Historical Redlining Contributed To Health Disparities, UCSD Public Health Dean Says
The ZIP code that covers much of San Diego's City Heights neighborhood is seeing a higher rate of coronavirus cases than San Diego County, and it's a similar situation in Southeast San Diego.
These communities, that have larger Black and Hispanic populations than the region, are where the nearly century-old and now illegal practice of redlining occurred — when a government-backed body marked maps of predominantly minority communities in red and labeled them a poor financial investment.
Cheryl Anderson, director of the UC San Diego Center of Excellence in Health Promotion and Equity, said the poor health outcomes in these areas are not a coincidence.
“Black Americans, being essentially by policy forced to stay in one part of a community, and white Americans being encouraged and supported in staying in another part of the community, the start lines are different, and so you now have certain neighborhoods that by sheer structure and design, don't get resources," said Anderson, also the newly named dean of UCSD's school of public health.
In an interview with KBPS, Anderson explained how the inequities are linked to the racist housing policy. The following conversation has been edited for length and clarity.
A: And then you look up and you see outcomes, whether they be educational in nature or health in nature. And you say, "Oh, it must be that there's something wrong with Black people, because Black people are having these poor outcomes." No. Black people were, by policy, forced into neighborhoods that were not developed, that were not invested in.
Q: Give me a specific example of a lack of investment.
A: So in San Diego, much of our county's activities are based on a concept of "3-4-50." "3-4-50" is a way that we think about chronic disease prevention in that three behaviors are responsible for four health conditions that are responsible for the mortality of 50% of our county. And these figures play out across the country as well.
When you look at those three behaviors, they are physical inactivity, inadequate diets and tobacco use. When you think about where, in our region, you have the least ability to be active ... so you've got a system that is more likely to result in you being physically inactive, where you see few grocery stores, few opportunities to get really adequate nutrition, whether it's where you're living or where you're working or where you're playing. You also see tobacco use being rampant because the sales of tobacco products are more so in those neighborhoods than in other neighborhoods.
Those are examples of how the lack of investment in certain communities, where people have been forced to live because of policies around housing, all tied together to then impact health outcomes. So you have a policy around housing that then settles people in a neighborhood where it is more likely to have tobacco and alcohol sold to you, where you are less likely to have green space and be physically active, where you are less likely to have access to grocery stores that allow you to nourish yourself in ways that are more adequate.
And then the chances of you developing high blood pressure, diabetes, lung disease are increased.
Q: We talked about policy driving some of these health and activities but two of the examples you brought up — poor diet due to lack of grocery stores and an over presence of tobacco relations — these are private businesses. So how can we explain private businesses setting up shop or not setting up shop in certain areas as a contributing factor?
A: Again, it goes back to what certain neighborhoods allow and don't allow, what the voting public allows for, what zoning is like in neighborhoods. And these things are very different in our neighborhoods where we have Black Americans and other historically marginalized groups and where we have white Americans. And so by sheer law, by setting up of that kind of infrastructure, you see it.
You see how certain neighborhoods attract wealthier families. Those wealthier families attract schools that are stronger and more likely to to perform better. Within those schools, because the families are wealthier, they have opportunities to do fund-raisers, to do drives that bring in that supplemental income to support the school, and the ability to do that in all of our communities isn't even.
And so at the end of the day, you have certain communities where they're working solely with what they've been allocated from a school district and other communities that are working with multiple times more than what they've been allocated from the school district because the families are able to to contribute in and to give those monies.
Q: Is there anything that the center is actively doing to make change?
A: We work with the Center for Community Health — it sits in the heart of City Heights. We have a relationship with the United Women of East Africa and their center also sits right in the heart of City Heights. And we try to think through not just how to treat people for high blood pressure, how to ensure that people have the ability to get medicines for diabetes, but how do we back into making sure that those communities have the kind of lifestyle practices that are going to be important?
We've created gardens together. We've been thinking about ensuring that the proper education is happening around nutrition and activity and the cultural underpinnings — we're making some of those things happen because we have such a nice multicultural community there, so I think that that's one step.
The other part of this is that we now need to connect with our our city planners, our elected officials, with our community voters to really start to say, "OK, let's talk about why it is that some communities have very beautiful facilities and other communities do not."
Now, with COVID-19, it's really exposed a lot of the inequities that we know are sitting there and we haven't really been systematically trying to dismantle. So COVID-19 meeting what has been going on with our race relations in this country really gives us this time to pause, stop, listen, try to really understand what it is that we're struggling with and why it is that we've gotten here. It's going to take quite a bit of effort. I mean, we have been we've been working really hard at going one step back from the conditions that we see show up in health care spaces. But what we really need to do is to go even more upstream to try and figure out how do we work in a concerted way across different disciplines and across different parts of our our region in the policy space, in the planning space, in the zoning space, to really get a handle on making a difference?
Q: Is there anyone anywhere already doing that work?
A: Recently we've heard that certain teams are rethinking the mascots for their team. Why are they rethinking that? They're rethinking it because certain businesses are saying we will not advertise. We will not support you if you continue to have this practice. And so I think what what needs to happen is we need to think about this from a systems perspective, and we're all accountable. We all have a role here. And so when you see the power and the privilege beginning to listen and say this is not OK, we have to figure out how it is that we're going to turn this around. Then they begin to use their monies in different ways.
Q: There might be some people out there, business owners or individuals who have nothing to do with health care, who have nothing to do with providing resources for a community, who may think that they are exempt from having to take any action because they're not part of what created it and they're not part of the system that can directly fix it. But it sounds like with your mascot example, you're saying that's not the case.
A: It may not be that someone is racist or engaged in racist practices, but they have to ask themselves the question, "Is racism a deal breaker?" So what I mean by that is when you engage with corporations or activities or communities where you can see these things happening — and now that the national conversation has opened, so that if you're listening and you're hearing more about what is actually happening — if you decide that this isn't going to affect you or this isn't for you, then you're not actually hearing what is being discussed.
So if you are supporting a community practice that has racist, historical origins, racism is not a deal breaker for you. So you may not be racist. You may not be practicing or engaging in a racist moment, but is racism a deal breaker for you? And if racism is a deal breaker for you, then the way you vote, where you spend your money and how you exercise your time and energy will somehow be engaged in trying to help us address this issue of racism.