In this, another in the Race and Vaccination series, we turn our attention to redlining. 

For those unaware, redlining is the practice of, according to Investopedia, ‘… a discriminatory practice that puts services (financial and otherwise) out of reach for residents of certain areas based on race or ethnicity’. The term used to be utilized almost exclusively in terms of real estate, but as you can see here, it has expanded to any practice where services are denied or made (sometimes almost impossibly) difficult for marginalized cohorts. 

Nowhere is this more true than how, or if, services can be accessed by those deemed ‘less than’ in this racialized society. 

For the purposes of this discussion here, we will focus on the dynamics in San Diego County, though make no mistake–these dynamics are absolutely in place in every other area of this country; we are using SD County only because this is where I make my home, and can verify (when possible) and challenge (when necessary) what academics, policy makers, and the media assert about housing trends in this region. 

Because we have to go wide lens when we talk about redlining, and, as well, we have to go historical. Only then can we zoom in, with both historical and present day context under our belts, and focus on the state of access to healthcare in the San Diego region. 

Yes, trust me, we will indeed get to vaccines. But before we can deal with the pandemic currently facing us all, we need to look at other less tangible pathogens that affect, and deeply, the health–actual, financial, emotional, structural–of the different cohorts, which then make for starkly different outcomes.  

To do so, we need to go all the way back, almost 90 years, to 1933, when state and local governments–including San Diego– colluded with the federal government to redline different neighborhoods and zip codes, a practice that has reverberations to this day, despite the Fair Housing Act of 1968. As the San Diego Union-Tribune tells the story (accurate except for the date of the Fair Housing Act):

“Faced with a housing shortage in 1933, the government adopted redlining policies to provide White, middle-and lower-class families with housing opportunities.

That policy essentially kept Black, immigrant and minority families from buying homes in certain areas until 1963, with the passing of the Fair Housing Act, which banned lending discrimination based on someone’s race as well as predatory interest rates and fees.”

Welp. 

Even with the passage of the landmark Act in 1968, which ended de jure discrimination, and rendered impotent and null the ‘restrictive covenants’ (my own house deed has one; chances are, if you bought a house built before 1970-1980 yours has one too), redlining persists. De facto redlining, which keeps whiteness at the top of the housing stock pyramid and also housing value appreciation, still occurs, albeit coded and covert. 

For years though, it wasn’t at all covert. What was happening anyway before 1933 simply became codified into law, and continues to happen, and not only with housing stock. A large swath of zoning law and lending policy is de facto redlining; as is the practice of real estate profiling; this is a necessary conversation for another day, but it is important to have all this in mind as we turn to the topic at hand.

Which is medical redlining, the effect of which has served to deeply affect the dynamic in terms of the current way the Covid crisis has been handled, and to whose benefit–and to whose detriment– policies, guidelines, and enforcement have been crafted and executed. 

These are the four largest medical groups in San Diego: Kaiser, Sharp, Scripps, and UCSD Medical. Not one has offices located in zip codes which have been coded (rightly or wrongly) as heavily populated by non dominant culture residents. 

There are no offices in any of these organizations in Encanto, Paradise Hills, City Heights, Logan Heights/Barrio Logan, Golden Hills/Sherman Heights; Spring Valley, Lemon Grove, National City, or North Park. 

All of these communities are located south of Interstate 8, which is the de facto dividing line between what is and is not ‘desirable’ by current common knowledge of those in power.

Just like major grocery chains, insurance companies, and banks/credit unions, major medical orgs have chosen to–not abandon, certainly, this would imply that they had once served there and then left–but to simply refuse to locate in areas they deem either unsafe or unprofitable, or, as with insurance, when they can’t refuse service outright, charge more than in more desirable areas. 

This is a very big deal, with major repercussions for the health and well being of entire communities. 

Added to this, San Diego County, with a land mass comparable to Connecticut (much larger if you take into account what is called the Greater San Diego Region, which encompasses southern Orange County, Riverside County, and Imperial County), is very much a car culture. Public transportation, despite whatever the Metropolitan Transit Development Board asserts, is abysmal.  

Again, access to good and reliable public transportation is a needed conversation; and again, we will have it another day. For these purposes here, it is necessary to look at who in San Diego uses public transportation, and how it ties into lack of access for healthcare as a whole. 

For those with the privileges that accompany owning a car–being physically able to drive or to have someone drive you; financing a vehicle or purchasing outright; car insurance (mandated in California); fuel costs; having a safe(ish) place to park; maintenance, and so on–San Diego County is fairly accessible. 

For others, it is a different story. 

While there is a small cohort of mostly white people who consciously choose public transportation (the population that MTDB ardently courts, with luxury coaches and dedicated lanes on the freeway, going up and down the 5 and the 15 corridors with express buses) most bus riders are bus riders out of necessity. 

