Reparations as Public Health |  Harvard Magazine
Reparations as Public Health |  Harvard Magazine

“Health is wealth” said Boston City Councilwoman Julia Mejia during a conversation Monday afternoon with Harvard’s Mary T. Bassett about slavery reparations as a public health measure. “All of these things are really interconnected… and health has to be a part – if not the backbone – of that [reparations] a conversation. Because people won’t do well, unless they are good.”

Bassett, director of the Harvard FXB Center for Health and Human Rights and a former New York State health commissioner, has been making the same case for several years. Writing in 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 the dramatically uneven toll of COVID-19 exposed the vast disparities in the health care system, Bassett and others noted in an FXB Center report that only a handful of peer-reviewed public health articles had ever mentioned benefits. One was an empirical study from 2021 showing how a full-scale benefits program that closed the black-white wealth gap would significantly reduce the transmission rates of COVID-19 not just for African Americans, but for all Americans .

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

Speakers pointed to multiple connections between racially disparate health outcomes and black-white disparities in other areas: housing, schools, employment, transportation. They spoke of the devastating 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 just $15, according to data from the Federal Reserve System . The structural forces shaping all of this, the speakers noted, stemmed from slavery and legal segregation.

Mejia, who self-identifies as Afro-Latina whose family moved from the Dominican Republic to Boston when she was a child, remembers growing up amid the effects of gentrification in the city’s Dorchester neighborhood and attending under-resourced schools. “I barely graduated, but I got away,” she said. Looking at Boston’s black neighborhoods today, she sees long-standing “food deserts” (where a lack of stores makes it expensive and difficult to buy healthy foods) and new health deserts that are forming as pharmacies and clinics close, including the kinds of places where she recounts as a child: “I grew up in community health centers.” She also sees serious unmet needs for mental health care, driven in part by the emotional damage of racism: “This historical trauma is passed down from generation to generation.” All of these deficiencies, she argues, are part of the same fundamental imbalance. “We’re just catching up on existing discrepancies,” she said.

Bassett, who advocates both policy interventions and direct cash payments as reparations, noted a surprising 2023 study by the Boston Public Health Commission: It documented a 23-year difference in life expectancy between Back Bay residents, an affluent white neighborhood and Nubian Square in Roxbury, a predominantly black neighborhood and one of Boston’s poorest areas. The two neighborhoods are only two miles apart. “That’s when we’ll know we’ve finally solved it when we no longer see these gaping disparities across racial and ethnic groups,” Bassett said. “We can never guarantee everyone the same level of health on an individual level. Bad things happen. But these group differences … should not exist.”

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

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