Vista City Council
August 9, 2022

Much like in the criminal justice system, the effects
of slavery in the civil legal system have caused African Americans to experience significant inequities . African Americans, particularly those with low incomes, experi- ence numerous barriers in the underfunded court sys-
tems, both nationwide and in California, that prevent
them from accessing justice in civil courts .

THIS PAGE INTENTIONALLY LEFT BLANK

394
Chapter 11 An Unjust Legal System
Endnotes
1 See, e .g ., Alexander, The New Jim Crow
(2020) (Alexander); see also
Wilkerson, Caste: The Origins
of Our Discontents (2020) .
2 See, e .g ., U .S . Const ., 13th, 14th, and
15th Amends .
3 See, e .g ., The Civil Rights Act of 1866,
The Reconstruction Acts of 1867-1868,
The Ku Klux Klan Act, The Civil Rights
Act of 1875, The Civil Rights Act of
1964, The Voting Rights Act of 1965,
and The Fair Housing Act of 1968 .
4 Alexander, supra .
5 The Sentencing Project, Report of the
Sentencing Project to the United Nations
Special Rapporteur on Contemporary
Forms of Racism, Racial Discrimination,
Xenophobia, and Related Intolerance
(March 2018) (as of Apr . 24, 2022) .
6 Ibid .
7 Greene, Race, Class, and Access to Civil
Justice (2016) 101 Iowa L . Rev . 1263, 1266–
67 (Greene); DeVito, Of Bias and Exclusion:

An Empirical Study of Diversity Jurisdiction,
its Amount-in-Controversy Requirement,
and Black Alienation from U.S. Civil
Courts (2021) 13 Geo . J . L . & Mod . Critical
Race Persp . 1 (as of Apr . 24, 2022) .
8 Libgober, Getting a Lawyer While Black: A
Field Experiment (2019) 24 Lewis & Clark L .

Rev . 53 (Libgober) (as of Apr . 24, 2022) .
9 The Civil Practice Act, Stats . 1851, ch . 1, §
394, p . 113; The Criminal Act of 1850,
Stats . 1850, ch . 99, § 14, p . 230 .
10 See, e .g ., Sutton, Symbol and Substance:

Effects of California's Three Strikes
Law on Felony Sentencing (2013) 47
Law & Soc’y Rev . 1 (2013), 37–71
(as of Apr . 24, 2022) .
11 Libgober, supra .
12 Death Penalty Clinic, Berkeley Law,
Whitewashing the Jury Box: How
California Perpetuates the Discriminatory
Exclusion of Black and Latinx Jurors
(June 2020) (as of Apr . 13, 2022) .
13 See generally Hinton and Cook, The
Mass Criminalization of Black
Americans: A Historical Overview
(2021) 4 Ann . Rev . Criminology
261-286 (as of Apr . 13, 2022) .
14 U .S . Census, Map Showing the Distribution
of the Slave Population of the Southern
States of the United States Compiled from the
Census of the 1860 (as of Apr . 24, 2022);
see generally Office of Coast Survey,
National Oceanic and Atmospheric
Administration, Mapping Slavery in the
Nineteenth Century (as of Apr . 24, 2022) .
15 See generally Blackmon, Slavery by
Another Name: The Re-Enslavement of Black
Americans from the Civil War to World War II,
(2008) (Blackmon) at pp . 53-54, 99-100 .
16 See generally Blackmon, supra .
17 Ibid .
18 Ibid .
19 Ibid .
20 See generally Alexander, supra, at pp .
50-73 .
21 See generally Higginbotham Jr ., Virginia
Led The Way in Legal Oppression, (May
21, 1978), The Washington Post (as of
Apr . 24, 2022) (Higginbotham); see
also Newby-Alexander, The “Twenty
and Odd”: The Silences of Africans
in Early Virginia Revealed (2020) 57
Phylon 25–36 (as of Apr . 24, 2022).
22 General Court, Minutes of the Council
and General Court of Colonial Virginia (July
9, 1640), p . 466 (as of Apr . 24, 2022);
Higginbotham, supra; The court’s sen-
tence suggests that he was not already
enslaved as it would be nonsensical to
sentence an already enslaved person
to a sentence in which they must be
enslaved for the rest of their life .
23 General Court, Minutes of the Council
and General Court of Colonial Virginia (July
9, 1640), p . 466 (as of Apr . 24, 2022);
Higginbotham, supra; the court’s sen-
tence suggests that he was not already
enslaved as it would be nonsensical to
sentence an already enslaved person
to a sentence in which they must be
enslaved for the rest of their life .
24 Ibid .; see generally Higginbotham,
supra;
25 Ibid .; see generally Higginbotham,
supra .
26 Ibid . see generally Higginbotham,
supra .
27 Commonwealth of Virginia
Legislature, Act I . An act about the
casual [sic] killing of slaves (1669)
Act I . (as of Apr . 24, 2022) .
28 An act concerning Servants and Slaves
XXXIV (1705), Records of the American
Colonies, p . 459 (as of Apr . 24, 2022) .
29 An act concerning Servants and Slaves
XXXV (1705), Records of the American
Colonies, p . 459 (as of Apr . 24, 2022) .
30 Ibid .
31 Higginbotham, supra .
32 A Member of the Washington Bar, The
Slavery Code of The District Columbia
Together with Notes and Judicial
Decisions Explanatory of the Same
(1862) (as of Apr . 24, 2022) .
33 Slaves, [sic] and Free Persons of Color,
A Digest of the Laws of the State of
Alabama (1833) (as of Apr . 24, 2022) .
34 North Carolina General Assembly, An
Act Concerning Slaves and Free Persons
of Color (1831) (as of Apr . 24, 2022);
Philadelphia Female Anti-Slavery
Society, Extracts from the American
Slave Code (compiling extracts from
slave codes in Louisiana, Mississippi,
Alabama, Georgia, South Carolina,
North Carolina, Tennessee, Arkansas,
Missouri, Kentucky, Virginia, Maryland,
Delaware, and the District of Columbia)
(as of Apr . 24, 2022) (Extracts) .
35 Roberts v. City of Boston (Mass .
1849) 59 Mass .
36 Day v. Owen (Mich . 1858) 5 Mich . 520 .
37 The American Slave Code, An Act
respecting fugitives from justice, and
persons escaping the service of their
masters Extracts from the American
Slave Code (as of Apr . 24, 2022) .
38 Ibid . The American Slave Code, An Act
to amend, and supplementary to, the Act en-
titled “An Act respecting Fugitives from Justice,
and Persons escaping from the Service of their

