Structural Racism and Historic Redlining Linked to Higher Diabetes Rates in U.S. Neighborhoods

How Does Historic Redlining Affect Diabetes Rates Today?

Researchers at the University at Buffalo have published findings linking the Home Owners' Loan Corporation (HOLC) redlining maps from the 1930s to present-day diabetes prevalence at the neighborhood level. Redlining was a federal policy that graded neighborhoods based largely on racial composition, labeling predominantly Black and minority areas as "hazardous" for mortgage lending. The study found that neighborhoods historically rated as high-risk continue to bear a disproportionate burden of type 2 diabetes.

The mechanism is not genetic but structural. Decades of disinvestment in redlined areas created environments with fewer grocery stores offering fresh produce, less green space and walkable infrastructure, higher concentrations of fast-food outlets, and reduced access to quality healthcare. These are well-established risk factors for obesity and type 2 diabetes. The research adds to a growing body of evidence showing that place-based policies enacted nearly a century ago continue to shape health outcomes through what public health researchers call "weathering" — the cumulative physiological toll of chronic social and economic disadvantage.

What Role Does Contemporary Structural Racism Play in Diabetes Disparities?

The University at Buffalo study goes beyond historical analysis by examining how contemporary structural racism compounds the legacy of redlining. The researchers assessed current neighborhood-level indicators including residential segregation indices, poverty concentration, healthcare facility density, and insurance coverage gaps. Areas where multiple markers of ongoing structural disadvantage overlapped showed the highest diabetes prevalence, suggesting that past and present forms of racism have a cumulative effect on metabolic health.

According to the CDC, non-Hispanic Black adults are roughly twice as likely to be diagnosed with diabetes compared to non-Hispanic white adults, and Hispanic Americans also face elevated risk. The study's authors argue that these disparities cannot be explained by individual behavior alone. Instead, they reflect environments that systematically limit access to the conditions necessary for metabolic health — nutritious food, safe spaces for physical activity, preventive healthcare, and economic stability. The findings support calls from organizations including the American Diabetes Association for addressing social determinants of health as a core component of diabetes prevention strategy.

What Can Be Done to Address Place-Based Diabetes Disparities?

Public health experts have increasingly called for place-based interventions that address the root causes of health disparities rather than focusing solely on individual-level risk factors. The CDC's National Diabetes Prevention Program has shown that lifestyle interventions can reduce the risk of developing type 2 diabetes by approximately 58% in high-risk individuals, but access to such programs remains uneven across communities. Neighborhoods with the highest diabetes burden often have the fewest prevention resources.

The study authors recommend policy approaches that include investing in healthy food retail in underserved areas, expanding community health worker programs, improving walkability and green space in historically redlined neighborhoods, and ensuring equitable distribution of diabetes screening and management services. Some cities have already begun piloting "health in all policies" frameworks that consider health equity when making zoning, transportation, and economic development decisions. The researchers emphasize that without deliberate efforts to reverse the structural conditions created by decades of discriminatory policy, diabetes disparities are likely to persist across generations.