Health-Based Reparations

Health-Based Reparations

By

Leonard Zwelling

https://www.nejm.org/doi/full/10.1056/NEJMp2026170?query=featured_home

My conservative readers are already outraged. The very mention of reparations drives them into a frenzy. The Perspective in The New England Journal of Medicine on November 26 by Drs. Mary T. Bassett and Sandra Galea should give everyone, liberals and conservatives alike, cause for consideration of why the case for reparations can be made. The authors make the case that the facts on the ground about the Black-White disparity in health outcomes can be partially corrected by moving resources selectively to the Black population.

Why?

Here are some of the facts they quote.

Black lives are four years shorter than White lives.

Black mothers are three times more likely to die of pregnancy-related illness than White mothers.

Black infants are twice as likely to die in the first year of life as White infants.

There are striking racial inequities that exist between Black and White Americans. These are facts, not debate points. The question is what we can do about it.

The authors make the case that these inequities stem from differences in resources, including power and money. Again, that’s pretty irrefutable. Reparations for slavery would address one of these striking inequities. Money. The questions for most of White America is would this work, how much are we talking about, and where would the money come from?

The authors make the case that there are three reasons to believe that some form of reparations would be of benefit to all Americans.

First, the money would advance the number of resources available to the Black community from better housing, to better food, to better schools. This would result in better health and a higher standard of living for everyone.

Second, the increased money would reduce the stress on the Black community and individuals within that community. This too would result in better health and presumably lower crime rates.

Third, the long-term effect of reparations would benefit future generations of Black Americans and the health of these generations.

The argument here is that reparations would directly benefit the Black community by narrowing the health disparities gap and do so for the long haul.

Now for the problems with these arguments.

First, this money would be the “cashing of the check” for which Dr. King came to Washington, DC in 1963. This will not go down well with the White community, nor is it likely to see the light of day in the Republican-controlled Senate likely to be seated in January.

Second, this money would be from the taxes of all Americans, many of whose families were not even here in 1865, let alone connected in any way to slavery. At least as many Americans were likely to have past generations victimized by prejudice as having been instruments of it.

Third, how much is this going to cost? It would have to be billions to have a meaningful effect on Black health and how would we even know the money was well spent? What’s the metric of success and how long will it take to make that measurement?

Structural racism is, I believe, real. It is cooked into the American pie. Structural racism is also at the root cause of Black inequality in health outcomes and in most other aspects of American society. The debate should be about that. Structural racism. Whether or not reparations for slavery is the way to fix any piece of structural racism is not only debatable, but can only be answered with research. Perhaps, an experimental approach to reparations in a limited geographic area, comparing health outcomes in that area with those obtained in areas not getting extra money would be a rational way to start. Pilot programs make more sense than dumping billions of dollars into the entire Black community with no way to know whether or not it did any good.

I can feel the passion in the opinions rendered by Drs. Bassett and Galea, but cold objectivity must prevail here if there can be any attempt to get the whole country behind the idea of reparations. As of now, the country is not inclined to go that route despite the cogent arguments in this editorial. More evidence will be needed to operationalize this, but the primary argument cannot be as a righting of the wrong of slavery, but rather as a way to make our country better for everyone.

Getting rid of structural racism is a good thing. Whether that can be done with money alone, is not at all clear. However, if health outcomes can be a measure of success and that measure can be improved with targeted tax dollars, perhaps that argument can be made. Perhaps.