395
Chapter 11 An Unjust Legal System
Masters,” Extracts From the American
Slave Code (as of Apr . 13, 2022) .
39 Dred Scott v. Sandford (1857) 60 U .S . 393 .
40 U .S . Library of Congress, Collection:

Slaves and the Courts, 1740 to
1860 (as of Apr . 24, 2022) .
41 U .S . Const ., 13th Amend .
42 See generally Kaczorowski, To Begin the
Nation Anew: Congress, Citizenship, and Civil
Rights after the Civil War The American
Historical Review Vol . 92, No . 1 (Feb .,
1987), pp . 45-68 (as of Apr . 26, 2022) .
43 An act to enforce the provisions of the four-
teenth amendment to the Constitution
of the United States, and for other pur-
poses Pub . L . No . 42-22 (Mar . 4, 1871)
17 Stat . 13 (as of Apr . 13, 2022) .
44 See generally Everly, Freedmen’s Bureau
Records: An Overview (Summer
1997) National Archives and
Records Administration’s Prologue
Magazine (as of Apr . 24, 2022) .
45 Alexander, supra, at pp . 36-38 .
46 Hammad, Shackled to Economic Appeal:

How Prison Labor Facilitates Modern
Slavery While Perpetuating Poverty in
Black Communities (2019) 26 Va . J .

Soc . Pol'y & L . 65, 66-67 (Hammad);
Whitehouse, Modern Prison Labor: A
Reemergence of Convict Leasing Under
the Guise of Rehabilitation and Private
Enterprises (2017) 18 Loy . J . Pub . Int .

L . 89, 90 (as of Apr . 24, 2022) .
47 Hammad, supra, at p . 66 .
48 Blackmon, supra, at pp . 52-53
49 Ibid .
50 Johnson, African Americans and
Homelessness: Moving Through History
(2010) 40 Journal of Black Studies
583–605 (as of Apr . 24, 2022) (Johnson) .
51 See generally Blackmon, su-
pra . African Ameri
52 Ibid .
53 Ibid .
54 Ibid .
55 Id . at pp . 52-54 .
56 Id . at p . 53 .
57 Ibid .
58 Alexander, supra, at p . 11 .
59 See, e .g ., Angola Museum at the
Louisiana State Penitentiary,
History of Angola (as of Apr . 16,
2022) (History of Angola) .
60 U .S . Const ., 13th Amend .; see generally
Pope, Mass Incarceration, Convict
Leasing, and the Thirteenth Amendment:

A Revisionist Account (2019) 94 N .Y .U . L .

Rev . 1465, 1467 (as of Apr . 24, 2022)
61 See, e .g ., Ruffin v. Commonwealth (Va .
1871) 21 Gratt . 790, 796 .
62 History of Angola, supra .
63 Oshinsky, Worse Than Slavery (1996) .
64 Ibid .; Blackmon, supra .; Cardon, “Less
Than Mayhem”: Louisiana's Convict Lease,
1865-1901 (2017) 58 Louisiana History:

The Journal of the Louisiana Historical
Association 417 (as of Apr . 24, 2022) .
65 Clark, Goshawk Environmental
Consulting, Inc ., Back to Bondage
Forced Labor in Post Reconstruction
Era Texas: Forced Labor in post
Reconstruction Era Texas (August
2020), at p . 5 (as of Apr . 24, 2022) .
66 Ibid .
67 Id . at p . 300
68 Ibid .
69 Blackmon, supra .
70 Blackmon, supra; Crouch, One Dies Get
Another: Convict Leasing in the American
South, 1866-1928, (1996); Mancini, Race,
Economics, and the Abandonment of
Convict Leasing (1978) 63 The Journal of
Negro History 339–352 (as of Apr . 24,
2022) ; Ledbetter, The Long Struggle to
End Convict Leasing in Arkansas (1993)
52 The Arkansas Historical Quarterly
1–27 (as of Apr . 24, 2022) .
71 Blackmon, supra, at p . 294-296 .
72 Id . at p . 377-382 .
73 Plessy v. Ferguson (1896) 163 U .S . 537 .
74 Alexander, supra, at pp . 38-44 .
75 Coffin v. United States (1895) 156 U .S . 432,
453; Equal Justice Initiative (EJI),
Lynching in America: Confronting the
Legacy of Racial Terror (2015), p . 20
(as of Apr . 24, 2022) (EJI 2015) .
76 Jordan, A History Lesson: Reparations for
What? 58 N .Y . Ann . Surv . Am .

