Reparations as Healing: A Public Health Argument

“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.”

— Bassett & Galea, writing in the New England Journal of Medicine

That sentence is not a complaint. It is a data point. And it is the foundation of one of the most urgent arguments in public health today: that reparations are not a political favor — they are a medical intervention.

When most people hear the word “reparations,” they think about money. About who owes whom, and how much, and whether it’s even possible after so many generations. What gets lost in those debates is a quieter, more urgent question: what happens to the body when economic harm goes unrepaired?

The answer, increasingly, is everything. Blood pressure. Cortisol levels. Infant birth weight. Life expectancy. The nervous system itself. Economic deprivation — especially deprivation rooted in structural racism — does not stay in the bank account. It moves into the body. It crosses the placenta. It shortens the telomeres. And it accumulates across generations in ways that no amount of individual resilience can fully undo.

This is the public health argument for reparations. Not as charity. Not as guilt. But as medicine.

The Body Keeps the Ledger

The racial wealth gap in the United States is not an abstraction. It is the material outcome of over 400 years of stolen labor, denied land, redlined neighborhoods, and blocked inheritance. And that gap — currently estimated at approximately ten cents of median wealth for every dollar held by white households — is inseparable from the racial health gap that runs alongside it.

Research published in Social Science & Medicine in 2025 confirmed what community health workers have long observed: wealth — not just income — is a powerful independent predictor of health outcomes for Black Americans. High-debt, low-asset households experience elevated anxiety, disrupted sleep, and measurable immune suppression. New York City’s own Environmental & Health Data Portal documents how household debt load correlates directly with stress-related illness — and Black New Yorkers carry that burden disproportionately.

The science goes deeper than stress. Researchers studying epigenetic aging have found that socioeconomic status and race combine to accelerate biological aging in Black Americans — measurable at the cellular level. In other words, economic inequality doesn’t just make life harder. It makes the body older, faster.

Wealth is not a luxury. For Black Americans, it is a vital sign.

The Life Expectancy Gap Is a Policy Outcome

In 2024, KFF’s analysis of National Center for Health Statistics data confirmed that while life expectancy is slowly recovering post-pandemic for Black Americans, racial disparities persist. Provisional 2022 data showed Black life expectancy at 72.8 years, compared to 77.5 years for white Americans — a gap of nearly five years.

KFF Health News reporting in 2025 traced this gap directly to the racial wealth divide — noting that progress made between 2000 and 2012 stalled precisely as wealth inequality grew again. The health gap is not a mystery. It follows the money — or rather, its absence.

A landmark 2021 study found that a full-scale federal reparations program closing the Black-white wealth gap would have significantly reduced COVID-19 transmission rates — not just for Black Americans, but for all Americans. Reparations, in that model, are an investment in shared public health infrastructure.

What Economic Repair Actually Does to the Body

The downstream effects of economic security are not abstract. They are physiological. When a household is no longer in survival mode — when rent is secure, when groceries are not a calculation, when a medical bill doesn’t mean choosing between insulin and electricity — the nervous system begins to regulate. Cortisol drops. Sleep deepens. Inflammation decreases. The body, freed from chronic threat response, can finally repair itself.

The American Academy of Family Physicians, in a 2025 position paper, named reparations a significant tool for addressing health inequities rooted in over 400 years of slavery and structural racist policy. Medicine treats the symptoms. Reparations address the cause.

Harvard’s FXB Center for Health and Human Rights, through its ongoing “Making the Public Health Case for Reparations” project, is working to bring this evidence into mainstream health scholarship. The conversation has entered peer-reviewed literature, hospital systems, and family medicine circles. The body of science is growing. The bodies carrying the burden cannot wait.

Evanston Is Watching

Evanston, Illinois became the first city in the United States to enact a government-funded reparations program in 2021. Its Restorative Housing Program provides $25,000 grants directly to eligible Black residents to address decades of housing discrimination between 1919 and 1969. As of late 2025, nearly $5.2 million had been distributed, reaching over 250 recipients.

