Californians are weighing in publicly on the idea of reparations to Black Americans, with the state’s Reparations Task Force set to report their recommendations by July 1. This initiative builds on smaller-scale efforts, such as in my hometown of Evanston, Illinois, which in 2021 became the first U.S. city to promise limited financial reparations for slavery and city-sanctioned discriminatory housing policies.
Nationwide, much of the reparations conversation has focused on the financial burdens set in place by slavery and subsequent racist government policies. As a direct result of these factors, the median wealth of white households is about eight times that of Black households in the U.S. today.
This racial wealth gap on its own makes a strong case for reparations. But it should be joined by an equally egregious and often less acknowledged health gap: In the U.S., Black lives are years shorter on average than white lives. And as with the wealth gap, racism is a key culprit.
I am an anthropologist and epidemiologist who studies health inequity, and last year I began my testimony to the California Reparations Task Force by recounting stark figures compiled by the National Center for Health Statistics: Life expectancy for Black women in the U.S is three years less than for their white counterparts. For men, the difference is a striking five years lower.
This racial health gap largely traces to stress-related diseases like heart attacks and strokes, and it is not related to genetic differences. In fact, racial groups do not map neatly onto our genes. Instead they are fluid categories that societies establish in response to cultural norms, defined and perpetuated by those in power to maintain social control.
One example from the U.S. is the arbitrary Jim Crow-era “one-drop rule,” aimed at preserving white racial purity in some formerly slaveholding states. It specified that Americans could be considered white only if they showed no signs of past intermarriage with people of non-European ancestry. This meant that an American could have majority European ancestry and still be considered Black, and the same is true today.
Studies of human genetic diversity teach us that humans evolved in Africa and then migrated relatively recently to other continents. As a result, all human populations outside of Africa, including Europeans and Asians, are effectively just slightly modified subsets of the human species’ original African genetic diversity. Although we may vary in superficial ways such as skin color or hair type, all people share the vast majority of the same pool of genes.
Genetics don’t explain the huge racial health gap in America. However, the experience of being Black in America does. Specifically, decades of public health research shows that racism is a crucial factor. Racism makes day-to-day interactions more stressful and influences many other factors that affect disease, including healthcare quality and access, educational opportunities and neighborhood traits such as air quality, industrial pollutant exposure and access to healthy food.
Or consider the prevalence of cardiovascular diseases among Black Americans, which contributes to the Black-white mortality gap more than any other cause of death. A 2015 review in the American Journal of Epidemiology looking at relevant studies found that evidence of genes driving these disparities is “essentially nil.” Instead, research links this gap to social inequities. For instance, a 2020 analysis of the Jackson Heart Study, which has followed thousands of people’s health for 25 years, found that lifetime discrimination substantially increased the odds of heart disease among Black participants. A separate 2021 study found that Black participants had higher levels of the stress hormone cortisol — which has effects on conditions including blood pressure and heart disease — on days when they reported experiencing racial discrimination.
The health gap looms the minute Black babies are born in the U.S. Black Americans are more prone to low birth weight, which can lead to childhood health problems and to higher rates of hypertension, stroke and heart disease later in life. A landmark 1997 study in the New England Journal of Medicine showed that African immigrants in Illinois had babies with birth weights close to those of white mothers — but subsequent research found that after a generation or two spent living in the U.S., this community began to experience lower birth weights resembling those of African Americans whose families have lived here for many generations.
Lower birth weights for these mothers had nothing to do with genetics, and everything to do with the cumulative stress of being Black in America.
Although my testimony to the California Reparations Task Force began with bleak statistics, it ended on a hopeful note: Because the racial health gap is not genetic, we can reverse it. Health improves when we reduce stressors — and when families have access to adequate resources. In a Chicago-area study, upward economic mobility reduced Black mothers’ odds of giving birth to a small-for-gestational age baby. Initial studies of pilot programs to guarantee a minimum income point to improvements in mental health outcomes, including depression, for the affected communities.
Economists can tally the wealth gap between Black and white families created by centuries of racist policies in the U.S. The stark health inequities caused by systemic racism are harder to put a dollar value on, but they are another historic injustice that merits reparations. Material resources offered by reparations programs will help close the health gap, too. And the years lost from Black lives matter.
