What Would Reparations Look Like? What They Are and How They Can Reduce Black Health Care Disparities

As a Black, queer, soon-to-be mother of a Black child living in a global pandemic, I'm calling for health care reparations for Black individuals and communities in the United States.The physical, mental, and financial health of Black people and our collective future is at stake. Black maternal and infant mortality rates are much higher than those of other races, and with other health issues disproportionately affecting us, we must seize upon the larger cultural awakening that Black Lives Matter. Once and for all, it's time to move toward securing the hard-earned human right to racially unbiased, high-quality health care in this country.

What are reparations?

Reparations are a form of economic, political, and social accountability for the harm done to Black Americans through violence, discrimination, and systemic oppression over centuries in the United States. Black folks whose ancestors were brought here on slave ships deserve reparations from the US government, its institutions, and honestly, from white folks themselves. Slavery, Jim Crow laws, employment and housing discrimination, mass incarceration, police brutality, and a historically racially biased health-care system have damaged Black communities—and they continue to fail us every day.

Reparations are in the news these days because they may finally become reality. On February 10, Rep. Shelia Jackson Lee (D-Tex.) reintroduced H.R. 40 in the United States House of Representatives. This bill would establish a commission to study and develop reparations proposals, confirming that reparations are needed to confront and combat the historical and contemporary harm done to the Black community by US laws and institutions. While H.R. 40 has been introduced many times in Congress, now the bill has support of President Joe Biden and his administration. Notably, Vice President Kamala Harris has officially supported this legislation since its introduction in the Senate last session.

Reparations are nothing new

Reparations for the Black community—and other communities in the United States—is not a new concept. One example is the infamous Tuskegee Experiment, in which doctors under the US Public Health Service studied about 600 Black men, the majority of whom had syphilis. Even though antibiotics to cure the disease where available, the men with syphilis didn't get them, and many died of the disease. After the study was made public in the early 1970s, the Black men and families who were affected filed a class action lawsuit to seek redress. They won a $10 million dollar compensatory reparations package that included benefits like lifetime medical insurance and burial services.

The US has provided monetary reparations to families who suffered during the forced internment of Japanese Americans during World War II. From 1942 to 1946, approximately 112,000 American citizens of Japanese heritage were moved to "relocation camps" throughout the Western US, abandoning their homes and businesses. Reparations to internees and their descendants came in 1988, when the Civil Liberties Act was passed.

Why reparations should focus on health and health care

Race-based health disparities are currently playing out in our modern-day reality. Black individuals and communities are disproportionally affected by COVID-19, per the CDC. Inadequate affordable housing, lower incomes, lack of access to high-quality education, and lack of access to culturally competent health care are some of the reasons the CDC cited for the disparity—with more Black people contracting COVID and also dying from it. Black workers are also overrepresented as essential workers, putting them at risk of COVID every time they go to their jobs.

We cannot forget that the current health of the Black community has been negatively affected long before COVID. "For Black people in the US, it all begins with the systemic racism that originated when slaves were brought into a space without adequate places to live," Dreisen Heath, a reparations researcher and advocate at Human Rights Watch, tells Health. Then once freed, Black people we did not have access to health care. Our "basic human rights were not realized until after emancipation, and then freed people went into legal segregation [where] the government designed policies that forced us into [geographic locations] that lacked resources like food, housing, and education," Heath explains.

"When health-care systems were created, they weren't created so that Black folks could survive or thrive," Krystal Redman, DrPH, the executive director of SPARK Reproductive Justice Now, a Georgia-based organization aimed at uplifting BIPOC resources and decisions regarding reproductive rights, tells Health. "Systems were created against us that placed Black folks with the furthest proximity to power."

Redman also says the concept of "weathering" plays a role when it comes to Black health. Weathering is a term developed by scholar Arline Geronimus to describe the long-term physical effects of trauma, racism and oppression, and how they affect our bodies over time. Weathering explains why Black folks continue to have such negative health-care outcomes—such as higher rates of maternal and infant mortality, poorer mental health, and shorter life expectancy.

What forms reparations could take

"Reparations must always be a part [of a] comprehensive investment plan in the Black community [because] we've been historically disinvested in [as a people]," says Heath. Reparations provide a specific solution to a specific harm, he explains, and international human rights law gives us guidance on what forms reparations can take:

Compensation

The most common form of reparations is compensation, with money given to the Black community in some form to remedy the large Black-white wealth gap that often contributes to health disparities.

Compensatory reparations can be direct cash payments to members of the Black community, but it can also be government and private entities investing in health-care institutions that are run by Black leaders and located in Black neighborhoods. Repayment could be satisfied by providing access to environmentally healthier housing and transportation, safe places to exercise, and the launching of farmers markets in Black areas. All Americans can help provide reparations to the Black community by shopping at Black businesses, donating to Black-run nonprofits, and investing in historically Black colleges and universities.

