Reparations as a Public Health Priority — A Strategy for Ending Black–White Health Disparities

“There has not been a single year since the founding of the United States when Black people in this country have not been sicker and died younger than White people.[..]

Though the racial gap in life expectancy has narrowed, Black Americans continue to die 4 years earlier, on average, than White Americans. The divides on other U.S. mortality measures are starker: Black mothers are three times as likely as White mothers to die from pregnancy-related causes; Black infants are more than twice as likely as White infants to die in their first year, according to the Centers for Disease Control and Prevention (CDC); and the rate of premature death (before 75 years of age) is 30% higher among Black Americans than among White Americans.

[..] Perhaps the most important insight into why these gaps persist comes from work that focuses our thinking about fundamental causes of health. This work shows that forces that shape our societal structures — including power, money, and access to resources — inevitably become embodied in health and will continue to shape health patterns unless they are addressed. This understanding clarifies that the Black–White health gap is inseparable from the enormous gap in resources between Blacks and Whites in the United States. Black Americans earn 65 cents for every dollar earned by White Americans. Even more dramatically, the average Black family has about $10 in assets for every $100 accrued by the average White family. In 2015, for example, the Federal Reserve Bank of Boston found a truly staggering racial gap in wealth in Boston: household assets averaged $8 for Black families and about $247,500 for White families. And power, money, and access to resources — good housing, better education, fair wages, safe work places, clean air, drinkable water, and healthier food — translate into good health.

[..] We believe that there are three pathways through which reparations could reduce health disparities. First, they would go some way toward expanding the extremely limited resources available to many Black Americans. Insofar as the relationship between resources and health is inarguable, there is no way to close a health gap without also addressing a resource gap. In the short term, reparations would give many Black Americans the means to obtain health-producing resources such as better neighborhoods, better schools, and access to cleaner air.

Second, reparations would help reduce the stress felt by many Black Americans, which is undoubtedly associated with poor health. Psychological strain has been clearly linked to poor health, and reparation funds that alleviated some of this strain could help improve the health of Black Americans.

Third, we would expect the ultimate effect of Black reparations to be intergenerational. Health is produced over the life course and across generations, and any effort in the present to level the wealth playing field could reset the potential wealth and assets — and consequent health — of future generations. Thus, any reparations provided today would be an investment in the future and in reducing disparities that have been intractable for generations.

[..] Black reparations would not solve racism — structural racism permeates all we do and bars Black Americans from equitable access to housing, occupational opportunities, and safe neighborhoods, to name but a few determinants of health. But reparations would represent a monumental break with the past.

[..] equity is not simply about repair in cash or in kind. Addressing the Black–White wealth gap through reparations is about saving lives. By bringing attention to the health benefits of addressing this gap, we can help shift a national conversation about reparations that often becomes mired in blame and accusation to one that centers the critical importance of health.”

Full editorial, Bassett MT and Galea S. New England Journal of Medicine 2020.10.8