L 557 at p . 588-589 .
77 Id . at p . 591 .
78 EJI 2015, supra, at p . 20 .
79 See generally Alexander, supra, at pp .
40-44 .
80 Luxenberg, The Forgotten Northern
Origins of Jim Crow (Feb . 12, 2019),
Time, Op-Ed (as of Apr . 24, 202
81 Ib
82 West Chester & Phil. R.R. Co. v. Miles (Pa .
1867) 55 Pa . 209 .
83 Patterson v. Taylor (Fla . 1906) 51 Fla . 275 .
84 Morrison v. State (Tenn .
1906) 116 Tenn . 534 .
85 Plessy v. Ferguson (1896) 163 U .S . 537, 548 .
86 See generally Jim Crow Museum,
Examples of Jim Crow Laws - Oct. 1960 –
Civil Rights (2001) (as of Apr . 24, 2022) .
87 See, e .g ., Alexander, supra; Small, The
War on Drugs Is a War on Racial
Justice (2001) 68 Social Research
896–903 (as of Apr . 24, 2022) .
88 Alexander, supra, at 130 .
89 Ibid .
90 Alexander, supra, at pp .
133-136, 144-149 .
91 Alexander, supra; 137-154 .
92 Alexander, supra, at pp . 50-73 .
93 Ibid .
94 Baum, Legalize It All: How to Win the War
on Drugs (April 2016), Harper’s Magazine
at p . 22 (as of Apr . 24, 2022) .
95 Primuth, Ronald Reagan’s Use of Race in
the 1976 and 1980 Presidential Elections
(2016) 100 The Georgia Historical
Quarterly 36–66 (as of Apr . 24, 2022) .
96 See generally Alexander, supra, at pp .
71-73 .
97 Schwartzapfel and Keller, Willie Horton
Revisited The Marshall Project (May
13, 2015) (as of Apr . 24, 2022) .
98 Ibid .
99 Ibid .

396
Chapter 11 An Unjust Legal System
100 President Richard M . Nixon, Remarks
About an Intensified Program for
Drug Abuse Prevention (June 17,
1971) (as of Apr . 24, 2022) .
101 Ibid .
102 Gorman, “War On Drugs” Continues In
United States Under New Leadership (1993)
307 BMJ: British Medical J . 369–371 (as
of Apr . 24, 2022); see also Reuter, Why
Has US [sic] Drug Policy Changed So Little
over 30 Years? (2013) 42 Crime and Just .
75–140, at pp . 80-85 (as of Apr . 24, 2022) .
103 See generally Feldman, Public Health
and the Policing of Black Lives, (2015)
7 Harvard Pub . Health Rev . 1–3 . (as
of Apr . 24, 2022); American Public
Health Association, Policy Statement:

Defining and Implementing a Public
Health Response to Drug Use and Misuse
(Nov . 5, 2013) (as of Apr . 24, 20
104 See, e .g ., Hudak, Biden should end
America’s longest war: The War on
Drugs Brookings (Sep . 2021) (as of
Apr . 24, 2022); see also Farber, The
War on Drugs turns 50 today. It’s time
to make peace (June 17, 2021), The
Washington Post (as of Apr . 13, 2022) .
105 See McCabe, Race/Ethnicity and Gender
Differences in Drug Use and Abuse Among
College Students National Library of
Medicine (2007) 6 J . Ethn Substance
Abuse 75-95 (as of Apr . 13, 2022); U .S .

Department of Health and Human
Services, National Institutes of Health,
Drug Use Among Racial/Ethnic Minorities
(Revised) National Institute on Drug
Abuse (2003) (as of Apr . 24, 2022) .
106 Anti-Drug Abuse Act of 1986, Pub . L .

No . 99-570, (Oct . 27, 1986) 100
Stat . 3207 (codified as amend-
ed at 21 U .S .C . § 801 et seq) .
107 Ibid .
108 Vagins and McCurdy, Cracks in the
System: Twenty Years of the Unjust
Federal Crack Cocaine Law American
Civil Liberties Union (Oct . 2006),
at p . ii (as of Apr . 13, 2022) .
109 Ibid .
110 Ibid .
111 Ibid .
112 Controlled Substances Act 21 U .S .C . §
801 et seq .
113 21 U .S .C . § 860 .
114 21 U .S .C . § 862 .
115 See generally Silva, Collateral Damage: A
Public Housing Consequence of the
War on Drugs (2015) 5 U .C . Irvine L .

Rev . 783 (as of Apr . 25, 2022) .
116 Williams, Fair Housing’s Drug Problem:

Combatting the Racialized Impact
of Drug-Based Housing Exclusions
Alongside Drug Law Reform (2016) 54
Harvard Civ . Rts .-Civ . Liberties L .

Rev . 769, 779 (as of Apr . 25, 2022) .
117 Ibid .
118 Sklansky, Cocaine, Race, and Equal
Protection (1995) 47 Stan . L . Rev .
1283–1322 (as of Apr . 25, 2022) .
119 Britton, Does Locked Up Mean Locked
Out? The Effects of the Anti-Drug Abuse
Act of 1986 on Black Male Students’ College
Enrollment, Berkeley Institute for
Research on Labor and Employment
(April 9, 2019, updated November
2020) p . 22 (as of Apr . 25, 2022) .
120 Borden, Every 25 Seconds: The Human
Toll of Criminalizing Drug Use In
The United States, (Oct . 12, 2016),
Human Rights Watch & Am . Civil
Liberties Union, p . 6 (2016) .
121 34 U .S .C . 12631§ et seq; see generally
Eisen, The 1994 Crime Bill and Beyond:

