Reparations done right can help us close our shameful health gaps

Juneteenth, which marks the day in 1865 when Union troops arrived in Texas to enforce the Emancipation Proclamation, should be a joyous celebration of freedom. 

Yet nearly 160 years later, that freedom feels like a dream deferred — a promise unfulfilled. 

The end of institutionalized slavery led to generations of institutionalized racism in the United States. The shameful results are all around us. Black babies are twice as likely as white babies to die before their first birthday. Black children are four times as likely to live in neighborhoods choked by pollution. Black adults are significantly more likely to have serious conditions including heart disease and Alzheimer’s. And at every age, Blacks are less likely to receive quality health care.  

Physicians and public health experts point to the insidious effects of structural racism as a driving factor for these disparities and many others. 

As a nation, we are slowly beginning to reckon with this destructive legacy. Last month, the groundbreaking California Reparations Task Force issued its official recommendations on how the state might begin to redress the immense financial, emotional and physical costs that longstanding discrimination has leveled on Black residents. More than a dozen cities, from Providence, R.I. to Durham, N.C. to Kansas City, Mo., are also considering reparations.  

This moment has the potential to turn into a movement, giving our nation a real opportunity to make amends for the brutal effects of centuries of racism woven into our laws, our policies and our practices. We must get this right. 

Opponents often dismiss the very notion of reparations as inconceivable: Too expensive, too late, too unfair to taxpayers who had no direct hand in past injustices. The truth, however, is that the United States has successfully paid billions in reparations in the past. In 1988, President Ronald Reagan signed a bill granting cash payments to Japanese-Americans who had been forced into internment camps during World War II. More recently, the government has compensated veterans exposed to toxic burn pits during their military service.  

And here is an even more fundamental truth: All of us — every race, ethnicity and income bracket — pay the price every day for the lack of reparations to Black Americans.  

Health disparities cost the U.S. hundreds of billions each year in excess medical costs, lost productivity and premature death. Meanwhile, racism impairs Black residents’ access to quality education, good-paying jobs and credit. All that discrimination stifles Black entrepreneurship and slows economic growth. In fact, all told, anti-Black racism has cost the U.S. economy an astounding $16 trillion in the past two decades alone. 

How would reparations help?  

Cash payments to individuals could certainly begin to close the yawning wealth gap in this country. But reparations could take other forms as well. 

From Long Island to South Los Angeles, Black and brown communities are significantly more likely to be exposed to toxic air pollution and other environmental hazards. These conditions dramatically impact health and make it difficult, if not, impossible to accumulate wealth through rising property values. An all-out drive to clean up affected neighborhoods would be a significant step toward repairing the enduring harms of structural racism. 

Reparations could also take the form of a major investment in public education to compensate for discriminatory funding policies that routinely result in much higher per-pupil spending in schools serving predominantly white children than those serving mostly children of color. Redress might also involve police and prison reforms, to ensure equal justice and fair treatment under the law. 

Any restitution must also include a true accounting of — and redress for — institutionalized racism in the medical field: the abhorrent experiments on Black bodies; the systemic exclusion of Black physicians; the implicit biases in algorithms that shape diagnosis and treatment; the deep inequities in access to quality health care. 

In my city of Boston, life expectancy in the wealthy, mostly white neighborhood of Back Bay approaches 92 years. Just two miles away, in the low-income, mostly Black community of Roxbury, life expectancy is barely 69 years. That’s a 23-year difference in life expectancy in neighborhoods separated by just a few stops on public transit. Similar disparities exist across America.  

True reparations would eradicate these differences, enabling millions of Black citizens to achieve — and contribute to society — their full potential. As my friend and colleague Mary Bassett, the former health commissioner of New York State, has written: “Until racism no longer drives negative effects on the health and length of a Black person’s life, equity remains theoretical.” 

The last time the U.S. paid reparations in the context of slavery, we got it horribly wrong. In 1862, about nine months before national emancipation would take effect, President Abraham Lincoln signed a bill ending slavery in Washington, D.C. The bill included reparations — for the slave owners — who could claim up to $300 in compensation for every man, woman and child they freed from bondage. 

The reparations lifted up the oppressors. Not the oppressed. 

We now have an opportunity to right this and so many other grievous wrongs by deploying reparations designed to compensate Black Americans for centuries of systemic human rights violations that cost them wealth, health, and opportunity.  

The great poet Langston Hughes asked, “What happens to a dream deferred?” The answer is evident in the deep inequities that scar and stain our nation. Building a society with health, dignity and justice for every member is our great unfinished task. Let’s work toward repair. Let’s invest in equity. We all stand to benefit.  

Michelle A. Williams is dean of the Faculty at the Harvard T.H. Chan School of Public Health.