Recipients used the funds for home repairs, mortgage assistance, and home purchases — all forms of housing stability with direct downstream health implications. The program’s focus areas now include health and wellness, as directed by the Reparations Stakeholder Authority of Evanston, whose community-led board centers Black residents as the architects of their own repair.

A 2023 survey by Northwestern University found that 70% of white Evanston residents viewed the reparations program as good public policy. This suggests that when communities see reparations in practice, they understand what reparations are: not punishment, but repair.

A Global Movement, An African Lens

The reparations conversation is not limited to the United States. A 2025 paper in PLOS Global Public Health built a public health framework for reparations and generational healing in Haiti — modeling the projected improvements in maternal health, child mortality, and infectious disease outcomes that a $30 billion restitution of France’s independence ransom could produce. That infectious disease burden is very real: in 2023, tuberculosis hit its highest recorded global case count in history, with communities shaped by colonial healthcare legacies — across sub-Saharan Africa, South Asia, and low-income neighborhoods in the US — bearing the heaviest toll.

In the African tradition, healing was never individualized. The village healed together, or not at all. The Ubuntu principle — I am because we are — is not simply a philosophy of belonging. It is a public health model. When one member of the community suffers a preventable harm, the community’s health is diminished. When that harm is repaired — economically, structurally, spiritually — the whole rises.

Reparations, understood through this lens, are not a transaction. They are a return to right relationship. A recalibration of who is protected, who is resourced, and who is allowed to rest.

What Healing Actually Requires

In wellness spaces, we talk a great deal about healing. About nervous system regulation. About ancestral trauma and somatic release. And those conversations matter — they are true, and they are necessary. But they are incomplete without this question: what are the material conditions in which healing is even possible?

You cannot fully regulate a nervous system that is still under structural threat. You cannot repair epigenetic damage while the same stressors that caused it remain in place. You cannot close a generational wound with breathwork while the policy architecture that opened it remains intact. Healing — real, lasting, biological healing — requires safety. Safety requires resources. Resources, for Black communities, were systematically extracted. Reparations are the correction.

The AAMC Center for Health Justice put it plainly: advocates for health equity must connect the dots between historic injustice and modern-day inequity. The gap between what was taken and what exists today is not a gap in effort or virtue. It is a gap in policy. And policy can be changed.

The village is only as healthy as its most neglected member. And the cure begins with acknowledgment, accountability, and repair — a logic that extends into how we hold each other accountable in community, including what Ubuntu teaches us about cancel culture and restorative accountability.

I Am Because We Are. And Together, We Heal.

References

1. Bassett, M.T., & Galea, S. (2020). Reparations as a Public Health Priority — A Strategy for Ending Black–White Health Disparities. New England Journal of Medicine. nejm.org
2. American Academy of Family Physicians. (2025). Health Impact of Reparations for Black Americans. aafp.org
3. Whittaker, S. et al. (2025). Race, wealth and health. Social Science & Medicine, 373. sciencedirect.com
4. Soled, D.R. et al. (2021). The Case for Health Reparations. Frontiers in Public Health, 9. ncbi.nlm.nih.gov
5. Barthélemy, E.J. et al. (2025). A public health framework for reparations and generational healing in Haiti. PLOS Global Public Health, 5(11). journals.plos.org
6. Harvard FXB Center for Health and Human Rights. (2022). Making the Public Health Case for Reparations. fxb.harvard.edu
7. KFF. (2026). Racial Disparities in Life Expectancy. kff.org
8. KFF Health News. (2025). The Growing Inequality in Life Expectancy. kffhealthnews.org
9. NYC Department of Health. (2023). How the Racial Wealth Gap Affects Health. a816-dohbesp.nyc.gov
10. AAMC Center for Health Justice. (2024). Racial Justice and Health Equity: Public Perspectives on Reparations. aamchealthjustice.org
11. Northwestern University. (2023). Overwhelming Support for Evanston Reparations Program. weinberg.northwestern.edu
12. Medrxiv. (2023). Epigenetic Age and Socioeconomic Status. medrxiv.org

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