How Federal Funding Shapes the Criminal
Justice System Brennan Center (Sept .
9, 2019) (as of Apr . 24, 2022) .
122 Eisen et al ., Undoing the 1994 Crime Bill
Democracy & Justice: Collected Writings,
(2019), at pp . 71–72 (as of Apr . 25, 2022) .
123 Blumenson and Nilsen, Policing for
Profit: The Drug War's Hidden Economic
Agenda, (1998) 65 U . Chi . L . Rev . 35, 51-52,
82 (as of Apr . 25, 2022); Rainbolt, Crime,
Property, and Justice Revisited (The Civil Asset
Forfeiture Reform Act of 2000) (2003) Public
Affairs Quarterly, vol . 17, no . 3, at pp .
219–239 (as of Apr . 25, 2022); U.S. v. Reese
(9th Cir . 1993) 2 F .3d 870, 878, 880 [in-
volving police officers who used exces-
sive force and were at least partly incen-
tivized by keeping seized drug money] .
124 See, e .g ., American Civil Liberties
Union, Half of People Facing Civil Forfeiture
in Montgomery County are African-
American (October 19, 2015) (as of Apr .
25, 2022); Fritz, Timbs v. Indiana: Civil
Forfeiture, Racism, and the War on Drugs
(May 14, 2021) 98 Denv . L . Rev . Forum
1 [summarizing findings in various
jurisdictions] (as of Apr . 25, 2022); Lee
et . al ., Taken: How Police Departments
Make Millions By Seizing Property (April
22, 2020) (as of Apr . 25, 2022) .
125 Eberhardt et al, Seeing Black: Race,
Crime, and Visual Processing The Journal
of Personality and Social Psychology
Vol . 87, No . 6 (2004), p . 876 [sum-
marizing and citing to previous
research] (as of Apr . 25, 2022) .
126 Ibid .
127 Eberhardt, et al ., Looking Deathworthy:

Perceived Stereotypicality of Black
Defendants Predicts Capital-Sentencing
Outcomes, Psychological Science
(2006) (as of Apr . 25, 2022) .
128 Weir, Policing in black & white American
Psychological Association, Monitor on
Psychology (December 2016) Vol . 47,
No . 11 at p . 36 (as of Apr . 25, 2022) .
129 Moy, A Taxonomy of Police Technology's
Racial Inequity Problems (2021) 2021 U .

Ill . L . Rev . 139 (as of Apr . 25, 2022); see
generally Okidegbe, When They Hear
Us: Race, Algorithms and the Practice of
Criminal Law (2020) 29-SUM Kan . J .L .
& Pub . Pol'y, 329 (as of Apr . 26, 2022);
Selbst, Disparate Impact in Big Data Policing
(2017) 52 Ga . L . Rev . 109 (as of Apr . 26,
2022); Richardson et al ., Dirty Data, Bad
Predictions: How Civil Rights Violations
Impact Police Data, Predictive Policing
Systems, and Justice (2019) 94 N .Y .U . L .

Rev . Online 192 (as of Apr . 26, 2022) .
130 Ward v. Flood (1874) 48 Cal . 36, 52 .
131 Los Angeles Inv. Co. v. Gary (1919) 181 Cal .
680, 684 .
132 Stats . 1850, ch . 140, p . 424 .
133 The Civil Practice Act, Stats . 1851, ch . 1,
§ 394, p . 113 .
134 The Criminal Act of 1850, Stats . 1850,
ch . 99, § 14, p . 230 .
135 People v. Howard (1860) 17 Cal . 63, 65 .

397
Chapter 11 An Unjust Legal System
136 An Act Respecting Fugitives from Labor,
and Slaves Brought to This State Prior to
Her Admission into the Union, Chap .

XXXIII, April 15, 1852; see generally
Smith, Remaking Slavery in a Free State:

Masters and Slaves in Gold Rush California
in Pacific Historical Review vol . 80, No .
1 (2011) pp . 28-63 (as of Apr . 25, 2022) .
137 See generally Berger, Surveying the
Golden State (1850-2020) Vagrancy, Racial
Exclusion, Sit-Lie, and the Right to Exist in
Public California Legal History Vol . 16
(2021) pp . 212-16 (as of Apr . 25, 2022) .
138 Leonardatos, California’s Attempts to
Disarm the Black Panthers (1999) 36
San Diego L . Rev . 947, 970, 978 (as
of Apr . 25, 2022) (Leonardatos) .
139 Id . at pp . 967–70, 986; King, Heller as
Popular Constitutionalism? The
Overlooked Narrative of Armed Black
Self-Defense (2018) 20 U . Pa . Const . L .
1237, 1256–57 (as of Apr . 25, 2022) .
140 Leonardatos, supra, at p . 968 .
141 Ibid .
142 Id . at p . 970; see also Zick, Framing the
Second Amendment: Gun Rights, Civil Rights
and Civil Liberties (2020) 106 Iowa L .

Rev 229, 255-256 (as of Apr . 25, 2022);
Riley, Indians and Guns (2012) 100 Geo .

L .J . 1675, 1712 (as of Apr . 25, 2022) .
143 Leonardatos, supra, at pp . 969-971 .
144 Id . at p . 987 .
145 Churchill, A Not So Friendly Fascism?:

Political Prisons and Prisoners in the
United States (2006) CR: The New
Centennial Review vol . 6, no . 1, pp . 1-54
(as of Apr ., 25 2022) (Churchill) .
146 Ibid .
147 Autodidact 17, Black Panther Chip
Fitzgerald joins ancestors Amsterdam News
(April 15, 2021) (as of Apr . 25, 2022) .
148 Churchill, supra .
149 Martin, Elmer G. Pratt, Jailed Panther
Leader, Dies at 63 (June 3, 2011), N .Y .

