“Need a Different Med”

“What in the world are you doing back here?” I stood in the doorway, confused by my patient’s appearance and mere presence.

He winced as he shifted upright in his bed, bracing the same shoulder that was cut open in a vehicular accident three weeks back. The last time I saw him, the shards of glass had been surgically removed, he was all stitched up, he had medication to heal the wounds, and was tolerating his pain with only Tylenol. He was just so happy to be free, he was nearly whistling out of the hospital. 

“Got a bad infection. Need different meds, I guess.”

Ahhh… The age-old tale of antibiotic resistance. You may have been warned against it when your doc told you to “take your antibiotics as prescribed and never stop taking them early.” 

Antibiotic resistance occurs when a medication wipes out the bacteria that makes us sick (good) but also destroys harmless bacteria that protect us (bad). If a stronger bacterium that does not respond to drugs is present, it may take over our bodily systems, often causing more harm than the original injury or illness (very bad). To prevent this, these days we focus less on how long you take the medication– it’s more about being precise with our prescription, being sure to target the right bacteria to heal the system.

Over time, we have played with various doses of social action to heal injustices that cause Black-White health inequities. We have called for apologies. We have called for ownership of blame and responsibility. We have called for policy changes, DEI training, hiring pipelines, and social media movements. We have been prescribed remedies to educational, political, and organizational injustices– so why are Black people still suffering some of the most detrimental health disparities in the nation?

I believe that reparations are the missing prescription in a centuries-long, arduous battle against racialized disenfranchisement of Black people in the United States. 

Defining Reparations

According to Merriam-Webster, reparations is defined as, “a repairing or keeping in repair”, “the act of making amends, offering expiation, or giving satisfaction for a wrong or injury,” and “the payment of damages, specifically, compensation in money or materials payable by a defeated nation for damages to or expenditures sustained by another nation as a result of hostilities with the defeated nation.” For at least a century, the provision of reparations for Black people in the United States has been a hotly debated topic. For me, the discussion goes beyond the boundaries of what we call the United States. My family is from Haiti, the first Black republic to liberate itself from the indignity of French enslavement in 1804. After 13 years of fighting, Haitians were suddenly freed– but with a price. The formerly enslaved were charged by France for post-emancipation damages and losses, totaling a sum of $21-115B, according to the New York Times. 

But we don’t have to look as far as the Caribbean to see a precedent for reparations. The Indian Claims Commission paid Native American/Indigenous individuals for land that was seized by the US. The US Congress appropriated funds to Japanese Americans who were victimized in WWII and sent to internment camps. As recently as 2016, France paid American citizens who are holocaust survivors and/or their posterity reparations. (For more, see the comprehensive list of US paid reparations from 1783 to 2023 developed by the University of Massachusetts Amherst).

Health and Economic Injustices

All of these reparations are warranted and much-needed, especially as we consider racialized health disparities in the United States. There are well-documented links between the legacy of slavery, perpetual Black economic disenfranchisement, and health disparities. Our ancestors were used for their bodies to allow the US her status as a financial superpower. Yet today, Black people make only 65 cents for every dollar a white person makes and have only about 1/10th the assets of their white counterparts. Black homeownership, life expectancy, and access to nutritious foods and healthcare are lower than all other groups in this country. 

Yes, the wealth gap and the health gap are inextricably tied.

A Tide That Lifts All Boats

There are many policymakers who believe in reparations by a different name. They call it “universal basic income” or UBI, and purport a long-term, monthly stipend from the government to citizens will stimulate economic, social, and health mobility for the entire US population. Multi-country study shows when UBI is provided to residents, these countries saw higher birth weights, better nutrition, better mental health, and better access to medications and healthcare. Specifically looking at UBI/reparations for Black US citizens, a study of 33,000 individuals found that wealth was associated with a longer life expectancy for Black people, even when controlling for other socioeconomic factors, like education. So when we demand “UBI” for Black people, know there is precedent and evidence for such a demand. 

Perhaps the betterment of Black people is not high on the dissenter’s list of priorities and they need a more… benign approach. According to the American Medical Association, healthcare is a $4.3T industry (with some inflation due to COVID-19). Researchers at Deloitte shared health disparities account for $320B in healthcare expenditure waste. Our current healthcare system is unsustainably broken, and we are all suffering under the weight of high-deductible plans, exorbitant medication costs, and decreasing healthcare quality. Think of reparations for the most marginalized in our society as a tide that lifts all boats– as we raise the threshold of health outcomes for some, we do so for all.

As the California Reparations Task Force task force attempts to make reparations a legislative reality in the state, let us remain grounded in this: We need a new prescription for antiracism– one that is not rooted in the ever-changing emotions of “remorse”, nor the opaque call for “responsibility”. We need a precise intervention that attacks health disparities at their source: economic injustice. All other actions are necessary but insufficient to fully heal the wound.