Published On June 17, 2022
In the long debate over cash reparations—paying money to the descendants of enslaved people—very little has been written about their possible effects on health. That has changed in recent years. A modeling study published in 2021, for instance, argues that if reparations had been paid in Louisiana before the start of COVID-19, transmission in the spring of 2020 could have been reduced by between 31% and 68% in the state’s population at large.
With payments to address past injustices, the argument goes, the country’s Black-white wealth gap would have leveled out considerably. Fewer people would live in crowded, substandard housing, making it easier for them to adhere to social distancing guidelines and stay-at-home orders. Fewer Black people, who early in the outbreak died at rates almost four times higher than white people, would have been working in the riskiest jobs on the front lines of transmission. Lead author Eugene Richardson, an assistant professor of Global Health and Social Medicine at Harvard Medical School, says, “This research should add to the compelling moral and historical arguments for restitutive programs.”
Cash payments recognizing the injustice of slavery could have other health benefits, according to a handful of new analyses. Black communities have much higher rates of diabetes, heart disease, cancer and other illnesses. Those rates are almost certainly tied to factors such as housing, stress, employment and nutrition—all of which are the racist practices that led to less historical wealth.
In 2016, Black American families held $10 in assets for every $100 held by white families. And the disparities in some places are much wider. In Boston, for example, Black household assets averaged $8, versus about $247,500 for white families, according to 2015 data from the Federal Reserve Bank of Boston.
Health interventions have been targeted specifically to Black communities for decades, but attempting to provide financial justice could be far more effective, says economist William Darity, director of the Samuel DuBois Cook Center on Social Equity at Duke University. More monetary resources provide the capability to make decisions that are the precursors to healthier lives, he notes. People might be able to get jobs that reduce exposure to adverse health outcomes, obtain better health insurance and medical care, exercise political influence to improve health-related conditions in their neighborhoods and cities, and experience less financial anxiety and stress.
In 2020, Mary Bassett, now Health Commissioner for New York State, and epidemiologist Sandro Galea, dean of Boston University’s School of Public Health, co-authored “Reparations as a Public Health Priority—a Strategy for Ending Black-White Health Disparities” in The New England Journal of Medicine. Closing the wealth gap, they argued, could be the most powerful national medical intervention possible, writing, “Power, money and access to resources — good housing, better education, fair wages, safe workplaces, clean air, drinkable water, and healthier food — translate into good health.”
There is, however, little existing evidence linking monetary reparations and better health. The health impact of past reparations—such as payments made to Japanese Americans incarcerated during World War II—wasn’t documented, according to Darity. But well-designed simulation exercises, such as Richardson’s work with COVID-19 mapping, could be one way to fill the evidence gap.
Another method would be to look at programs tracking other types of cash payments. GiveDirectly, a non-profit started in 2008, offers unconditional payments directly to target populations in 10 countries. Guaranteed income programs in many nations have also provided cash infusions. Both have led to documented health benefits, Darity notes.
During one two-year pilot program in Stockton, California, 125 adults received unconditional monthly payments of $500 for 24 months. The participants were randomly selected from Stockton neighborhoods in which residents were at or below the city’s median household income. One year into the program, participants’ symptoms of anxiety and depression improved. By the end, there were indications that overall physical and psychological health, including self-reported fatigue, pain, and emotional wellbeing also got better.
Some direct cash payment programs in sub-Saharan Africa have been found to improve overall nutrition quality and measurements of child deprivation while reducing sexual risk behaviors, teen pregnancy and early marriage. They have also helped curb financial poverty and child labor and have led to better education, household resilience and civic participation. Programs have also increased the likelihood that people seek health care when they’re ill.
Any effort to provide cash reparations will face strong political opposition, and even those who champion this approach don’t see this kind of wealth redistribution as a full solution to racial disparities. “Achieving racial justice requires dismantling structural racism, ending its effects and, ultimately, providing compensation for the victims,” says Darity. “That last step is reparations, and all three are important. Adoption of a reparations plan need not be delayed until the first two steps are taken, however.”
In the meantime, many proponents of reparations are also looking at more immediate fixes. Michelle Morse, New York City Health Department’s Chief Medical Officer and Deputy Commissioner of the Center for Health Equity and Community Wellness, and a co-author on Eugene Richardson’s 2021 paper, helped implement a new program at Brigham and Women’s Hospital in Boston. It aims to reduce racial inequities in heart failure outcomes.
The pilot program involves a change in electronic health records to provide an alert to physicians when a patient is admitted to the hospital with heart failure. It reminds them that, historically, Black and Latinx patients have been excluded from the specialty cardiology service. The clinician is asked to consider that fact when deciding where to admit that patient. Researchers are currently measuring the impact of the program.
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