Times (as of Apr . 25, 2022) .
150 Chalfin et al ., Police Force Size and
Civilian Race National Bureau
of Economic Research (Dec .
2020) (as of Apr . 25, 2022) .
151 Hadden, Slave Patrols: Law and Violence
in Virginia and the Carolinas
(2001) (Hadden) .
152 Williams, Jr ., Slave Patrol Ordinances of
St. Tammany Parish, Louisiana, 1835-1838
(1972) Louisiana History: The Journal of
the Louisiana Historical Association vol .
13, no . 4, p . 404 (as of Apr . 25, 2022) .
153 Hadden, supra .
154 Russ, supra, at p . 403 .
155 Russ, supra, at p . 404-412 .
156 Russ, supra, at p . 403 .
157 Russ, supra, at pp . 401-403 .
158 Spruill, Slave Patrols, “Packs of Negro
Dogs” and Policing Black Communities
(2016) Phylon (1960-) vol . 53, no . 1,
2016, pp . 42–66 (as of Apr . 25, 2022) .
159 Narrative of Walter Rimm, Image 254 of
Federal Writers’ Project: Slave Narrative
Project Vol . 16, Texas, part 3, Lewis-
Ryles, 1936 (as of Apr . 5, 2022); see also
U .S . Library of Congress, Collection:

Born in Slavery: Slave Narratives
from the Federal Writers’ Project, 1936
to 1938 (as of Apr . 25, 2022) .
160 See generally Parry, Police Dogs and
Anti-Black Violence Black Perspectives
(July 31, 2017) (as of Apr . 25, 2022);
Stephens, Police Wanted “A Dog That Would
Bite A Black Person,” (Oct . 29, 2020), The
Marshall Project (as of Apr . 25, 2022) .
161 Stole and Toohey, The City Where Police
Unleash Dogs on Black Teens The
Marshall Project (February 12,
2021) (as of Apr . 25, 2022) .
162 Sack, Mississippi Reveals Dark Secrets of a
Racist Time (Mar . 18, 1998), N .Y .

Times (as of Apr . 25, 2022) .
163 See generally Memorandum in Support
of Application for Clemency of Clyde
Kennard Pardon Docket No . 06-0005;
Minchin, Clyde Kennard: A Little-
Known Civil Rights Pioneer Mississippi
History Now (as of Apr . 25, 2022) .
164 German, The FBI has a history of targeting
black activists. That’s still true today
(June 26, 2020), The Guardian
(as of Apr . 25, 2022) .
165 Krivo and Peterson, Extremely
Disadvantaged Neighborhoods and Urban
Crime (1996) Social Forces 75(2): pp .
619-648 (as of Apr . 25, 2022) .
166 Krivo et al ., Segregation, Racial Structure,
and Neighborhood Violent Crime
(2009) American Journal of
Sociology vol . 114, no . 6 pp .
1765–1802 (as of Apr . 25, 2022) .
167 California Task Force to Study and
Develop Reparation Proposals
for African Americans (Dec . 7,
2021), Testimony of Bruce Appleyard,
(as of Apr . 25, 2022) .
168 U .S . Census Bureau, Quick Facts: U.S.
(as of Apr . 25, 2022) .
169 Pierson et al ., A large scale analysis of
racial disparities in police stops across the
United States (2017), Nature Human
Behavior 4, 736–745 (as of Apr . 25, 2022) .
170 Ibid .
171 Ibid .
172 Goncalves and Mello, A Few Bad Apples?
Racial Bias in Policing vol . 111, No . 5,
American Economic Rev . 1406-
41 (as of Apr . 25, 2022) .
173 Kahn et al ., How Suspect Race Affects
Police Use of Force in an Interaction
Over Time (2017) vol . 41, No . 2,
(2017) Law and Human Behavior
117-126 (as of Apr . 25, 2022) .
174 Engel et al ., Racial Disparities and
COVID-19 National Commission on
COVID-19 and Criminal Justice,
Council on Criminal Justice, (Nov .
2020), at p . 9 (as of Apr . 25, 20
175 Lamont and Molnár, How Blacks Use
Consumption to Shape Their Collective
Identity (2001) vol . 1, No . 1 (2001) Journal
of Consumer Culture (as of Apr . 25, 20
176 Ibid .
177 Id . at p . 37 .
178 Columbia Broadcasting System (CBS),
CBS This Morning, Interview with Michelle
Obama, Former First Lady of the United States
(May 7, 2021), CBS (as of Apr . 25, 2022) .
179 Ibid .
180 Butler, Stop and Frisk and Torture-Lite:

Police Terror of Minority Communities
(2014) 12 Ohio St J . Crim . L . 57,
57 (as of Apr . 25, 2022) .

398
Chapter 11 An Unjust Legal System
181 Voigt et al ., Language from police body
camera footage shows racial disparities
in officer respect (2017) vol . 114, No . 25,
Proceedings of the National Academy
of Sciences (as of Apr . 25, 2022) .
182 Kamalu and Onyeozili, A Critical
Analysis of the ‘Broken Windows’ Policing in
New York City and Its Impact: Implications
for the Criminal Justice System and the
African American Community (2018) vol . 11,
No . 1, Afr . African J . of Criminology and
Just . Stud . Studies 71 (Apr . 25, 2022) .
183 Ibid .
184 Sood, Biases Behind Sexual Assault: A
Thirteenth Amendment Solution to
Under-Enforcement of the Rape of Black
Women (2018) vol . 18, No . 2, U . Md .

