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 (, 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.