Where Do You Draw the Line? by Martine Hackett

In the spring of 2020, New York City was the epicenter of the COVID-19 pandemic in America. The net out-migration from the city increased by an estimated 130,837 from March 2020 through June 2021, as compared to pre-pandemic trends. People moved out of the city to avoid the spread of disease in crowded spaces, seeking safety and space in the suburbs. Residents from the city’s wealthiest neighborhoods were the most likely to leave.

By leaving the city to avoid this infectious virus and terrifying disease, the people who left followed a pattern that has existed for hundreds of years. Fleeing dense urban spaces for the clean air, open space, and the healing properties of nature.

What they did was cross a line, between city and suburb, a line that was not physical but psychological, that holds significance in its power to separate. The practice of public health has long seen that separating or using what was originally a public health term, segregating the sick from the well can stop the spread of diseases that were considered contagious. How this was done has changed over time.

Consider the cordon sanitaire, a technique that began in the Middle Ages. A cordon sanitaire is generally created around an area experiencing an outbreak of infectious disease, or along the border between two nations. Once the cordon is established, people from the affected area are no longer allowed to leave or enter it. Traditionally, the line around a cordon sanitaire was physical; a fence or wall was built, armed troops patrolled, and inside, inhabitants were left to deal with the disease on their own.

This separation between sick and healthy, keeping people who could contaminate away from those who have the power to control physical spaces, and the efforts to maintain those boundaries no longer need to be physical. The lines between city and suburb, between low resourced and high resourced communities, between homeowners and renters, between school districts, are all lines that have been drawn to protect those within from the dangers of those on the other side of the line.

Reformers in the 19th century believed that since disease always accompanied the dirt, pollution, and ugliness so common in the industrialized world, health could be restored by bringing people back to pure air, pure water, pure food, and pleasant surroundings and in direct contact with nature.

When the leading public health experts in the early 19th century thought that the miasma or atmosphere of filth that was associated with death, disease, and poverty, then the solution was to physically separate from the people considered to be the spreaders of disease: Immigrants from southern and eastern Europe, Chinese laborers, and Black migrants from the South.

The suburbs started as a way of drawing lines between healthy and unhealthy places, healthy and unhealthy people, and the segregated suburbs that we see today were formed in part, in response to public health concerns.

The suburbs were seen as a fortress, insulated from the problems of cities and protecting its residents from the ills of the city.

Crossing the line from cities to the suburbs, starting in the mid 19th century through the post World War II boom that many people associate with Levittown, Long Island was informed by the intersection of three components: race, space, and health.

In describing the concept of the White Spatial Imaginary, George Lipsitz (2011) starts with the thought that the ideal is presented as private property, ordered suburban houses, and homogeneous communities.

White identity in the US is place-bound–it exists and persists because segregated neighborhoods and segregated schools are nodes in a network of practices that skew opportunities and life chances along racial lines.

Because of practices to racialize space and spatialize race, Lipsitz states, whiteness is learned and legitimated, perceived as natural, necessary, and inevitable. Racialized spaces give those who consider themselves white the privilege of access to opportunities and multiple health protections. 

How did notions of public health in the 20th century support the white spatial imaginary? By using definitions of threats to public health as the reason to create what is known as zoning ordinances that are the basis for thousands of local laws in suburbs across the country that explicitly draw lines of separation between what is considered a healthy or unhealthy space. 

The Power of Zoning

Zoning acted as a quarantine from offending groups. The New York City 1916 zoning law, the first comprehensive zoning in the nation, sought to limit the health threat of skyscrapers that blocked natural light and contributed to the spread of tuberculosis. Because migrants and Black people were viewed as disease carriers, segregating them was a typical goal of zoning.

In perhaps the most significant decision to establish zoning in suburban areas was the United States Supreme Court decision Village of Euclid v. Ambler Realty (1926). Public health and public welfare were key justifications to restrict private land use. The decision explained that the apartment house in the suburbs is a ‘mere parasite’ that interferes with the free circulation of air and sunshine, depriving children of quiet and green grass and are nuisances.

Euclidean zoning in the 20th century protected the health, safety, and welfare of the general public by separating residential from industrial uses. Decisions of where to draw the line for land-use actions were for the purpose of health benefits to the public and general welfare.

The single-family home promotion was a racial restriction without issues of race directly. Promotes a theory from pre-WWII that described certain groups of people–tenants and racial minorities, as a threat to the “health” and “stability” of neighborhoods–racialized land use calculus. Zoning was promoted by white property owners to defend their neighborhoods and commercial areas from those who would decrease the value of those investments. Thousands of local zoning ordinances since have promoted and maintained racial exclusion (Colored Property, Freund)

Zoning generated race and class segregation in the Underwriting Manual of the Federal Housing Administration in 1936, best known for creating over 200 maps of areas across the country that created areas that were rated the best for investment (colored green) to those that were considered “dangerous” (colored red). The manual states that “the best artificial means of providing protection from adverse influences is through the medium of appropriate and well-drawn zoning ordinances.” Zoning protects by preventing “infiltration of business and industrial uses, lower class occupancy and inharmonious racial groups.” This is the basis of redlining.

Zoning practitioners used the court’s validation of municipal police power to protect the health and general welfare through local ordinances that exclude renters and the poor through upzoning or large lot sizes to build new homes.

Today in Nassau County, the consequences of drawing lines around primarily white communities and separating from communities of color are reflected in the district lines drawn to determine the 62 school districts in Nassau County and other places that reinforce the separation of race and class. 

Racial Residential Segregation and Health

The lines drawn between communities, where residential segregation represents white suburban residents cordoning themselves off from communities that are  considered threatening to their way of life, today is a picture of neighborhoods that have hoarded opportunities, wealth, and protective factors and neighborhoods that do not. Neighborhood disadvantage is a key source of stress for Black residents, especially in segregated communities like Nassau County.

The inequality of neighborhood conditions shapes inequality in health outcomes. Fewer trees and more asphalt create hotter neighborhoods that endanger the health of residents who are vulnerable to extreme heat. 

Communities that are majority people of color and low income are exposed to greater concentrations and more kinds of harmful chemicals through the air in their neighborhoods due to their proximity to local sources of pollution. Neighborhoods that were redlined in the 1930s and considered ‘dangerous’ have higher levels of harmful air pollution today. 

Black and white disparities in hypertension and cardiovascular disease can be explained by discrepancies in neighborhood conditions and residential segregation. Investigating the impact of neighborhood differences helps us see how health is shaped by the social and physical environment, not just medical care.

The idea of suburbs as healthier places than cities is not true for racially segregated communities of color.

Today, zoning is so ingrained in suburban land use that it does not recognize or acknowledge the issue of segregation built into it. 

The Lasting Effects of Line Drawing 

The connection between race, place, and health is alive and well in the suburbs. The drawing and maintenance of the boundaries and the lines between suburban places, between cities and suburbs, between access and availability of resources, between safety and threats, lives on. The consequences of maintaining these lines are found in the bodies of those exposed to the harmful effects of those lines–in their housing choices, housing affordability, school quality, the air they breathe, and the stress they embody. 

The fact that the highest number of COVID 19 infections and deaths were overwhelming to residents of communities of color in Nassau County says that suburban spaces are not healthy for everyone. Recognizing that the very lines originally drawn to protect the health of the public in fact create poor health outcomes is the first step to a true realization of public health and protection for all. 

Martine Hackett is an associate professor in the Department of Population Health at Hofstra University and is a public health educator and advocate. Her latest research is on the history of suburban development, public health, and race.