L .J . Race, Religion, Gender & Class
405, 413 (as of Apr . 25, 2022) .
185 Id . at pp . 405-407 .
186 See generally Davey, Snapshot on the
State of Black Women and Girls:

Sex Trafficking in the U.S. (2020)
(as of Apr . 25, 2022) .
187 See generally University of Michigan
College of Literature, Science, and the
Arts, The Celia Project (as of Apr . 25, 2022) .
188 See, e .g ., van de Rijt, et al ., Racial and
gender differences in missing children’s
recovery chances vol . 13, No . 12 (December
31, 2018) (as of Apr . 26, 2022) .
189 U .S . Department of Justice, Federal
Bureau of Investigation, 2020
NCIC Missing Person and Unidentified
Person Statistics (2020) (as of Apr . 26,
2022); U .S . Census Bureau, Quick
Facts: U.S. (as of Apr . 25, 2022 .)
190 Sommers, Missing White Woman
Syndrome: An Empirical Analysis of Race and
Gender Disparities in Online News Coverage
of Missing Persons (2016), vol . 106, No .
2 The J . of Crim . L . and Criminology
275–314 (as of Apr . 26, 2022) .
191 See generally Our Black Girls (as of Apr .
26, 2022); see also Black Coalition Fighting
Back Serial Murders (as of Apr . 26, 2022) .
192See, e .g ., Burch, Who Killed Atlanta’s
Children? (Apr . 30, 2019), N .Y .

Times (as of Apr . 26, 2022) .
193 Ibid .
194 Ibid .
195 Ibid .
196 See Human Rights Campaign
Foundation, A National Epidemic:

Fatal Anti-Transgender Violence
in the United States in 2019 (Nov .
2019) p . 2 (as of May 19, 2022) .
197 Rummler & Sosin, 2021 is Now the
Deadliest Year on Record for
Transgender People (Nov . 18, 2021),
PBS (as of May 19, 2022) .
198 Sherman et al ., Transgender and Gender
Diverse Community Connection,
Help-Seeking, and Mental Health
Among Black Transgender Women
Who Have Survived Violence: A Mixed-
Methods Analysis (2021) 28 Violence
Against Women 890, 892, 908 .
199 Human Rights Campaign Foundation,
supra .
200 Nat . Center for Transgender Equality,
Blueprint for Equality: A Transgender
Federal Agenda for the Next Presidential
Administration and Congress (Oct .
2016) p . 28 (as of May 19, 2022) .
201 Id.
202Barton et al ., Mass Shootings Are
Soaring, with Black Neighborhoods
Hit Hardest (September 3, 2020),
The Trace (as of Apr . 25, 2022) .
203 Ibid .
204 U .S . Department of Justice and the
U .S . Equal Employment Opportunity
Commission, Advancing Diversity
in Law Enforcement, (Oct . 2016)
(as of Apr . 25, 2022) .
205 Ibid .
206 See, e .g . Cagle, Long Beach Police
Department pilot alleges racial discrim-
ination on the job (February 17, 2022)
Spectrum News, (as of Apr . 25, 2022);
Choi et al ., Black female police offices
allege discrimination, harassment in law-
suits (Jan. 7, 2022) National Broadcasting
Company News (as of Apr. 25, 2022);
Baker, Black Campus Police Officers Say
They Suffered ‘Unbearable’ Racism (June
22, 2021) N.Y. Times (as of Apr. 25, 2022.)
207 The Washington Post, Police shootings
database 2015-2022 (as of Apr . 25, 2022) .
208 Campaign Zero, Mapping Police
Violence Database (Mar, 15 2022),
Campaign Zero, (as of Apr . 25, 20
209 Sharara, et al ., Fatal police violence by
race and state in the USA, 1980-2019:
a network meta-regression (Oct . 2,
2021), The Lancet (as of Apr . 25, 20
210 See, e .g ., Say Their Names Memorial (as
of Apr . 25, 2022); Stanford Green Library
Exhibit (as of Apr . 25, 2022); #Say
Their Names (as of Apr . 25, 2022) .
211 See Rosenhall, California’s attempt to
reduce police shootings, explained (July 18,
2019 and updated on May 7, 2021) [sum-
marizing data from government and
scholarly sources] (as of Apr . 25, 2022) .
212 Cal . Department of Justice, Racial and
Identity Profiling Advisory Board
Annual Report 2022 pp . 6-8 (as
of Apr . 25, 2022) (RIPA 20
213 Id . at p . 8 .
214 Mendelson, Police Use Force on Black
Angelenos at Dramatically Higher Rates, Data
Shows Rates (July 7, 2020) [summarizing
data from the California Department
of Justice and American Community
Survey] (as of Apr . 25, 2022) .
215 Cal. Department of Justice, Use of Force
Incident Reporting 2016-2020
(as of Apr . 25, 2022) .
216 RIPA 2022, supra, at p . 8 .
217 Ibid .
218 Id . at p . 9 .
219 Id . at p . 8 .
220 Gross and Bames, Road Work: Racial
Profiling and Drug Interdiction on
the Highway (2002) 101 Mich . L .

Rev . 651 . [internal citation omit-
ted] (as of Apr . 25, 2022) .
221 Webb, Driving While Black: Tracking
Unspoken Law-Enforcement
Racism (January 9, 2007), Esquire
(as of Apr . 25, 2022) .
222 ACLU, ACLU Files Racial Profiling Lawsuit
Against the California Highway Patrol (June
1999), ACLU (as of Apr . 25, 2022) .
223 Ibid .
224 Zamora, CHP stops more minorities/
Agency admits law-abiding blacks, Latinos

399
Chapter 11 An Unjust Legal System
run greater risk of being pulled over (Apr .
20, 2001), S .F . Gate (as of Apr . 25, 2022) .
225 White and Holman, Marijuana
Prohibition in California: Racial Prejudice
and Selective-Arrests (2012) 19 Race,
Gender and Class J . 75 (as of Apr . 25, 20
226 Krupnick, ‘A farce of social equity’:

