COVID-19 morbidity is linked to social, economic and environmental factors, including residential location, air pollution and median household income (H. A. Washington Nature 581, 241; 2020). These have an overlapping determinant that could prove to be an important predictor of COVID-19 disparities: land use.
The United States has a strained history of land use and land governance, including ethnic constraints on land ownership and unfair mortgage-lending practices. Decisions on land-use classification have led to hazardous and polluting facilities being sited next to minority and other vulnerable residential communities. Despite policies enacted in 1968 to protect against housing discrimination (go.nature.com/39v1bt3), the United States is witnessing a correlation of historical ‘redlining’ — the systematic denial of services to residents of certain areas, on the basis of race or ethnicity — with COVID-19 incidence today.
It is crucial that land-use practices are considered when making public-health management decisions. This could help to mitigate the multi-generational, compounding impacts of isolated or confined residential spaces. Those who live in such areas will continue to take a disproportionate hit unless land-use equity is made a priority in governance.
