90-Year-Old Housing Discrimination Still Shapes Colon Cancer Care Today

In the 1930s, the federal government drew maps that would shape American neighborhoods for generations. The Home Owners' Loan Corporation, a New Deal agency, color-coded residential areas based on their racial and ethnic composition. Green zones were safe bets for mortgage money. Blue zones were acceptable. Yellow zones were declining. Red zones—predominantly Black, immigrant, and minority neighborhoods—were marked hazardous and starved of investment. Nearly a century later, those lines still matter. A new nationwide study of 149,917 colon cancer patients diagnosed between 2007 and 2017 shows that people living in those long-ago redlined neighborhoods are significantly less likely to receive quality cancer care and significantly more likely to die from the disease.

The research, led by S.M. Qasim Hussaini of the University of Alabama at Birmingham and published in JCO Oncology Practice, examined colon cancer outcomes across 196 cities in relation to the original HOLC maps. The findings are stark. Patients in formerly redlined areas were diagnosed with advanced-stage disease more often than those in the greenest, most-favored zones. They waited longer for treatment. They received surgery less frequently. When they did have surgery, their lymph nodes were less thoroughly examined for cancer spread. They received chemotherapy at lower rates. The cumulative effect was measurable in survival: people in the worst-rated redlined areas faced a 13 percent higher risk of death compared to those in the best-rated areas, even after accounting for how advanced their cancer was at diagnosis.

The specific disparities are substantial. Patients in formerly redlined neighborhoods were 24 percent more likely to receive care that didn't meet national guidelines. They were 34 percent less likely to undergo surgery. They were 26 percent less likely to have at least twelve regional lymph nodes evaluated during their operation—a standard measure of surgical quality. They were 20 percent less likely to receive chemotherapy after surgery, the treatment designed to eliminate remaining cancer cells and prevent recurrence. These are not marginal differences. They represent thousands of people receiving substandard care because of where they live.

The mechanism linking 1930s housing policy to 2010s cancer outcomes is not mysterious. Redlined neighborhoods experienced systematic disinvestment. Banks wouldn't lend there. Businesses wouldn't open there. Public resources flowed elsewhere. Over decades, these areas accumulated fewer parks and green spaces, less access to nutritious food, more environmental toxins, and higher concentrations of poverty and stress—all factors that shape health. But the cancer disparities also reflect something more direct: unequal access to quality medical care itself. Redlined neighborhoods often lack robust healthcare infrastructure. Patients may travel farther for treatment, face longer waits, encounter providers with fewer resources, or experience discrimination in the healthcare system itself.

Hussaini emphasized that this is the first national study to connect historical redlining directly to current cancer care quality across all states. Previous research had documented disparities in specific cities or specific cancers—breast cancer in New Jersey, lung cancer in Massachusetts—but this work is broader and more systematic. It examined 149,917 patients of all ages and races, tracked multiple aspects of care from diagnosis through treatment and survival, and used standardized measures from the National Cancer Database. The consistency of the findings across different regions and patient populations suggests something structural, not accidental.

Colon cancer is particularly significant in this context because it is largely preventable and treatable. About 150,000 Americans are diagnosed with it each year, making it the third most common cancer and the second leading cause of cancer death. Early detection through screening and prompt, guideline-concordant treatment can save lives. Yet the disease kills people at vastly different rates depending on where they live—or more precisely, where they lived when a federal agency decided their neighborhood was too risky for investment. The study suggests that nearly a century of accumulated disadvantage—in wealth, in environmental quality, in healthcare access, in social stability—continues to determine who survives cancer and who does not.

The researchers note that these findings underscore what they call the long shadow of institutional racism. The redlining maps were explicit tools of racial discrimination, justified by pseudoscientific claims about neighborhood stability and property values. They were federal policy, not the work of individual prejudice. And their effects did not fade when the practice officially ended. Instead, they calcified into geography, into patterns of disinvestment that persist and compound. A child born in a redlined neighborhood in 1940 inherited not just lower property values but reduced access to education, employment, healthcare, and safety. Their children and grandchildren inherited the same disadvantages. When that grandchild is diagnosed with colon cancer in 2015, they are more likely to be diagnosed late, treated inadequately, and to die—not because of individual choices or biological differences, but because of a policy decision made before they were born.