Healing ARC Newsletter
Study in JAMA Network Open Links Racial Wealth Gap to Health Inequities
BOSTON, MA – For years, public policy makers have recognized that, on average, Black Americans have significantly less wealth than White Americans and die earlier, and they have grappled with a simple question: what could close the wealth and longevity gaps?
Now, top researchers from Harvard Medical School, the University of Pennsylvania, Johns Hopkins University, Drexel University and Duke University have an answer. After analyzing longitudinal wealth and health data for 33,501 Black and White middle-aged Americans for up to 26 years in a government Health and Retirement Study, the comprehensive data points to reparations as an intervention that can begin to balance the scales.
In a newly published study in JAMA Network Open, the researchers conclude that providing reparations to Blacks would help close the wealth gap and, in turn, reduce the health and longevity gaps that currently exists with Whites. Specifically, researchers concluded that reparation payments could “substantially narrow” racial inequities in mortality.
Researchers noted that the median life expectancy of Black participants in the study was 77.5 years, four years shorter than the life expectancy of 81.5 years for White participants, a difference that “reflects the pervasive effects of structural racism,” they noted. Meanwhile, on average, in 2019, White households had a mean wealth of $980,549, or six times more than the mean wealth of $142,330 in Black households.
They concluded that the wealth gap accounts for a “considerable portion of these inequities in survival.”
Researchers wrote that few studies have studied the role of wealth in racial health inequality, and they projected the effect of equalizing wealth through reparations payments, concluding that differences in wealth accounted for much of the life expectancy gap. In their analysis, they indicate that fully closing the wealth gap would nearly equalize the chances of dying between Whites and Blacks, decreasing the current racial inequity in life expectancy.
“Many health workers are aware of the deadly impacts of racism on health for Black people, but few have supported reparations as a remedy,” said Dr. Michelle Morse, a co-author of the study and internal medicine physician and Assistant Professor at Harvard Medical School. “This research makes it clearer than ever for the medical and public health community to consider reparations as a remedy to advance racial justice and health equity.”
The data, rarely available in health studies, includes net value of investments, housing equity, vehicles, and other assets. Researchers sought to identify existing health disparities and the potential health effects of a significant wealth transfer to Blacks.
“Wealth may improve health through stable access to health care, housing, food, and education, while offering protection from chronic stress associated with economic uncertainty. Parental wealth plays a key role in children’s educational and economic opportunities,” the report says, adding that transferring wealth to Black Americans would “likely” aid historically Black universities, colleges, and hospitals, as well as offering possible “psychological benefits” for recipients.
“Our study demonstrates a reparations plan that raised Black net worth sufficiently to eliminate the racial wealth gap for Black American descendants of U.S. slavery would lengthen Black lives dramatically,” said Dr. William Darity Jr., professor of Economics, African and African American Studies at Duke University, and a co-author of the study.
Key findings include:
- Among the research subjects, whose average age was 59 at the outset of the study, the odds of dying for Blacks was 26% higher than for Whites, equivalent to 4.0 fewer years of remaining life expectancy.
- After adjusting for differences in wealth, survival did not differ significantly by race.
- Payments to close the mean racial wealth gap were associated with significant-to-complete reductions of the difference in life expectancy.
“Our findings add to the compelling moral case for reparations,” said Dr. Kathryn Himmelstein, a study co-author and infectious disease fellow at Harvard’s Massachusetts General and Brigham and Women’s Hospitals. “Compensating Black families for the economic legacy of slavery and discrimination would do more than heal their finances – it would improve their health and add years to their lives.”
Some activists and scholars have long advocated reparations for Black Americans as compensation for the racism that began with slavery and continued with Jim Crow laws, New Deal programs that initially excluded many Black Americans, housing policies that limited Black families from gaining intergenerational wealth, and other racist government policies and practices. Reparations advocates point to historical precedents like the U.S. government’s payments to previously interned Japanese Americans and Germany’s payments to Holocaust survivors. Poll data from 2021 suggest 36% of all Americans, including 86% of Black Americans, support reparations (up from 15% of Americans in 2014), and 196 members of Congress have signed on to a bill that would establish a federal commission to study reparations.