California is failing its Black cannabis
businesses (Nov . 4, 2021), The Guardian
(as of Apr . 25, 2022); Major, Five
Years After Recreational Legalization,
California is Failing its Black Cannabis
Business Owners (Nov . 9, 2021), Black
Enterprise (as of Apr . 25, 2022) .
227 U .S . Department of Justice, Federal
Bureau of Investigation, Criminal
Justice Information Services Division,
Hate Crime Statistics 2019 Hate Crime
Statistics (as of Apr . 25, 2022) .
228 Cal . Department of Justice, Hate Crime
in California (2020), p . 8 (as
of Apr . 25, 2022) .
229 Id . at p . 31 .
230 See generally Rickford, Black Lives
Matter (2016) 25 New Labor
Forum 34 (as of Apr . 25, 2022) .
231 Newton, L.A. Finds Mixed Results in
Curbing Police Dog Bites (Mar . 1, 1996),
L .A . Times (as of Apr . 25, 2022) .
232 Lawson v. Gates (Cal . Lawson v. Gates
(Super . Ct . L .A . County of Los Angeles,
Mar . 27, 1995) No . BC 91-31232) .
233 Los Angeles County Sheriff’s
Department Special Counsel,
33rd Semiannual Report of Special
Counsel (September 2013), at
p . 9 (as of Apr . 26, 2021)
234 Ibid .
235 See generally Roussell and Gascón,
Defining ‘Policeability’: Cooperation,
Control, and Resistance in South Los Angeles
Community-Police Meetings (2014) 61 Social
Problems 237 (as of Apr . 26, 2022) .
236 See generally Meyer, Police Shootings at
Minorities: The Case of Los Angeles (1980)
452 The Annals of the American
Academy of Political and Social Science
98 (as of Apr . 26, 2022); Knight,
Justifiable Homicide, Police Brutality, or
Governmental Repression? The 1962 Los
Angeles Police Shooting of Seven Members
of the Nation of Islam (1994) 79 The
Journal of Negro History 182 (as of
Apr . 26, 2022); Herbert, Morality in Law
Enforcement: Chasing ‘Bad Guys’ with the
Los Angeles Police Department (1996) 30
Law & Society Rev . 799 (as of Apr . 26,
2022); Stuart, Constructing Police Abuse
after Rodney King: How Skid Row Residents
and the Los Angeles Police Department
Contest Video Evidence (2011) 36 Law &
Social Inquiry 327 (as of Apr . 26, 2022) .
237 Ibid .
238 Ibid .
239 Ibid .
240 Pen . Code, § 13670, subd . (a)(2)) .
241 Center for Juvenile Law and Policy,
Loyola Marymount University Loyola
Law School, 50 Years of Deputy Gangs
in the Los Angeles County Sheriff’s
Department: Identifying Root Causes and
Effects to Advocate for Meaningful Reform
(Jan . 2021) (as of Apr . 26, 2022) .
242 Id . at p . 24 .
243 U .S . Census Bureau, 2020 Population
and Housing State Data (Aug . 12,
2021) (as of Apr . 26, 2022) .
244 Los Angeles Times Staff, Police Have
Killed 963 People in L.A. County
Since 2000 (Apr . 12, 2022), L .A .

Times (Apr . 26, 2022) .
245 Branson-Potts, Grim Sleeper’s victims
were vulnerable, young, and at
times ignored (May 5, 2016), L .A .

Times (as of Apr . 26, 2022) .
246 Ibid .
247 Ibid .
248 See generally Murch, Living for the City:

Migration, Education, and the Rise of
the Black Panther Party in Oakland,
California, (2010); Street, The
Historiography of the Black Panther
Party (2010) 44 J . Journal of American
Studies 351 (as of Apr . 26, 2022) .
249 Ibid .
250 Ibid .
251 Alderman and Inwood, How Black
Cartographers Put Racism on the Map (Feb .
24, 2021), Next City (as of Apr . 26, 2022) .
252 Peele, et al ., Exclusive: Blacks are only 7%
of the Bay Area, but 27% of those killed
by police (June 28, 2020 and updat-
ed on Sept . 2, 2020), The Mercury
News (as of Apr . 26, 2022) .
253 Chanin, et al ., Traffic enforcement in San
Diego, California: An analysis of SDPD
vehicle stops in 2014 and 2015 (Nov .
2016) p . 71 (as of Apr . 26, 2022) .
254 Campaign Zero, We evaluated policing in
San Diego. Here’s what we found
(as of Apr . 26, 2022) .
255 Ibid .
256 Ibid .
257 Ibid .
258 Ibid .
259 Cal . Department of Justice,
Sacramento Police Department Report
& Recommendations 2019 (as of Apr .
26, 2022); Cal . Dept . of Justice,
Review of Sacramento Police Department
Report & Recommendations Phase
II 2020 (as of Apr . 26, 2022) .
260 Complaint for Injunctive Relief,
People ex rel. Becerra v. County of
Kern (Cal . Super . Ct . County of
Kern, Dec . 22, 2020) No . BCV-20-
102971 (as of Apr . 26, 2022) .
261 Stipulated Judgment, People ex rel.

Becerra v. County of Kern (Cal . Super .

Ct ., County of Kern, Dec . 22, 2020) No .

BCV-20-102971 (as of Apr . 26, 2022) .
262 Complaint for Injunctive Relief, People
ex rel. Bonta v. City of Bakersfield
(Cal . Super . Ct ., County of
Kern, Aug . 23, 2021) No . BCV-21-
101928 (as of Apr . 26, 2022) .
263 Stipulation for Entry of Final
Judgment and Permanent Injunction,
People ex rel. Bonta v. City of Bakersfield
(Cal . Super . Ct ., County of Kern, Aug .
23, 2021) No . BCV-21-101928 Stipulated
Judgment (as of Apr . 26, 2022) .
264 Cal . Dept . of Justice, Attorney General
Bonta Launches Independent Review
of Torrance Police Department
(as of Apr . 26, 2022) .
265 Assem. Bill No. 89 (2021-
2022 Reg . Sess .) .

