Reparations as Public Health

“Health is wealth,” said Julia Mejia, Boston City Councilor At-Large, during a conversation Monday afternoon with Harvard’s Mary T. Bassett about reparations for slavery as a public health measure. “All these things are really interconnected…and health has to be a part—if not the anchor—of this [reparations] conversation. Because people are not going to do well unless they are well.”

Bassett, the director of Harvard’s FXB Center for Health and Human Rights and a former New York State health commissioner, has been making this same case for several years. Writing in the New England Journal of Medicine in 2020, she called reparations a “long overdue approach” to closing the stubbornly persistent health gap between black and white Americans: “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.” In 2022, after COVID-19’s dramatically unequal toll had laid bare the healthcare system’s enormous disparities, Bassett and others noted in an FXB Center report that only a handful of peer-reviewed public health articles had ever referenced reparations. One of those was an empirical study from 2021, showing how a full-scale reparations program that closed the black-white wealth gap would have significantly lowered COVID-19 transmission rates not just for African Americans, but for all Americans.

All this is at the center of an FXB Center project called “Making the Public Health Case for Reparations,” which is funded by the Robert Wood Johnson Foundation. Monday’s conversation, one of several in the project so far, was hosted jointly by The Harvard Chan Studio and the FXB Center. Natalia Linos, executive director at the FXB Center, served as moderator for the discussion between Bassett and Mejia, who sponsored a 2022 city ordinance to study the effect of slavery in Boston. In 2023, Mejia’s ordinance prompted the formation of a task force exploring potential reparations for the city’s black residents.

The speakers drew repeated connections between racially divergent health outcomes and black-white disparities in other areas: housing, schools, employment, transportation. They spoke about the destructive effects of underinvestment in black neighborhoods and pointed out that the racial wealth gap remains staggering: for every $100 in wealth held by white households in 2022, black households had only $15, according to data from the Federal Reserve system. The structural forces shaping all of these, the speakers noted, stem from slavery and legal segregation.

Mejia, a self-described Afro-Latina whose family moved from the Dominican Republic to Boston when she was a child, recalled growing up amid the aftereffects of redlining in the city’s Dorchester neighborhood and going to classes in under-resourced schools. “I barely graduated, but I made it out,” she said. Looking around Boston’s black neighborhoods today she sees longstanding “food deserts” (where a lack of stores makes it expensive and difficult to buy healthy foods), and new healthcare deserts forming, as pharmacies and clinics close, including the types of places she relied on as a child: “I grew up going to community health centers.” She also sees serious unmet needs for mental health care, driven in part by the emotional harms of racism: “That historical trauma has been carried from generation to generation.” All these deficiencies, she argued, are part of the same fundamental imbalance. “We’re just catching up to the discrepancies that exist,” she said.

Bassett, who has argued for both policy interventions and direct cash payments as reparations, made note of a startling 2023 study by the Boston Public Health Commission: it documented a 23-year difference in life expectancy between residents of the Back Bay, a wealthy white neighborhood, and Nubian Square in Roxbury, a predominantly black neighborhood and one of Boston’s poorest areas. The two neighborhoods are just two miles apart. “This is when we’ll know that we finally solved it, when we no longer see these gaping disparities by racial and ethnic group,” Bassett said. “We can’t ever guarantee everybody the same level of health on an individual level. Bad things happen. But these group differences…should not exist.”

Findings like that one demonstrate the importance of collecting and analyzing data, Bassett added, especially for research modeling the potential public health effects of reparations. The FXB Center’s project is engaged in such work. “It’s interesting, because it’s hard to model things that are beyond the data,” she said. “But that helps us imagine what kind of impact there would be” for health and life expectancy from economic reparations. “And that seems to me an important role for researchers, to expand our imaginations. And that should be supported in the public health community.”

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