But the study’s authors cautioned that reparations payments “would not fully address structural determinants of health that would continue to be operative, such as political power, social capital, incarceration, policing, and discrimination in health care.”
Long-term solutions would need to include “eliminating ongoing practices that harm Black households, such as discriminatory lending and disproportionate burdens of penalties and fines,” researchers wrote.
Researchers also recognized the findings “merely document the association between wealth and survival, and any causal interpretation rests on the unproven assumption that greater wealth improves health.”
In conclusion, grappling with this issue, researchers concluded: “Racism harms the health and well-being of Black individuals through multiple mechanisms. Our study explores the importance of one mechanism—wealth inequality—through which past and present racial injustices increase mortality. Reparations payments are a means to redress the harms of enslavement and other racist policies and practices. Our study explores the importance of one mechanism—wealth inequality—through which past and present racism is associated with increased mortality.”
Cass Georges Finds Her Way Coordinating Community-Hospital Engagement
BOSTON, MA – At Brigham and Women’s Hospital (BWH) in Boston, Cassandra “Cass” Georges, a 26-year-old UMass Amherst graduate, plays an instrumental role in implementing a groundbreaking care model that is transforming patient care in medicine and eliminating an inequity in the hospital’s Emergency Department.
In 2015 a study found that over a 10-year period, on average, fewer Black and Hispanic heart failure patients were admitted to a specialty cardiology unit that improves patient outcomes. Subsequently doctors developed the Healing ARC framework, a race-conscious intervention that curtails racism in the admissions process and improves accountability.
The “ARC” in Healing ARC stands for acknowledge, redress and closure. Georges, who majored in public health at UMass, coordinates the community engagement that is central to completing the ARC. She is a program manager in the hospital’s Office of Ideas (Inclusion, Diversity, Equity and Social Justice), which champions and engages in health equity work with a core mission of addressing and reducing health equity barriers, particularly in underrepresented and vulnerable communities.
With a license to be creative granted by her supervisors, Georges organizes the “Wisdom Council,” a group of neighborhood leaders whose constituents are impacted by racism at the hospital. She explains why community engagement is such a vital part of the Healing ARC and restorative health equity work.
“We are reaching out to community members so we can leverage their input and insights in the hospital’s decision making,” Georges says. “There are too many times when attempts to address health disparities are designed at the top of the bureaucracy and ignore community views and opinions. Historically, instead of going to harmed populations and including their thinking in the remedy, they are completely cut out of picture.”
With the Healing ARC, it is starkly different, she says. “The community engagement is what propels this intervention forward in an inclusive, meaningful way.”
Stage one of the Healing ARC framework requires providers and institutions to acknowledge that racism contributes to inequitable health outcomes. Stage two is designed to redress the harm by providing redress to the harmed population, including opening access to services and care historically denied. Stage three is to facilitate closure through reconciliation and agreement that the harm has been redressed.
“Without the community, we cannot complete the Healing ARC. Completing the ARC is centered around restorative justice so it is essential there are other voices besides the culpable institution” Georges says. “We really need the community to be engaged with what the hospital is doing. This is the only way we can counter the pain and suffering that may have been caused by the acts of racism that kept Black and Hispanic patients out of the cardiology unit.”
She finds it “transformational” that the Healing ARC forces engagement with external partners that are authentic outside voices, strikingly different than an echo chamber in an institution.
“We have had some robust conversations centered around the three stages of the framework and have broken them up into their respective categories to begin identifying the best path to redress,” Georges says. “We dug deep to discuss what the acknowledgement of institutional racism even looks or sounds like because we honestly didn’t know where to begin, and honesty is the grounding piece to the healing ARC framework.”
For Georges, her “love” and “passion” for advocacy comes from enduring a difficult journey. She spent her childhood in foster homes spread across Massachusetts, as a product of the state’s child welfare system. “I grew up all over Massachusetts,” she recalls. “As many in foster care I was placed in many different homes. So, I think my love and my passion for advocacy stemmed from that, from kind of being young and having to figure out how to navigate the world for myself, and for other kids like myself. We were all trying to battle this system that operated against us and silenced us all our lives. So that is where my drive comes from.”
Georges relates her childhood journey to the importance of leveraging community trust through the Wisdom Council.
