Redlining; HOLC assessment; Infant Mortality; Healthy Start Initiative; Structural Racism; Maternal Morbidity; Maternal Mortality


Health Policy | Maternal and Child Health | Public Health


For nearly three decades, Healthy Start Initiative(HSI) has served communities with high rates of adverse pregnancy outcomes--with the goal to lower them by 50%. Despite a large focus on social determinants of health, HSI has narrowly addressed racism. The effects of legal housing discrimination continue to be felt and have profound implications for pregnancy. To understand the historical context of racism in these communities, we geospatially evaluated the relationship between HSI service areas and Home-Owners Loan Corporation(HOLC) graded maps. Using data from John Snow Inc, National Healthy Start Association, and Mapping Inequality we found that 73 of 100 communities served by HSI were subject to anti-Black housing discrimination. For majority, over 60% of the HOLC-assessed areas in the service areas were red or yellow graded. Given this we propose three programmatic shifts that HSI can implement to address structural racism and broaden their policy and advocacy efforts in the communities they serve.