Health in All Policies: A Policy Framework for Reparations for African Americans

Health equity for African Americans will not come without restitutive justice—and by this, I mean reparations. Passing H.R. 40 in the United States Congress will be a start. H.R. 40 would establish a national commission to examine slavery and discrimination in the colonies and the United States since 1619 and recommend appropriate remedies. Once the nation assesses the impact of 400 years of slavery, segregation, and racial discrimination, we must adopt an equity-minded policy framework to grant reparations to African Americans. And yes, this means cash payments.

A policy framework for reparations must be three-fold: cash payments to individuals, a superfund for community development, and policy reform for wealth-building. Cash payments will enable African Americans to access resources for their health and wellbeing on their own terms. A superfund to improve African American communities will repair structural damage caused by housing and employment discrimination. This includes major investments in healthcare, education, jobs, and infrastructure. And a reform of wealth-building policies to explicitly target the economically disenfranchised will enable African Americans to maintain this wealth intergenerationally. This includes policies for paying for college, buying homes, and saving for retirement.

The central goal of reparations is to close the racial wealth gap, which has persisted over time and worsened since the 2008 financial crisis. The typical African American family owns just six percent of the wealth of a White family. It would take African American families a whopping 228 years to catch up to where their White counterparts are today if current economic trends persist. Clearly, time alone cannot close this gap.

Through closing the racial wealth gap, reparations will also improve health outcomes. Health and wealth work bidirectionally as two of the greatest race disparities in the United States. Poverty drives poor health, which in turn, impedes wealth accumulation. With nearly 40 percent of African American children born into poverty, it is no surprise that African Americans are more likely than White Americans to suffer from certain health conditions, get sick, and die from these conditions. When African American families do escape poverty, they are often one crisis away from returning due to the lack of a financial cushion that intergenerational wealth affords. The children of middle-class African Americans are also at a higher risk of slipping back into poverty as adults.

Wealth, defined as the accumulation of resources, is often built through intergenerational transfer. White terrorism has destroyed African American communities and potential for wealth-building whenever possible, as seen in Tulsa (1921) and Rosewood (1923). Home ownership through the post-World War II boom was the greatest wealth accumulation for most Americans. But African Americans were systemically barred from this opportunity. For over 40 years, the Federal Housing Administration practiced redlining, explicitly refusing to back loans to African Americans or even others who lived near them. As Ta-Nehisi Coates wrote in his case for reparations, “Redlining destroyed the possibility of investment wherever black people lived.” Redlining continues today.

Reparations for African Americans are not a novel concept, nor a radical one. African Americans are familiar with Union Army General Sherman’s order to give families of freedmen up to 40 acres each toward the end of the Civil War, which became known as “40 acres and a mule”. President Johnson later reversed this order. The reparations movement has been gaining traction outside of the African American community, from for-profit, non-profit, and intergovernmental organizations. Aetna issued a public apology for selling insurance policies on enslaved people. Harvard formerly remembered enslaved people owned by the university. Georgetown has furthermore given admissions preferences to descendants of enslaved people owned by that university. Notably, a United Nations working group concluded that the history of slavery, segregation, racism, and inequality in the United States justifies reparations for African Americans.

The United States government is no stranger to issuing reparations. It paid reparations to former slave owners through the District of Columbia Compensated Emancipation Act of 1862. It also paid reparations to Japanese Americans for forcibly relocating and incarcerating them in camps during World War II. Furthermore, it has begun to issue reparations from France to Holocaust survivors and their descendants living in the United States.

Yet, the government cannot fathom paying reparations to African Americans, on whose backs it churned the national enterprise of slavery and became the world’s economic superpower. We must reject the notion that African Americans are somehow undeserving of reparations. This notion is driven by racist undertones and falsehoods, whether it is White supremacist ideology that typecasts African Americans as lazy or the lie that civil rights legislation was enough. And we must stop regarding reparations as another government “handout”, but rather, as the restitutive justice that it is.

“Health in all policies” never rang truer than in reparations for African Americans. We must adopt a policy framework for reparations for African Americans, starting with the passage of H.R. 40.

—Keianna Dixon