice has been outlawed. But research suggests that this history of structural racism is having a continued negative effect on heart health for黑人美国人.
一个study published December 21, 2021, inProceedings of the National Academy of Sciences（PNA）专注于居住在美国七个城市949个社区的4,779名中年人的多民族样本的心血管健康：洛杉矶；纽约;芝加哥;明尼苏达州圣保罗；明尼阿波利斯；温斯顿·塞勒姆（Winston-Salem），北卡罗来纳州；和巴尔的摩。
这项研究称，早在1930年代，联邦房屋所有者贷款公司（HOLC）使用的地图根据歧视性评估对潜在购房者的抵押贷款有多大风险进行了分级。在这些地图上，最“危险”的发行贷款场所的颜色为红色，比例很高，黑色，低收入和移民居民。主要是白人和富裕社区的绿色颜色，以表明银行提供抵押贷款的“最安全”场所。
Overall, about 19 percent of study participants lived in “hazardous” redlined neighborhoods, while roughly 5 percent lived in the “best” communities. Using these historical HOLC maps, researchers examined the cardiovascular health of modern-day residents of each neighborhood, using factors such asblood pressure,血糖，胆固醇，超重和肥胖，饮食，体育锻炼和吸烟。
Surprising Findings
在这些危险因素的基础上，生活在历史悠久的红线社区中的黑人的心血管健康要比居住在其他地方的黑人差得多。但对于研究中研究的其他三个小组并非如此：白人，西班牙裔和中国人。
“We were surprised by these findings,” says the lead study author,Mahasin Mujahid，博士, an associate professor of epidemiology in the school of public health at the University of California in Berkeley. “We had hypothesized that our findings would be more pronounced among Black participants, but that there would still be associations for other racialized groups.”
该研究发现，生活在历史上红线社区的黑人的健康状况较差，持续存在着多种不同的心脏健康危险因素。例如，这些社区中的黑人的可能性降低了78％healthy blood pressure和60 percent less likely to have a健康的体重.
“我们的发现是一个n important reminder that Black people have a different history in this country, from slavery through Reconstruction, Jim Crow and the civil rights movement,” Dr. Mujahid says. “The effects of this unique history continue to shape the current reality of Black Americans in relation to health outcomes, especially心脏健康。”
研究局限性
该研究的一个局限性是，分析中未直接衡量的因素，例如社会经济地位，可能影响了黑人的心脏健康结果。研究人员指出，红线的社区通常往往是高产社区，不公平的贷款实践通常与就业和生活的其他方面的歧视相吻合，这也可能对健康产生负面影响。
穆贾希德说，最重要的是，红线阻止黑人家庭以家庭住宅的形式将积累的财富传给了后代。房屋所有权是美国家庭能够进入中产阶级并允许其孩子取得更大财务成功的最常见方式之一。
尽管从技术上讲，红线可能已经过去了，但结构性种族主义和歧视仍在为黑人的健康状况造成更严重的健康状况。
One研究，于2015年10月出版一个merican Journal of Public Health例如，发现生活在具有较高水平的反黑偏见社区的人们比居住在更宽容的社区中的人过早死亡的可能性高24％。
另一项研究研究了纽约市的谁在学术医疗中心得到护理，这些医学中心提供了其他地方无法获得的高级治疗和技术的访问。这个study, published in February 2017 in theInternational Journal of Health Services, found that Black patients were half as likely as white patients to receive care at academic medical centers even after accounting for differences in health insurance.
可以搬家吗？
也有可能将隔离的社区迁移到更多样化的社区，可能有助于黑人改善他们的心脏健康。一个study published in July 2017 inJAMA内科found significant improvements in blood pressure among Black people who moved to less-segregated communities.
这个isn’t a sure thing, however, because even though Black people who move away from historically redlined communities improve their chances of upward mobility and higher earnings, they also may leave behind strong social support networks that can be beneficial for their health, Mujahid says.
Whether Black people remain in historically redlined neighborhoods or move away, they need to be vigilant about the potential for their health to be shaped by where they were born and how generations of their family lived, Mujahid adds.
穆贾希德说：“临床医生和卫生提供者应该认识到，由于种族主义或歧视性的政策，他们的许多患者的健康状况更糟。”“红线只是一个例子，但是还有更多例子。”
