Reparations payments to Black individuals have been proposed to redress these injustices and, consequently, narrow racial wealth and health gaps. 12 - 14 The ideology of “colorblindness” has helped to perpetuate the effects of these policies into the present. 8 - 11Ĭurrent racial wealth inequities arose from centuries of government policies, including 250 years of slavery, rescission of the 1865 Field Order 15 (the promise of “40 acres and a mule” to formerly enslaved people), Black codes and Jim Crow laws, official tolerance of and participation in vigilante violence, exclusion of most Black workers from New Deal programs such as Social Security, discriminatory application of the homebuying provisions of the GI Bill, government-sponsored redlining that excluded most Black families from federally guaranteed mortgages, discriminatory criminal punishment, and lax enforcement of Civil Rights era laws designed to end discrimination in employment, policing, housing, health care, and lending. 7 However, because wealth data are less commonly collected in surveys, few studies have examined the role of wealth in racial health inequality. 5, 6 Because wealth is transferred intergenerationally, racial wealth gaps better reflect sustained economic disadvantages than do gaps in income or other measures. Although the median income of White familes is 1.65-fold higher than that of Black families, the difference in wealth (the value of all assets owned by a household) is 8-fold. 4 Although the role of income in mediating racial health inequities is well-documented, differences in income understate the extent of overall economic inequality. Racial health inequities in the US are shaped by structurally driven differential access to economic resources. Indeed, some scholars view “group-differentiated vulnerability to premature death” as a definition of racism 2 and suggest that inequities in excess deaths should serve as a metric of progress in eliminating racism. In the US, Black individuals have a higher mortality rate than White individuals, 1 a difference that reflects the pervasive effects of structural racism. Reparations payments to eliminate the racial wealth gap might substantially narrow racial inequities in mortality. In simulations, reparations to close the mean racial wealth gap were associated with reductions in the longevity gap by 65.0% to 102.5%.Ĭonclusions and Relevance The findings of this cohort study suggest that differences in wealth are associated with the longevity gap that exists between Black and White individuals in the US.
After adjusting for differences in wealth, survival did not differ significantly by race (hazard ratio, 1.00 ). Adjusting for demographic variables, Black participants had a hazard ratio for death of 1.26 (95% CI, 1.18-1.34) compared with White participants. Black participants’ median life expectancy was 77.5 (95% CI, 77.0-78.2) years, 4 years shorter than the median life expectancy for White participants (81.5 years). Results Of the 33 501 individuals in the sample, a weighted 50.1% were women, and weighted mean (SD) age at study entry was 59.3 (11.1) years. The survival effects of eliminating the current mean wealth gap with reparations payments ($828 055 per household) were simulated. Additional models controlled for educational level and income. Using parametric survival models, the associations among household wealth, race, and survival were evaluated, adjusting for age, sex, number of household members, and marital status. Main Outcomes and Measures The primary outcome was all-cause mortality by the end of survey follow-up in 2018. Data were analyzed from January 1 to September 17, 2022.Įxposures Household wealth, the sum of all assets (including real estate, vehicles, and investments), minus the value of debts. Participants included 7339 non-Hispanic Black (hereinafter Black) and 26 162 non-Hispanic White (hereinafter White) respondents. Objective To assess the contribution of wealth inequities to the longevity gap that exists between Black and White individuals in the US and to model the potential effects of reparations payments on this gap.ĭesign, Setting, and Participants This cohort study analyzed the association between wealth and survival among participants in the Health and Retirement Study, a nationally representative panel study of community-dwelling noninstitutionalized US adults 50 years or older that assessed data collected from April 1992 to July 2019. The role of wealth inequality in mediating racial health inequities is unclear. Importance In the US, Black individuals die younger than White individuals and have less household wealth, a legacy of slavery, ongoing discrimination, and discriminatory public policies. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.