Structural Racism and Pedestrian Safety: Measuring the Association Between Historical Redlining and Contemporary Pedestrian Fatalities Across the United States, 2010‒2019

Abstract

Objectives. To examine the association between historical redlining and contemporary pedestrian fatalities across the United States. Methods. We analyzed 2010–2019 traffic fatality data, obtained from the Fatality Analysis Reporting System, for all US pedestrian fatalities linked by location of crash to 1930s Home Owners’ Loan Corporation (HOLC) grades and current sociodemographic factors at the census tract level. We applied generalized estimating equation models to assess the relationship between the count of pedestrian fatalities and redlining. Results. In an adjusted multivariable analysis, tracts graded D (“Hazardous”) had a 2.60 (95% confidence interval = 2.26, 2.99) incidence rate ratio (per residential population) of pedestrian fatalities compared with tracts graded A (“Best”). We found a significant dose‒response relationship: as grades worsened from A to D, rates of pedestrian fatalities increased. Conclusions. Historical redlining policy, initiated in the 1930s, has an impact on present-day transportation inequities in the United States. Public Health Implications. To reduce transportation inequities, understanding how structurally racist policies, past and present, have an impact on community-level investments in transportation and health is crucial. (Am J Public Health. 2023;113(4):420–428. https://doi.org/10.2105/AJPH.2022.307192 )

Historic redlining and health outcomes: A systematic review

“…Of the 36 included articles, 31 (86%) found a significant association between worse redlining scores (i.e., HOLC grade C or D) and adverse health outcomes. More specifically, living in a redlined neighborhood, compared to neighborhoods with better redlining scores (i.e., HOLC grade A or B), was associated with more severe asthma (Friedman et al., 2022; Nardone, Casey et al., 2020; Schuyler & Wenzel, 2022), increased preterm birth rates (Hollenbach et al., 2021; Krieger, Van Wye et al., 2020; Nardone, Casey et al., 2020), increased late‐stage cancer diagnoses (Krieger, Wright et al., 2020), poorer breast cancer outcomes (Bikomeye et al., 2023), increased prevalence of cardiovascular disease or events (Al‐Kindi et al., 2023; Deo et al., 2023; Jadow et al., 2023; Motairek et al., 2022; White et al., 2021; Wing et al., 2022), increased COVID‐19 infection and death rates (Li & Yuan, 2022), poorer diabetes outcomes (Linde et al., 2022; White et al., 2021), increased gunshot wounds rates (Benns et al., 2020; Jacoby et al., 2018; Mehranbod et al., 2022; Spitzer et al., 2023), increased heat‐related illness rates (Li et al., 2021), increased infant mortality (Huang & Sehgal, 2022; Lynch et al., 2021), increased kidney failure rates (Nguyen et al., 2023), more childhood obesity (Kowalski et al., 2023), increased pedestrian fatalities (Taylor et al., 2023), increase in fatal encounters with police (Mitchell & Chihaya, 2022), worse postoperative outcomes (Diaz et al., 2021), increased maternal mortality (Gao et al., 2022), overall worse self‐rated physical health (Lynch et al., 2021; McClure et al., 2019), poorer mental health (Lynch et al., 2021), and increased prevalence of visual impairment and blindness (Hicks et al., 2023).…”

The impact of historical redlining on neurosurgeon distribution and reimbursement in modern neighborhoods

“…Differences in billing and reimbursement might demonstrate several factors, including patient ability to pay, insurance coverage variations, and perhaps even differences in the complexity of procedures performed ( 1 , 2 , 19 ). This may underscore obstacles faced by Grade D communities, such as barriers to care, lack of transportation, longer wait times, or delayed diagnosis and care ( 20 , 21 ). This financial discrepancy not only highlights economic challenges faced by healthcare professionals in these redlined areas but also emphasizes the systemic economic constraints these regions continue to grapple with ( 22 ).…”

Emergency Department Visits for Pedestrians Injured in Motor Vehicle Traffic Crashes — United States, January 2021–December 2023

“…However, the visit proportion in the current study was higher among Asian persons than among White persons, whereas pedestrian death rates in 2018 indicated the reverse (3). Unsafe walking environments and limited investment in infrastructure for pedestrians (e.g., sidewalks, street lighting, and crosswalks) can result from past development that prioritized vehicles (4) and historical segregation and disinvestment in neighborhoods based on race and income (5). Healthy community design strategies exist that address pedestrian injury inequities while minimizing harms, such as displacement, that can occur among persons from some racial and ethnic groups and with lower incomes (6).…”