Here is a quick and dirty snapshot of the cohort: disabled, sick (there is a difference), old, poorer, of color. 

Most of these would have, if we were to use the language of the medical profession ‘comorbidities’; that is to say that rarely does this population have only one challenge. They are old and/or sick and/or brown and/or lower income and/or disabled/sick and or Black/brown. This matters. This exponentiation of challenges guarantees that policymakers and lawmakers see them as less constituents to be served than as problems to be either ignored or reluctantly and resentfully addressed, or, more accurately, contained. 

This matters so much in healthcare. The twin insults of no access in areas where this population disproportionately lives, coupled with real, sometimes insurmountable, difficulties in making long treks to access what care is available, makes for, according to an article in Facing South, adverse healthcare outcomes even in the best of times, not just in San Diego County, but nationwide. 

So. As I have mentioned before, I have Kaiser, who chooses not to locate in my zip code, but, when pressed, responds that there are offices and hospitals within a 20 minute drive of my home. Seems reasonable (if you ignore the niggling question of why they couldn’t have been located in Encanto or Logan Heights rather than La Mesa or Bonita; why can’t the residents of Tierrasanta or Sunnyside or Del Cerro drive the 20 minutes?), but it becomes much less so when public transportation comes into play. And Kaiser is the most accessible of the major health care providers; Scripps, Sharp, and UCSD are far worse. 

I’m happy to be the example. I put the Kaiser locations into Google Maps and checked to see how long it would take me to get to the offices I most usually frequent for visits and prescriptions. There are three areas: La Mesa, Clairemont Mesa/Kearny Mesa, and Mission Gorge/Grantville. I allow about 20 minutes to drive and to park in La Mesa; for Clairemont and Mission Gorge, I allow 30 to 40 minutes. 

To get to La Mesa, according to Maps, it takes me 14 minutes to go 5.2 miles; 53 minutes by transit. To get to either the Kaiser Medical offices in Mission Gorge, it is another 14 min drive (usually a bit longer) to go ten miles, but a whopping four hours and 19 minutes if one is using public transport. 

By contrast, according to Google Maps, walking to Kaiser Mission Gorge would take me two hours and 40 minutes (not counting stops for dehydration, short breath, and cramping leg muscles).

Hear this. Read it again. Fictive imagination: imagine if you had only one or two of the aforementioned challenges and had to make a 10am appointment. 

Now to Covid.

Kaiser, when I made my appointment, didn’t ask me where I wanted to get my shot; they have dedicated pop up sites. I was assigned one in Clairemont, 13 miles away. That office is near but not a part of the regular medical offices. Only open during the day.

Again, according to Maps, about a 19 minute drive (about right) but a 2 hour 21 minute transit ride. 

So, the trip that took me about 40 min round trip to get my shot would take a more marginalized person over half a day. 

If you’re on public transportation, forget about working that day. When I was at the Kaiser pop-up, I saw the cross-section of people; office workers; students; middle class retirees. Most of whom had at least some flexibility, and, I am sure, most of whom drove. 

Why does this matter? Why is it important that the most marginalized and vulnerable in this current crisis have the most trouble becoming safe? Does it matter that, even as they manage to navigate the cruel, and ridiculous, and ridiculously cruel transit system, they are forced to be cheek by jowl with other vulnerable people (with public transit, social distancing is a joke)? Is this a public policy issue, or a public health issue, or both?

It gets worse if the person in question, like myself, had the vaccine that requires a second shot. I don’t at all look forward to my own. There are reports of some who have had adverse reactions within hours, sometimes minutes, of the second shot. Imagine waiting for a bus, or being on a bus, when that happens.

Making new barriers, or brutally enforcing existing ones, however unintentionally, makes for a redlining hothouse; and indeed, the rates of infection (and death) in San Diego county closely mirrors the redlining map the San Diego UT featured in its article. It would be naive at best and sadistically disingenuous at worst to insist that these are unintended consequences of a bygone era. 

It is not. Redlining exists to funnel resources to dominant culture at the expense of more marginalized cohorts. 

Period. Full stop.

Never has it been in sharper relief than during this current crisis. 

What to do? Possible policy solutions in our next discussion. 

Meanwhile, consider your own area, and compare and contrast with the dynamic in San Diego. Go wide lens–not just Chicago, but Chicagoland; not just Atlanta, but its surrounding counties; not just D.C. but the entire tri-state area. Think not just about covid, but also of policies silently but brutally in place for decades that affect quality of life, access, and mortality. 

Then comment. 

Norms apply. Comments required.  I am hoping for no fewer than 100 comments and 300 responses.

This is the work; where the rubber meets the road. Do the work. 
Join us in The Bistro to comment and respond.

Other articles in the series:
Vaccine Strata
Read Lace’s Thoughts about Inoculations in the April 2021 Newsletter