· Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
The Home Owner’s Loan Corporation (HOLC) was created by Congress in 1933 in order to provide alleviation for mortgages in the era after the Great Depression when many Americans were at risk of foreclosure. They developed maps that labeled neighborhoods by “security risk,” which assigned areas a letter, A through D, where A was least risky and D was most risky and colored red on the map. Neighborhoods with African Americans and immigrants were nearly always colored red, or most risky, a process known as redlining. This policy, and other policies at the time, contributed to segregation and further widened income disparities between African Americans and whites. It was not until the Fair Housing Act of 1968 that this process was made illegal, however there were lasting effects of this practice.
· Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).
Evaluation of this policy is essential, because as stated above, this policy contributed to segregation and income inequality among the African American community. This policy has lasting effects, contributing to disparities in the present day, including intergenerational income disparities. Additionally, this policy has created unintended health consequences, due directly to lower income and wealth across generations.
· Specify the outcomes and populations you think most affected or least affected by the policy.
I think African Americans were most affected by this policy. In order to study this further, you could look at a health outcome of hypertension.
· Propose a study design to evaluate the policy.
I would utilize a descriptive study to start in order to describe the scope of the problem. I would describe the number of patients with hypertension within one city using partnerships with several primary care clinics across the area. You could identify hypertension using ICD-10 codes. With this information, I would describe the prevalence of hypertension by race/ethnicity within historically redlined areas. You could also overlap census data at the tract level (overlapped with redlined maps) to define the median household income, highest education level attained, and other social determinants of health by race and ethnicity to understand how deeply this policy affected African Americans.
· Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
Because this is a historical policy, it becomes challenging to educate the public about its lasting effects. Further, there are so many other factors that contributed to segregation, so causal inference without taking those other factors into account would be challenging. I do believe, however, that there is enough evidence that the government contributed to segregation, through the process of developing policies that promoted and propagated it (such as redlining), and more studies looking at its lasting effects are imperative.