History to Health: The Lasting Effects of Redlining on Life Expectancy

In a Pharmacy Times® interview, Leonard Egede, MD, MS, FACP, professor and department chair of medicine at the University at Buffalo, presented a study investigating redlining and its historical and contemporary impacts on life expectancy at the American Heart Association (AHA) 2024 Scientific Sessions. Egede emphasized the importance of raising awareness for Black Americans and other minority groups who face statistically worse health outcomes due to the long-lasting effects of structural racism in the health care system.

Pharmacy Times: Can you introduce yourself? What did you present at the AHA 2024 Scientific Sessions?

Leonard Egede, MD, MS, FACP: I’m Leonard Egede. I'm the professor of medicine and the chair of department of medicine at the University of Buffalo. We are the American Heart Association Scientific Sessions, and the focus today is to present on contemporary structural racism and its relation to life expectancy.

Pharmacy Times: The study found that both historic redlining and contemporary structural racism were directly associated with decreased life expectancy. Can you expand on these findings and their significance?

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Egede: I think to talk about how we came up with the measures, so we had a measure of historic structural racism, which is redlining. And redlining is really one of those measures that we use as an expression of structural racism. And then we also have a measure of contemporary racism which actually looks at current practices at a neighborhood level. So, combining that historic measure that's based on the redlining map and these contemporary measures that look at multiple social risk factors, we then created a way to try we called one of them structural, historic, and they were contemporary. And the goal was to see what the impact was on life expectancy, and what we found was that a major effect was lower life expectancy, especially for minority groups.

And so, what does that really mean for us today? It means that even though we look at redlining as historic, they still have impact today. And then even as we look at some of the contemporary measures, that tells us that there are still things happening today that have an impact on how people actually live and function, but I think the most important part is its impact on mortality. So, when your left expenditure is affected, it means it has long term impact on people's lives.

Pharmacy Times: What are the public health implications of these findings, particularly in terms of addressing structural racism to improve life expectancy?

Egede: We have argued that at some point we can't ignore the past. We actually have to account for the past, but a lot of these things are tied to policy. So, policies are tied to housing, transportation, food, employment, education, and we believe that the more we learn about these pathways, the more we're able to change outcomes, and that policies really think about underlying poverty as a driver of some of these outcomes. But policies that change how neighborhoods are supported and [providing] the resources will make a huge difference.

Pharmacy Times: Why is it important to consider both historic and contemporary measures of structural racism, when consider, when considering cardiovascular and life expectancy outcomes?

Egede: As we know, cardiovascular risk is tied to your environment. So, it's not just about disease is a function of both biology clinical factors, but also you build environment and where you live has a huge impact. I think more and more we're recognizing that. As you look at cardiovascular risk, you need to pay attention to some of these historical factors that impact neighbors. For example, African American men have high blood pressure and have poor outcomes when it comes to [that], [and they are] more likely to have poor outcomes for cardiovascular risk. And so, the question becomes, what drives that? A lot of those factors are structural in the environment and in these social factors. So, it's really important to actually address those issues to improve health for a large proportion of the population.