Racial Health Disparities can Undermine Dreams of Home Ownership for African-Americans

Racial inequities in health intersect with other factors such as wealth inequalities, the recession and subprime lending, to increase foreclosure risk for African-American homeowners, a new study lead by a Yale School of Public Heath researcher has found.

The study in Social Science & Medicine was conducted through in-depth, semi-structured interviews of 28 middle and working-class African-American homeowners — most over age 50, and 23 of them female. The interviews took place in 2012 and 2013 in a northeastern urban neighborhood that the investigators named Locust Park.

Analyzing coverage of mortgage strain and foreclosures in minority communities that were published in regional and national newspapers between 2005 and 2013, the authors determined that the dominant public narrative has focused almost entirely on housing market dynamics, particularly subprime lending. However, the prevailing story the interviewers heard was not about the bursting of the housing bubble or the rise in subprime lending.

“Subjects told us that illness in particular — their own, or that of a family member — often acted as a shock that upset the balance of fragile household finances,” said lead author Danya E. Keene, assistant professor in the Department of Chronic Disease Epidemiology.

That shock occurred when illness resulted in job loss or limitations on work options, when medical bills intersected with chronic financial hardship, when care required by a family member limited a wage-earner’s ability to work, and when untreated medical needs affected ability to perform jobs which had been relied on for income. Some study participants described forgoing medical care or medical insurance as a way to pay the mortgage.

While illness and medical debt are common among those facing foreclosure in general, existing racial disparities in health are an added source of fragility for African-American homeowners. African Americans experience higher rates of chronic conditions and disabilities than their Caucasian counterparts; the Centers for Disease Control report, for instance, disproportionate incidences of problems such as heart disease, stroke, hypertension, and diabetes, as well as overall lower life expectancy. Such disparities persist regardless of education levels and socioeconomic status and are thought to result from an ongoing history of racial injustice.

African Americans also become ill earlier in life, meaning both more years of individual fragile health, and increased likelihood that family members will need caretaking. Caretaking can create additional financial difficulties, particularly among single female homeowners, who are likely to do more of it than their male counterparts.

Additionally, African Americans have been less likely than their Caucasian peers to have health insurance. These combined health-related factors can increase mortgage strain not only among older persons, but also among middle-aged adults too young to qualify for income supports or who have not been able to save adequately for retirement.

“Our findings tell a story about the insidious reproduction of racial marginalization,” Keene said. “Many participants had viewed home ownership as the route to upward mobility for themselves and their children. However, when health inequality intersected with other sources of disadvantage, this dream was threatened. For many participants, poor health itself was a barrier to the possibility of a well-being and a brighter future.”

The Robert Wood Johnson Foundation’s Health and Society Program funded the study.