“Throughout my life. I had this anxiety centered around authority,” she says. “Because when you are in the child welfare system, they tell you what to do, where to go, when to go, you are removed from making your own decisions until you age out of the system. They monitor everything. You do not really have much autonomy over yourself. Your voice as you once knew it is stripped from you. And so, for me, the biggest thing is protecting people’s dignity, autonomy and amplifying or creating spaces for their voices to be heard. As I have grown, I have had to relearn what trust means for myself and carry that with me in the career field I am in. As a result, I have been able to create my own chosen family, and I bring that sense of community and healing with me into professional spaces, it drives the patient centered work that I do.”
What eased her journey, she says, was befriending teachers who became important mentors and helped guide her. She attended the Urban Science Academy in West Roxbury for high school and participated in a Student to Success Jobs program, which, ironically landed a job as a summer intern at BWH. Though she acknowledges it was difficult trying to plan her future without her parents, she credits a college access counselor and her senior year teachers with advising her to apply to college as an independent, which paved the way for her to attend UMass.
“I think it’s important that I’ve taken my past and I’ve turned it into something that I can be proud of,” she says.
Dr. Bram P. Wispelwey, an Instructor in Medicine at BWH and at the Harvard T.H. Chan School of Public Health, credits Georges with defining what authentic community engagement can be. “With the skills of both an orchestrator and conductor, Cass is brilliantly co-developing and convening a community Wisdom Council to imagine what institutional accountability looks like when it comes to pursuing health equity,” Dr. Wispelwey says. “Perhaps her greatest attribute is her remarkable ability to distill the Wisdom Council’s community perspectives into direct action steps within the hospital.”
Further, Dr. Wispelwey, who helped develop the Healing ARC framework, says: “Cass operates at the level of a co-creating, thought partner who is actively bringing herself and her experience into the work. Her deep investment in the project, which includes building out presentations and coordinating numerous conversations at all levels of BWH, shines through in the Wisdom Council’s own participation and excitement.”
Dr. Wispelwey cites Georges’ organizing abilities for advancing implementation of the Healing ARC. “Cass has moved Healing ARC from a theoretical concept to a concrete reality,” he says. “She has been instrumental in building the Wisdom Council into a dynamic, idea-generating community.”
For instance, at an upcoming session the Wisdom Council will meet with directors of the hospital’s non-physician employees, individuals working as receptionists, security, telephone operators, and more. The people on the frontlines. Georges wants to work out arrangements so they can hear the concerns of these works, learn if they have experienced racism at the hospital and what they perceive can be done about it.
“These are the people who live within the harmed communities,” Georges says. “These are people we need to bring into the conversation, hear their opinions, talk to them, and find out what they are thinking so that we can amplify their voices as we move through the ARC framework. A large piece of the puzzle is missing when you leave them out. And historically they are never a part of these conversations. They will see other racist patterns that we have not even thought about. They have seen all kinds of different patterns.”
What are her aspirations for the Healing ARC?
“This is not the first time I have been asked that question. And it is something that I ask myself as well. I am very intentional and very transparent about making sure that this is something that is exploratory, this is not something where we end up just telling the community what to do. My goal is to help the Healing ARC framework become extremely transformational. And so, my aspiration is that at the end of this, we have a clear playbook to show other hospitals and communities. We already have the framework, it is well explained, but through the piloting that we are doing with the community, we will have specific examples of how to engage that we can then show to other institutions. It is my hope that we can provide something tangible to a multitude of institutions and champion redressing disparities in a way that centers patient dignity, equity, and shared decision-making power.”
Dr. Manisha Sharma is Making a Difference
Tell us a little bit about yourself. Where did you grow up? What did your parents do for a living? Why did you decide to become a doctor?
I am an immigrant’s kid. I am first generation born in the United States to an Indian woman and a Pakistani father. I was born in Spanish Harlem in New York City. I have a little bit of that ‘Spicy Mami’ component in me. I grew up in a lot of different places. I was born in the seventies in New York City. Then when I was a teen, like around 13, we moved to Kansas. That’s a little different from Spanish Harlem. My mom is a retired pediatrician. During the eighties there was a movement to get physicians to the Midwest. My mom decided to move to the small town in Kansas because my aunt was out there. Kansas was a culture shock. Suddenly, you are in a small town, where if you blink, the town is gone. You are told things like: ‘Oh you are Indian, What tribe are you?’ Your identity is: You are the foreign doctor’s daughter, even though my mother is a U.S. citizen. As quickly as I could, I escaped Syracuse, Kansas and moved to Kansas City with my aunt and uncle.
