Association Between Racial Wealth Inequities and Racial Disparities in Longevity Among US Adults and Role of Reparations Payments, 1992 to 2018

Introduction

This cohort study aims to identify, address and quantify the relationship between longevity ( “all cause mortality”) and wealth as it relates to Black individuals versus white individuals. Furthermore, the study then models how reparations payments to the black community could potentially affect the longevity ( “all cause mortality”) gap between Blacks and whites. The study adds to the currently growing academic literature about reparations payments and their potential effect on the well-being of the Black community. By further exploring the direct connection between reparations and health outcomes, the authors attempt to specifically describe the role of monetary resources in determining  health inequities across racial groups. 

Many of the authors of this study, including Dr. Kathryn Himmelstein, Dr. Michelle Morse, and Dr. Bram P. Wispelwey are research fellows or instructors at Harvard’s School of Medicine. They are joined by various other practitioners and professors in the field of Health Policy like Dr. Mary T. Bassett, a professor at the Harvard School of Public Health and Dr. Atheendar S. Venkataramani from the UPenn School of Medicine. Dr. Jourdyn A. Lawrence and Dr. Jaquelyn L. Jahn from the Drexel School of Public Health also co-authored the report and both have a focus on race and health inequity. Lastly, William A. Darity, Jr, is a professor of Public Policy and African-American studies at Duke University. Dr. Darity’s book, “From Here to Equality” makes the case for reparations as a way to close the racial wealth gap. 

Methods and Findings

This first part of this study evaluated data from the HRS – Health Retirement Study, which has been conducted at the University of Michigan via survey collection from respondents every two years, since 1992. The wealth component of HRS was an input variable, in addition to many other variables such as income, race, education level, sex, marital status and others. As an outcome variable, longevity was calculated month and year of death from postmortem interviews with the Family and the National Death Index. For the reparations modeling portion of the study, $840,900 was distributed to each participating Black household, and was calculated by the mean 2019 household wealth gap between white and Black families. 

The findings suggest that when reparations payments were distributed to Black households, the gap in median longevity curtailed from 4 years to 1.4 years. The results were even stronger, -0.1 years (Black longevity exceeding white longevity) in models that excluded income and educational attainment. The results of this study suggest that Black middle-aged and older adults have a median longevity that is 4 years shorter than their white counterparts. Additionally, the study emphasized that financial reparations —transferring payments to Black US residents— have significant health benefits for the Black community. 

Five Weibull survival models were conducted that adjusted for different variables within each model. There were some key similarities and differences among the models: 

• In all models, being male was associated with greater likelihood of mortality. In addition, being married or partnered was associated with lower rates of mortality.  
• When adjusting for wealth, the racial longevity gap between Blacks and whites was removed entirely. In all other models that did not adjust for wealth but adjusted for income or educational attainment, there was still a significantly higher likelihood of death for Black participants over white participants.  
• Overall, the hazard of death decreased with each higher wealth decile; however, the largest decreases in hazard of death occurred within changes in the bottom 7 deciles of wealth compared to changes in the higher deciles of wealth. 

Conclusions

While reparations alone do not reduce all the structural determinants of health outcomes, this research study shows reparations intervention produces an improved, meaningful effect on the longevity of Black people in the US. This change reveals other multiple causes, which includes increasing access to healthcare, removing economic stress caused by chronic illness, and boosting neighborhood and community-level resources that support long term health. It is important to note that this study only focuses on the association between wealth and mortality and not on causal implication that wealth may have upon health outcomes. Most importantly, this study provides reliable data on the relationship between racial, economic, and health inequalities to advance the public health case for reparations in the U.S.