value Blacks live by helping to close the racial wealth gap

IInstitutional declarations of support for Black Lives Matter have been ubiquitous since the killing of George Floyd. However, the radical transformative change demanded by hundreds of thousands of protesters across the country has not materialized.

Health systems can and should help move the country in this direction. It is important to address immediate social needs, such as food insecurity, housing or access to health care, as some health systems are now doing. But to truly value Black Lives Matter, they must also be willing to address one of the most important drivers of racial health disparities: the racial wealth gap.

At its most basic, wealth is the value of one’s assets minus the total amount of debt. The racial wealth gap is large, exists at every income level, and hasn’t changed in over a century. The median net worth of a white family in the United States in 2019 was $188,200, compared to just $24,100 for a black family.


The reasons for this gap are numerous and complex. But many can be traced back to a common denominator of structural racism: the end of slavery, when black families were set free to “freedom” with few or no assets; the effects of historical redundancies and contemporary home valuation differences on intergenerational wealth building through home ownership; subtle differences in the tax code that disproportionately affect how much black families receive on their returns; and more.

In an essay we wrote for the New England Journal of Medicine, we described the opportunities health systems have to rethink their role in building black wealth. Wealth matters for health, which should make it a natural focus for health systems that seek to prevent and treat disease. Greater wealth is associated with a reduced likelihood of early death, lower rates of chronic diseases such as high blood pressure and diabetes, and better overall functional status across the lifespan. Given the racial wealth gap that exists, it’s not surprising that it can be difficult to move the needle on health disparities without addressing this upstream determinant.


Consistent with the anti-poverty medicine model, we describe three key approaches—cost reduction, revenue maximization, and debt reduction/savings enhancement—to do this work and offer examples of how each can be applied. This work is easily done through medical-financial partnerships. These cross-sector collaborations between health and community-based financial organizations can improve the financial, physical, and mental well-being of those they serve.

To reduce costs, for example, health systems can connect staff and patients with public benefits to which they are entitled, allowing families to better meet basic needs. To maximize revenue, health systems can provide employees with a living wage or offer free tax preparation services for employees and patients to take advantage of potentially thousands of dollars in tax credits. To reduce debt and increase savings, health systems can connect black staff and patients to long-term investment products, such as child development accounts and 529 education plans, or make matching 401K contributions to all employees.

Health systems can purposefully source goods, services and food with black-owned businesses, which provides more opportunities to build wealth. Health systems can also limit business practices that can contribute to wealth shortages, such as health system consolidation, which can reduce prevailing wages by increasing health care costs and implementing aggressive bill collection practices.

We know some in the healthcare industry will protest: Is this it really the performance of health systems? Do health systems not have enough to focus on providing health care? Shouldn’t health systems stay in their lane and resist this scope creep?

We believe that if health systems are to work to promote health, a focus on the racial disparity in wealth is critical. We recognize that many health systems are now struggling with increased labor and supply costs, but we accept that this work complements their core role of providing health care.

Health systems are actually in a unique position to address the racial wealth gap because they are often economic drivers in their communities with both job opportunities and purchasing power. In addition, the health care sector is the largest employer of black Americans, even though black staff are often the lowest paid and have the worst health outcomes. Health systems have in-house expertise, including HR and business administration professionals, and can adopt an asset-based community partnership approach to bring in outside expertise to help staff and patients manage wealth.

Change is not always easy, but it is necessary for black lives to truly matter. Concrete steps like these are needed to make more progress in addressing the effects of racism, which sparked national protests on an unprecedented scale just two years ago.

The US is still at a crossroads, with an opportunity to fundamentally rethink and redefine the impact that health systems can have on erasing the ravages of structural racism on black lives. By focusing on closing the racial wealth gap, health systems have the chance to truly live up to the title of leading institution. In this way, the medical profession, in humble partnership with the communities it serves, can unironically claim that it not only values ​​black lives, but adds value to those lives.

George Dalambert is a pediatrician at the Children’s Hospital of Philadelphia (CHOP) Care Network and medical director of CHOP’s Medical Financial Partnership. Atheendar Venkataramani is an assistant professor of medical ethics and health policy and director of the Opportunity for Health Lab at Penn Medicine. Eugenia C. South is an assistant professor of emergency medicine at the Perelman School of Medicine at the University of Pennsylvania and faculty director of Penn Medicine’s Urban Health Lab.

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