The Impact of Redlining on Contemporary Food Access and Cardiometabolic Risk

In an interview with Pharmacy Times^®, Rebekah Walker, PhD, associate professor and division chief of Population Health at University at Buffalo, NY, discussed the persistent effects of redlining on health outcomes and food access in effected communities, which she presented at the American Heart Association (AHA) 2024 Scientific Sessions. She gave insight into the data gathered from her study, finding that food access has strong ties with increased cardiometabolic diseases.

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

Rebekah Walker, PhD: My name is Rebecca Walker. I am an associate professor and the division chief for our division of Population Health at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo. Today at AHA, I talked about an analysis we did looking at direct and indirect relationship between historic redlining and for cardiometabolic outcomes.

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Pharmacy Times: In what ways did redlining impact health outcomes in affected communities? Are we still seeing those effects today?

Walker: So, we looked at one particular pathway, or possible pathway, for the relationship, and what we were trying to understand is historic redlining is a historical factor, so it's something that happened in the past. However we have, there's a lot of research that shows it is currently having impact on outcomes today. What we don't have as much information about is what pathways explain how something from the past is impacting health outcomes today. We were interested in looking at food access as a particular possible pathway, given the impact that diet has on different cardiometabolic diseases like diabetes, obesity, coronary heart disease and hypertension, which were the 4 outcomes we were interested in. We used a methodology called structured equation modeling that allows us to look at if there is a pathway through which a particular variable impacts another one.

So historic redlining is a historic outcome. It was a process that the homeowners Loan Corporation used in order to grade neighborhoods. They grade them into 4 categories. The fourth category was colored red. That's where the term redlining comes from, and individuals living in that neighborhood were limited in their access to credit, mortgage, being able to obtain a mortgage, and so that really set in place a lot of socioeconomic factors for individuals in those neighborhoods. And so, what we found was that that pathway through food access today has explains the relationship between the historic redlining and today's outcomes.

Pharmacy Times: Can you discuss your study and primary findings? What were the direct and indirect relationships found between food access and increased prevalence of disease?

Walker: The way that we measured food access was at a census tract level. So, it looked at the relation the proportion of healthy food suppliers to healthy and unhealthy food suppliers. What we found was that the food access when there was less food access to healthy food, that the relationship between historic redlining and these cardiometabolic diseases was explained through that pathway. So, what it would suggest is that if we can introduce interventions that focus on improving food access at a neighborhood level, that we would be able to decrease the prevalence of the cardiometabolic diseases and mitigate some of that impact of structural racism on cardiometabolic outcomes.

Pharmacy Times: How can public health initiatives address the legacy of redlining to improve food access and reduce cardiometabolic disease prevalence?

Walker: Some of the interventions that that this study suggests is things that would be done at a community level. So, changing the food environment at a community level might be able to mitigate some of this relationship, and might be able to decrease the prevalence of diabetes, obesity, coronary heart disease, hypertension. Those would be things like changing the access that individuals have to healthy food, so increasing the supermarkets or areas that have healthy food options. It would also be doing things like increasing that the transportation access that individuals have to different food options.

But in addition to that, really addressing the underlying factors that lead to individuals having limited food access, doing things like removing deterrents that keep people from accessing food in in other areas. Changing where bus lines run, improving the way that bus lines can get people to other areas, addressing some of the socioeconomic disparities that we see through things like financial incentives, cash incentives, that would be able to provide the funds that are necessary to purchase healthier food. So those would all be different types of interventions that could be rolled out at a population level and really studied to see if it would change the health outcome. And that would be what we ultimately would want to see is, yes, we would like to increase food access, but what we really want to see is that change in overall health outcomes, as well.