Reparative justice

Another type of reparations is reparative justice—a rehabilitative measure that allows Black communities to directly address the intergenerational impact of slavery, segregation, mass incarceration, and other racist systems. Reparations are "only successful once [the harm that has been done] is acknowledged; then you design and implement repairs measures together with the affected community," Heath says. For example, Evanston, Illinois recently passed a historical reparations program that allows eligible Black residents to receive $25,000 in home equity so they can build wealth. The program was created in consultation with Black residents and is not a direct cash payment program.

Satisfaction measures

Satisfaction measures tell the stories of Black American history in an honest way, such as a memorial or commemoration of a racist practice and how it affected the Black community in a specific area. For example, Heath knows of a hospital that once practiced race-based eugenics and forced sterilization; now the hospital has a plaque in the front entryway that acknowledges this historical harm and expresses a public apology.

Reparations are "only successful once [the harm that has been done] is acknowledged, then you design and implement repair measures together with the affected community," Heath says. In the case of the hospital, a plaque that informs the community of what happened there is an example of this kind of repair measure—as is training hospital employees to recognize implicit bias and practice culturally competent care.

As I am currently navigating the health-care system to ensure a healthy pregnancy and birth, I have found a lack of resources for soon-to-be Black mothers. Yes, research acknowledges that Black maternal and infant mortality is a crisis, but most research stops there and does not indicate that a repair measure is even being considered, let alone a repair measure that is actually informed by Black women.

To help remedy this issue, compensatory reparations should be provided to fund Black health-care providers, as well as to fund Black-run maternal health care services. The few confidential resources that suggest what repair could look like come from nonprofit organizations led by Black women themselves, which unfortunately is a common occurrence in the Black community when it comes to health care.

Even when harm is acknowledged by the majority health-care community, Black individuals are often tasked with finding solutions and implementing change without any resources. So I'm left to fend for myself with little support, when what I really need are reparations that go toward preventing maternal and infant mortality, creating patients know-your-rights documents, and building access to culturally aware patient advocates who can check in on patients while giving birth—to make sure my birthing experience is consensual, respectful, and in my best interest.

The counterarguments against reparations

Getting policymakers, providers, and everyday citizens on board to support reparations—especially those who are not a part of the group set to receive them—can be complicated. People who oppose reparations often counter by arguing that slavery was so long ago, or that they themselves aren't racist and shouldn't have to account for historical racism. Some say that Black people are responsible for elevating themselves, the "pull yourself up by your bootstraps" argument. People who "question or oppose [reparations] often do not understand why people are in need of repair [in the first place.]," Heath says.

Here's what Black leaders say to those anti-reparations arguments. As a response to "slavery was so long ago," Joia Adele Crear-Perry, MD, founder and president of the National Birth Equity Collaborative, a nonprofit Black maternal and infant health organization, explains to Health that slavery continues to play out today. She references the rate of killings of Black individuals by police, and how the modern-day US is linked to past racist systems.

She also hits back at the "I am not racist" defense by explaining that racism is interpersonal, and many studies have shown the negative effects of implicit bias toward Black folks in medicine. As for the "bootstrap" argument, Redman says that white folks have had generations to accumulate wealth, and that systems were created to help them thrive. Meanwhile, Black people are constantly starting at day one and navigating systems that work against us.

Here's the wealth gap in numbers: The Brookings Institute think tank released a study in 2020 revealing that white families in the US have a net worth of $171,000, while Black families have less that 10 times this amount. "Gaps in wealth between Black and white households reveal the effects of accumulated inequality and discrimination, as well as differences in power and opportunity that can be traced back to this nation's inception," the study states. "The Black-white wealth gap reflects a society that has not and does not afford equality of opportunity to all its citizens."

Now is the time to act

Black individuals living in the US deserve and demand reparations now. "With Joe Biden as president, and, more importantly, Kamala Harris as vice president, we have a real chance to start moving on reparations," Heath says. During a February press panel, White House Press Secretary Jen Psaki said President Biden "certainly would" support a study of reparations. "He understands we don't need a study to take action right now on systemic racism, so he wants to take actions within his own government in the meantime."

If reparations were in place, I would be able to have a less-anxious pregnancy, and my future child would benefit immensely from entering a world where they will be seen as worthy of survival. We need action now, so that my beautiful Black community has the health care needed to survive and access to mental-health care that will help us continue to cope. We deserve the dignity to live, survive, and thrive—because Black Lives Matter, and healthy Black lives are the only way to ensure a real future for our community.