Mary T. Bassett, M.D., M.P.H., and Sandro Galea, M.D., Dr.P.H.
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. A growing consensus highlights a structural basis for these preventable disparities — structural racism — clarifying the need for a structural solution. Black reparations are one such solution and, we believe, a long-overdue approach to persistent Black–White health disparities in the United States.
Though the racial gap in life expectancy has narrowed, Black Americans continue to die 4 years earlier, on average, than White Americans. The divides on other U.S. mortality measures are starker: Black mothers are three times as likely as White mothers to die from pregnancy-related causes1; Black infants are more than twice as likely as White infants to die in their first year, according to the Centers for Disease Control and Prevention (CDC); and the rate of premature death (before 75 years of age) is 30% higher among Black Americans than among White Americans.
These racial inequities have been the focus of attention from the medical and public health communities in recent years. The National Institute for Minority Health and Health Disparities, for example, began as a program within the National Institutes of Health (NIH) Office of the Director in 1990, and through a succession of legislative iterations become an Institute of the NIH in 2010. Its mission, in part, is “to reduce and encourage elimination of health disparities.” The CDC has, since 2011, issued Health Disparities and Inequalities Reports and Strategies for Reducing Health Disparities, highlighting public health approaches. Private foundations such as the Robert Wood Johnson Foundation have adopted health disparities reduction as a core goal, and a generation of scholars has worked assiduously on this challenge for several decades.