Excerpted From: Mariya Denisenko, The Impact of Government Sponsored Segregation on Health Inequities: Addressing Death Gaps Through Reparations, 80 Washington and Lee Law Review 1687 (Fall, 2023) (350 Footnotes) (Full Document)


Mariya_Denisenko.jpegImagine that you live in a predominantly Black neighborhood in Richmond, Virginia. Your sixty-three-year-old brother begins to speak incoherently and cry out in pain. He is taken by ambulance to the nearest hospital. He is diagnosed with septic shock and immediately requires the resources of an intensive care unit. Unfortunately, this struggling hospital serving your neighborhood closed its I.C.U. a few years ago. Your brother must be transferred across town to get the care he needs. He deteriorates during transport and later dies. The doctors tell you that the delay in care due to the transportation time contributed to his death.

Alternatively, imagine that you live in a close-knit Black community in Philadelphia. One day you notice you are having difficulty breathing and are subsequently diagnosed with a very rare form of cancer. You then realize many of your neighborhood friends have also been diagnosed with rare cancers. When you start to wonder if it is a coincidence, your eye catches the oil refinery across the road with smoke rising above it.

Finally, imagine that you are a primary care physician serving patients in a Black neighborhood of Chicago. One of your long-term patients comes in for her annual visit. You notice her labs indicate her diabetes is out of control. You ask her about it, and she tells you she often needs to choose between buying insulin and putting food on the table for her kids.

These are not just imaginative exercises. These are the realities of Linda Jones-Smith, Kilynn Johnson, Dr. David Ansell, and thousands of people like them who are forced to confront health care inequalities that stem from racial segregation of neighborhoods.

It is no secret that the United States health care system is riddled with complexity, expense, and disparate health outcomes. Of all developed nations, the United States spends the most money on health care, yet staggers behind other developed countries in life expectancy. While the statistics on life expectancy are complicated and multifactorial, recent studies illustrate that, as a whole, people in the United States are less healthy than their counterparts in other developed nations.

But not everyone's health in the United States is negatively impacted. When evaluating health outcomes within the United States, the factor most predictive of one's life expectancy is one's zip code.

Death gaps--stark differences in life expectancy--in neighborhoods as close as one mile apart are widespread in the United States and are largely a function of inequality. Wealth inequality, exposure to toxic chemicals, and unequal access to health care services plagues certain neighborhoods. Unsurprisingly, it is the neighborhoods where Black Americans reside that predominantly face these challenges.

These inequities are easy to identify because most cities in the United States are highly segregated. This segregation is the result of laws and policies promulgated by governments of the United States. Through the twentieth century, in violation of the Constitution, the federal government and local governments implemented laws aimed at segregating cities. These efforts created racially segregated neighborhoods where residents' health is detrimentally impacted to this day. To make amends for this injustice, Congress must legislate to eliminate the detrimental impacts of segregation on Black communities.

This Note explores the ways federal and state laws and practices have contributed to health inequities faced by Black Americans. This Note then provides a framework to address this government sponsored injustice. In Part I, this Note evaluates how the federal government and state governments implemented various concurrent laws and practices that segregated cities throughout the country. These practices included implementation of segregated public housing, racially restrictive zoning laws, discriminatory lending practices, and the use of racially restrictive covenants to limit Black homeownership in White communities. Part II proceeds to analyze how government sponsored segregation of neighborhoods and limitation of Black homeownership detrimentally impacts the health of Black Americans to this day. This analysis focuses on how segregation contributes to wealth inequities, exposure to toxins from pollution, and lack of access to health care services faced by residents of Black neighborhoods. All of these factors contribute to worse health outcomes for Black Americans and at times differences of decades in life expectancy between Black Americans and their White counterparts. Part III of this Note proceeds to argue that in order to amend for decades of discriminatory legislation, Congress must pass a comprehensive reparations package aimed at eliminating health inequities. While recognizing that such legislation is likely to get challenged in the courts, this Note outlines how courts could rely on the Thirteenth Amendment to uphold this legislation.

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Inequalities in health outcomes faced by Black Americans are a symptom of racism and discriminatory policies implemented by the United States Government and individual state governments. Rectifying the government sponsored deprivation of property rights faced by Black Americans is a step toward addressing the root cause of health inequities. But it cannot be the only step taken. Black Americans face racism and discrimination within the health care system itself. While reparations would be a step toward amending the government enforced racism, health care institutions must also take steps to address inequities faced by Black Americans within health care systems.

J.D. Candidate, Class of 2024, Washington and Lee University School of Law; Bachelor of Science in Kinesiology, University of Illinois Chicago, Class of 2014; Doctor of Physical Therapy, University of Illinois Chicago, Class of 2017.