Did you always want to be a doctor?
I wanted to be a musician. I went to Berklee College of Music to sing. But I ended up doing a lot of different things. I was not disciplined. I did not fit the stereotypical description of a “good Indian girl”. For the longest time, my mom would say, ‘I don’t know where you came from.’ I did not become a doctor because of my parents or any of that. I went against the grain. One day in Boston, where I lived for a long time, I was crossing in a crosswalk, and was hit by a car in Copley Square. That was a trigger for me to be a doctor. I had four major hip surgeries. I had to learn how to walk again. But I had an experience with the healthcare system that stung me. I came from privilege; I had never gone without. At one point in my recovery, I was dropped by an insurance company because I was considered a pre-existing condition. That made me want to learn more about this injustice. I became a healthcare rights advocate. I learned about the healthcare system. I realized it was bigger than me. And so, I decided that to change the system, I had to become part of it and better understand it. So, in my early 30s, I become a doctor. But I did not want to be just any doctor. I really wanted to be an activist, a physician activist, an advocate. I wanted to do social medicine and that is what I did. I was clear that I did not love medicine for the sake of medicine. I just love helping people.
Do you feel like at any point in your career that you were the victim of racial bias?
Oh God. There are so many. There is this thing about South Asians and medicine. There is always this perception that South Asians are doctors, engineers, or lawyers. There are a large number of South Asians in the medical field. Regardless, there is always racial bias. If I am in a room filled with White people, whether they are students, physicians, or otherwise, I am not perceived to be a doctor. I’m the nurse, or I’m somebody who’s not a physician. I have had patients spit on me and tell me they will not let me touch them. I have had patients ask me what kind of doctor I was, “the ‘dot kind’ or the ‘feather kind’ ”? There are times when you are scared to be in the room with some patients.
How does it affect you personally when you see patients that are impacted by structural racism in the healthcare system?
Well, I am going to speak up when I see it. That is just who I am. But I have colleagues and friends, even some of color who will not speak up. They will say, ‘Well, it is what it is.’ Or ‘Oh, you’ll get used to it.’ They are just so defeated by what they see. You are taught to just shut up. It is just one of those components “as part of your job”. One of many stark moments came when I was in training in the Bronx. One of the attendings was a White Cuban. We had a patient who was Jamaican, and she was speaking Patois and I understand Patois. We were doing our rounds. And he insists the patient has an altered mental state. ‘I don’t understand anything she’s saying.’ I remember looking at him and saying that she is speaking Patois. He is demanding that we get a CT of her head. He was doing it with good intention. But the issue was, she was saying things like, ‘I don’t want him in the room.’ She was extremely uncomfortable with him in the room. She only wanted to be treated by doctors of color.
How does this biased environment impact doctors?
Medicine is so pathological in the sense that you survived it. So now you are teaching the next generation to survive it. And then they go teach the next generation. And that is exactly what must stop. This should not be about surviving through medicine. This should be about thriving through medicine. If you are Black and Brown in medicine, if you are an ‘othered,’ minoritized population in medicine, we should not be just surviving. We should be thriving. When you talk about racism and medicine, we are taught to survive it. But that is what must change, that is why it is so important that we dismantle the structural racism that permeates throughout the medical field. I try to remember what I learned from Dr. Camara Jones: We need to constantly be asking, ‘How is racism operating here (in our environment)?’
How important is the Healing ARC framework?
The Healing ARC framework is critically important to the future. Those satisfied with the status quo will always look for reasons not to act. We do not want them saying there are no tools to fix the structural racism. We do not want them saying there is nothing that can be done. The Healing ARC removes that argument. It enables effective tools.
Are you surprised that a Medscape poll found that only 22% of all physicians see racial disparities in how patients are treated?
