In the United States, ongoing discriminatory, racially targeted public policies have systematically displaced racial and ethnic minority groups. Examples of this are biased credit and mortgaging practices such as redlining. According to the New York Times, redlining is defined as racial discrimination of any kind as it relates to housing. It stems from government maps that outlined districts where people of color lived and were therefore regarded as risky investments [22]. This caused many real estate agents to direct Black homebuyers and renters away from buying homes in predominantly White neighborhoods, alternately isolating Black families from integrated neighborhoods and placing them into racially segregated neighborhoods [22]. To influence these decisions, private bank lenders use racial discrimination tactics to deny Black homes from qualifying mortgage loans, such as government map lines [22]. Racial segregation in the environment within communities of color still shows its lingering effects to this day. Areas that faced racial segregation have dealt with increased health inequities related to education, housing conditions, inequities to transportation infrastructure, access to health care, and increased risk of COVID-19 exposure due to physical, economic, and social conditions linked with redlining [23].

Another challenge that is faced in the U.S. is the issue of affordable housing. Due to decades of structural racism, there are vast racial disparities in housing that persist until today. Data from the National Low Income Housing Coalition show that Black, Native American, and Hispanic households are more likely to be extremely low-income renters when compared to White households and are more likely to struggle to pay rent and find affordable, accessible, and suitable than their White counterparts [24]. Data shows that 27% of Black households are extremely low-income renters compared to 6 percent of White households [25]. Low-income renters are individuals who earn less than 50% of their area medium income, and extremely low-income renters are those who earn less than 30% of their area medium income [26]. Low-income renters are more likely to struggle to afford rent and are at increased risk of negative health outcomes such as poorer health, food insecurity, low academic achievement, and substandard housing conditions [25].

Many low-income renters of color face exploitation by their landlords and are being forced to live in substandard housing conditions. According to The State Housing Laws and the Uniform Housing Code, substandard housing is defined as “any condition which exists to the extent that it endangers the life, limb, property, safety or welfare of the occupants or general public” [27]. A prime example of this is the Church Street South Complex, which was located in New Haven, Connecticut. The building was constructed in 1969 and had 301 units, housing roughly 1000 low-income adults and children. For 50 years, the apartment complex had deteriorated due to years of poor maintenance [28]. A study done by Yale’s Occupational and Environmental Medicine Program contained information on 268 residents who lived in 118 apartments at the Church Street South complex from 2008 through 2015. Of the 170 children surveyed, they found that 48% had physician-diagnosed asthma. Of the 118 residents, 93% reported that their apartments had visible mold, and 85% had water intrusion or leaks [28]. The study found that of 170 children, 48% had physician-diagnosed asthma, and 98% of them experienced onset or worsening asthma conditions while at Church Street South. However, 66% of the 104 children who lived in the Church Street South complex had improved physician-diagnosed asthma and/or respiratory conditions after leaving the complex [28].

Environmental and occupational hazards disproportionately impact communities of color leading to inequities in exposure to environmental pollutants. Communities of color are more likely to be exposed to higher levels of particulate matter—fine inhalable particles like dust and soot due to living close to burning fossil fuels at a percentage 50% more than Whites [33]. The microscopic particles found in soot can cause adverse health effects due to the microscopic particles that can penetrate deep into the lungs, skin, and eyes [34]. This can cause asthma, bronchitis, coronary heart disease, premature death, heart attacks, strokes, and aggravated asthma among children [34].

Black Americans are more likely to live in older urban homes, increasing their risk of higher concentrations of indoor contaminants such as mold exposure [35]. Indoor exposure to mold and moisture is linked to and may cause various symptoms such as stuffy nose, wheezing, red or itchy eyes, or skin. Other people may experience more severe symptoms, such as asthma and other upper respiratory infections [36,37]. Houses with insignificant ventilation, poorly sealed walls, and flooding can lead to mold and moisture. Poor bathroom ventilation has also been shown to lead to increased mold and moisture. Most of these issues are found in older buildings needing renovation, which are the same houses that racial and ethnic minority groups are more likely to live in [35].

Another environmental and occupational hazard that disproportionately impacts communities of color is indoor allergens and microbial exposure. Indoor allergens and microbial exposures such as pest allergens such as mice, rats, and cockroaches have been identified to contribute to pediatric urban asthma in low-income children living in urban homes [37]. In the National Cooperative Inner-City Asthma Study, the results showed that in the United States, mouse allergen had been found in 95% of home dust samples inside inner-city homes [38]. There was an even higher rate when houses with mouse allergen had a simultaneous cockroach infestation [38]. In addition, according to the Third National Health and Nutrition Examination Survey, Black Americans were four times more likely to be sensitized to cockroaches than Whites, demonstrating inequitable housing conditions among races [39].

The COVID-19 pandemic has given way to devastating job loss, unrivaled unemployment rates, subsequent increased risk of eviction, economic hardship in renter households, and precarious housing all among racial and ethnic minority groups and low-income households [40]. Historical and present tendency data show that people of color are more likely to face eviction during pandemics, fueling health inequities. Studies have shown that Black renters have faced the highest eviction rates before COVID-19 and noticeable racial disparity [41,42]. Studies have also shown that eviction can lead to an increased infection rate for COVID-19 as it leads to overcrowded living environments, homelessness, transient living conditions, reduced access to healthcare, sleeping outdoors or in cars, and leading to the sharing of accomodations designed for fewer people [43]. These same factors could also reduce the ability to adhere to COVID-19 mitigation strategies (e.g., hygiene practices like handwashing, social distancing, and self-quarantine) [43]. Overcrowding can increase the risk of respiratory illness and influenza and comorbidities like diabetes and high blood pressure, increasing vulnerability to severe or fatal cases of COVID-19 [44]. Eviction may also lead to reduced access to COVID-19 testing and a reduced likelihood that infected individuals would seek timely medical care that could decrease community transmission [45]. The threat of eviction can also have negative health effects such as an increased likelihood of being hospitalized for a mental health condition [45]. Furthermore, eviction is a stressful life event that can have enduring negative health effects and promote a cycle of multigenerational poverty [46].

Pre-pandemic, over 70% of Black and Latinx adults reported not having adequate emergency funds to pay for three months of expenses. Being evicted during COVID-19 added to fuel this inequality; meanwhile, only half of the White adults reported having this issue [47]. Lacking the privilege of being able to afford an emergency savings alongside an emergency or loss of employment can give way to greater economic hardship and an unstable housing environment. This can influence a person’s ability to pay rent during a pandemic and affect their ability to treat any complications that can occur from COVID-19 [40]. Before COVID-19, 1 in 5 Black female renters reported experiencing conviction compared with 1 in 12 Hispanic or Latinx women and 1/15 White women [48]. Black women renters experienced eviction filings at double the rate of White renters in 17 out of 36 U.S. states studied [49]. These data emphasize the disproportionate health inequity fueled by the risk of housing loss occurring during the pandemic.