How Reparations Could Improve Black Health and Wellbeing

A leading public health expert describes how reparations can close the life expectancy gap for Black people in America.

A backdrop of a graph with lines representing worsening and improving health outcomes. Black people move toward the positive trend leading to a better quality of life. 

We all know that having access to wealth is crucial to leading healthier, more prosperous lives. Yet the enduring legacy of slavery in America has created vast disparities in wealth and opportunity for Black people. Can reparations for this destructive legacy serve as an important step toward supporting the health and healing of Black people in America?

Mary T. Bassett, M.D., the director of Harvard’s FXB Center for Health and Human Rights and former health commissioner for the state of New York, firmly believes they can.

To achieve health equity, “what really needs fixing is access to resources,” she wrote in a thought-provoking 2021 New England Journal of Medicine Perspective with Sandro Galea, M.D. And that’s where reparations come in. By closing the racial wealth gap, reparations can help close the gap in racial health outcomes and life expectancy, which, for Dr. Bassett, is the ultimate goal.

I recently spoke with Dr. Bassett about the RWJF-funded research project at the FXB Center that she is leading, Making the Public Health Case for Reparations, which explores Black reparations as a public health strategy for achieving health equity. This is the first installment of our two-part conversation.

You’re a leading national thinker on the intersection of race, wealth, and health, but you haven’t previously focused on reparations and, more specifically, exploring the public health case for this type of approach. What led you to undertake this project, Making the Public Health Case for Reparations?

Dr. Bassett: First, the idea of reparations is not new. It’s literally centuries old, but it returned to public awareness only 10 years ago when Ta-Nehisi Coates published an article in The Atlantic. Obviously, I had heard of reparations, and, as I trained in medicine, I witnessed vast racial inequities in health.

At the time of that article, though, I considered reparations a sort of fringe idea—morally sound but politically impossible, and therefore not worth pursuing. Only recently did I come to the idea that reparations are important to public health.

I’ve been thinking about the health of Black people for a long time. Since colonial times, Black people have been sicker and died younger than White people. Yes, we’ve made progress, but the gap persists, and it is much too large. And, of course, the COVID-19 pandemic highlighted how fragile these gains are.

Whatever has been done is not enough. We must be bolder if we want to save lives. People think of reparations as a political project. I’d like to think of them more as a humanitarian effort important to saving lives.

Although 77% of Black Americans support reparations (according to Pew data from 2022), only 7% think it’s likely in their lifetimes. This creates a significant “hope gap,” even with supporters. What do you think this statistic is telling us?

Dr. Bassett: It’s not surprising that many Black people aren’t hopeful that we will ever achieve a national consensus for making reparations. We have a real ebb and flow of commitment to equity in this country. There is no doubt that, in my lifetime, the 1960s were a highpoint—with the Civil Rights Act, the Voting Rights Act, and Fair Housing Act. My generation is the beneficiary of arguably the first period of legal equality. We’re in a period now where books are being banned and voter registration is being suppressed. So, there’s always a push forward and a push back.

At the same time, though, the proportion of Whites who support reparations has increased. It’s still very much a minority, but it used to be far lower. A recent Pew Research Center poll found that 18% of White Americans support financial reparations for descendants of Black slaves, and another survey put the figure at closer to 20%. So, I think there is a growing awareness that there is a tear in the fabric of our democracy. The fact that we as a country are even having this conversation just wouldn’t have been possible even 20 years ago.

You’ve written previously that “closing the resource gap is necessary to closing the health and life expectancy gap.” Can you explain what you mean by this and share more about that connection?

Dr. Bassett: William Darity and A. Kirsten Mullen offered a key insight when they proposed the Black-White wealth gap as the primary metric for measuring the impact of 250 years of enslavement, 90 years of Jim Crow, and 60 years of “separate but equal.” They proposed that eliminating the wealth gap should be the goal of reparations, which they argued should be monetary and delivered at the household or individual level.

We’ve introduced the idea that we can measure progress toward achieving equity or repairing the past by looking at health outcomes, particularly differences in Iife expectancy. Many will argue, for example, that rates of premature mortality are the single best metric of structural racism’s impact on the lives of all people of color, especially those of African descent. Premature deaths are what’s driving the racial differences in life expectancy.

Now, I don’t believe that we should view elimination of the wealth gap as the indicator of success. I believe that eliminating disparities in life expectancy or premature mortality should be the end goal. We need to close the resource gap to close the health and life expectancy gap.

That’s what brings health into this conversation—and, to be honest, health has been largely absent from the reparations conversation, probably because a lot of people like me thought that reparations simply weren’t possible. But reparations aren’t a fringe idea anymore. They’re certainly a minority idea, but it’s a sign of growing momentum that we as a country are including the word “reparations” in our national conversations on race.

Read part two of my Q&A with Dr. Mary Bassett, where we discuss preliminary findings from the Making the Public Health Case for Reparations research study, learnings from early career researchers, and how we can advance health equity.