I am surprised it was 22%. I remember a poll of white medical students awhile back about 50% thought that Black patients perceived pain differently than White people because they have thicker skin. What does that tell you? These were educated students on their way to becoming doctors. The Medscape poll is a testament to the level of bias in the medical field and the amount of work that needs to be done to fix it.
Are you optimistic that race-conscious interventions, like those inspired by The Healing ARC, can help dismantle structural racism?
Yes, I am extremely optimistic. I recently led a workshop for family medicine physicians, students, and residents. There was hope in the room. A lot of them were young, White doctors, physicians-to-be. Interestingly, the leadership was of an older generation and White men. But I give them a lot of credit to sit back and listen when I made them uncomfortable with talk about structural racism. But the young doctors gave me hope. They were saying this exists and this is wrong. It showed that they are aware of the environment they are stepping into.
What can individual physicians do about structural racism?
Listen and learn. Ask yourself the questions. If you are in a position of power and someone is coming to you to talk about these issues, create a safe space. Create psychological safety for people to come see you, to tell you this is existing. Create a safe space for your patients to tell you that they feel uncomfortable with you or what is happening. Ask yourself, ‘Does racism operate here?’ And then do something about it. Help dismantle the structural racism that exists in our institutions. Be a part of the solution.
What can hospital administrators do to eliminate racism in their systems?
They need to ask themselves what are they doing to perpetuate it? Hospital administrators need to look at who is in their C-suite. Who is in power? Are they being inclusive in terms of people who advocate for equity, people who will be change-makers in an institution? How are they promoting physicians of color? Is the hospital administration setting minoritized physicians up for success? Are there pipelines for their advancement? How are they intentional with their work? How are you dealing with racism as an individual? The good hospital administrator today must be comfortable with being uncomfortable with issues about racism. And they must look in the mirror and ask, ‘Am I actually contributing to racism in medicine as an administrator, as an institution, as a person in power?’ This is what really needs to happen in hospitals in Massachusetts and around the country. The Healing ARC campaign is providing a platform for these questions to be asked.
Can racism be rooted out of the healthcare system in America?
Yes, but first we must acknowledge it exists. That is a first step, right? Acknowledge it. Cities and communities around the country are declaring that racism is a public health crisis. These narratives are really, really important. Once you name it, you can start to change it. We have had racism for 400 years in this country. That is what the country was built on. It has permeated into an array of institutions. Do I think we are moving the right direction? Yes. Because people are coming out and saying, ‘This happens to me, this is happening to me,’ With technology and social media, people are seeing the things that are happening. The Black & Brown patients at Brigham and Women’s Hospital in Boston that were not being admitted equally to the cardiology unit. Thanks to courageous professionals, like Drs. Michelle Morse, Bram Wispelwey, Michael Wilson, Regan Marsh and a whole team of folks, that is being directly challenged. They documented the structural racism in a study and developed The Healing ARC to address it. People know about the structural racism at the hospital; the hospital has acknowledged it and now The Healing ARC is fixing it. The bigger point is people are not ignoring racism anymore. Right? I hope that we can really, truly see racism uprooted in my lifetime. I am cautiously optimistic. We need to invest more into race-conscious interventions that are highly effective at rooting out racism.
How does racism in healthcare get eliminated?
Like we said, first it must be acknowledged. And that is what is happening. We are getting a broad range of people from the medical field to public officials to community and civic leaders, to see it and believe it. Then the next step is what The Healing ARC is doing: Giving people tools to fix it. The tools are a critical piece of the equation. People need to know what they can do to eliminate the racism in the medical field. And based on this new knowledge, we need to change curriculums, change the way doctors are trained, and make changes to the race and gender of the people in power, so the governing bodies can be more inclusive.
The Institute for Healthcare Improvement’s Kedar Mate Explains How to Engage Racism in Medicine Post COVID-19 Pandemic
“Too often we get trapped in our sense that inequities are impervious to change, that racism, sexism, and homophobia are so structurally embedded that to tackle them is beyond our collective room…it is crucial for us to change the narrative around inequities. To understand them not as inevitabilities, but as things that we can in fact improve.”
Dr. Kedar Mate, President and Chief Executive Officer at the Institute for Healthcare Improvement (IHI), gives a powerful address at IHI’s annual forum.