400
Chapter 11 An Unjust Legal System
266 Assem. Bill No. 750 (2021-
2022 Reg . Sess .) .
267 Assem. Bill No. 1506 (2019-
2020 Reg . Sess .) .
268 Sen. Bill No. 2 (2021-2022 Reg . Sess .) .
269 Id. at § 2, subd . (b) .
270 Assem. Bill No. 118 (2021-
2022 Reg . Sess .) .
271 Assem. Bill No. 26 (2021-2022 Reg . Sess .) .
272 See Federal Judiciary Act of 1789, § 29,
1 Stat . 73, 88 (1789) (“[J]urors shall
have the same qualifications as are
requisite for jurors by the laws of the
State of which they are citizens… .”) .
273 Equal Justice Initiative, Race and the
Jury: Illegal Racial Discrimination
in Jury Selection (2021) (as of
Apr . 26, 2022) (EJI 2021) .
274 18 U .S .C . § 243 (1948) (“No citizen
possessing all other qualifications which
are or may be prescribed by law shall be
disqualified for service as grand or petit
juror in any court of the United States,
or of any State on account of race, color,
or previous condition of servitude . . . .”) .
275 U .S . Const ., 14th & 15th Amends .
276 EJI 2021, supra, [citing Douglas L .

Colbert, Challenging the Challenge:

Thirteenth Amendment as a
Prohibition Against the Racial Use of
Peremptory Challenges 1 Cornell
Law Review 76, (1990)] .
277 Grimsley, African American Wrongful
Convictions Throughout History
(Feb . 28, 2013), Innocence
Project (as of Apr . 26, 2022) .
278 Equal Justice Initiative, Lynching in
America: Confronting the Legacy
of Racial Terror (3rd ed . 2017) p .
32 (as of Apr . 26, 2022) .
279 EJI 2021, supra .
280 Report on the Alleged Outrages in the
Southern States by the Select Committee
of the Senate (Washington, D .C .: 1871),
179 (quoting Judge Daniel Russell of
North Carolina); Cong . Globe, 42d
Cong ., 1st Sess . 158 (1871) (statement of
Senator Sherman quoting the report) .
281 Norris v. Alabama (1935) 294 U .S . 587 .
282 Id. at p . 588 .
283 Id. at p . 591 .
284 EJI 2021, supra .
285 Graetz, Trusting the Courts: Redressing the
State Court Funding Crisis (2014) 143
Daedalus 96 (as of Apr . 26, 2022);
Archer, Tackling Tough Issues: Scrutiny of
State Court Funding, Sentencing Guidelines
Aims to Improve the System (2004) 90 ABA
Journal 8 (as of Apr . 26, 2022); Podgers,
In Defense of the Courts: A Symposium
Finds Consensus on the Need, but No Easy
Path to Restoring Court Funding (2011) 97
ABA Journal 56 (as of Apr . 26, 2022) .
286 In re Humphrey (2021) 11 Cal .5th 135;
see also Sen . Bill 262 (2021-2022
Reg . Sess .) §§ 3, 4, 5 (amending
Pen . Code, § 1269bb, and adding
sections 1269d, and 1302 .5 .) .
287 See generally Brunt, Toward a Just
Model of Pretrial Release: A History
of Bail Reform and a Prescription for
What’s Next (2018) vol . 108, No . 4, J .
of Crim . L . and Criminology 701,
709–738 (as of Apr . 26, 2022) .
288 Boyd, Representation on the Courts? The
Effects of Trial Judges' Sex and Race
(2016) vol . 69, No . 4, Political Res .

Q . 788–799 (as of Apr . 26, 2022) .
289 See generally Barkow, Prosecutorial
Administration: Prosecutor Bias and the
Department of Justice (April 2013) 99 Va .

L .Rev . 271, 271–342 (as of Apr . 26, 2022) .
290 Compare Sloan, Racial Bias by
Prosecutors: Evidence from Random
Assignment (June 14, 2019) U . of
Notre Dame, Dept . of Econ .
(as of Apr . 26, 2022) .
291 Edlund, Eyewitness Racial Attitudes and
Perpetrator Identification: The Lineup Method
Matters (2008) vol . 10, No . 1, North Am . J .
of Psychol . 15, 25, 28 (as of Apr . 26, 2022) .
292 Joshi and Kline, Lack of Jury Diversity: A
National Problem with Individual
Consequences (September 1, 2015)
Am . Bar . Assn . (as of Apr . 15, 2022) .
293 Coleman, The Persistence of
Discrimination in Jury Selection: Lessons
from North Carolina and Beyond (June
2018) 42-JUN Champion 28, 32 (citing
additional studies) (as of Apr . 26, 2022) .
294 Fukurai et al ., Where Did Black Jurors
Go? A Theoretical Synthesis of Racial
Disenfranchisement in the Jury
System and Jury Selection (1991)
vol . 22, No . 2, J . of Black Studies
196–215 (as of Apr . 26, 2022) .
295 Levinson, Forgotten Racial Equality:

Implicit Bias, Decisionmaking, and
Misremembering (2007) 57 Duke L .J .
345, 398–407 (as of Apr . 26, 2022) .
296 Id. at p . 345 .
297 See generally Sommers, On Racial
Diversity and Group Decision Making:

Identifying Multiple Effects of Racial
Composition on Jury Deliberations (2006)
vol . 90, No . 4, J . of Personality and Social
Psychol . 597–612 (as of Apr . 26, 2022) .
298 Schmitt et al ., Demographic Differences
in Sentencing: An Update to the 2012 Booker
Report U .S . Sentencing Commission
(Nov . 2017), at p . 17 (as of Apr . 26, 2022) .
299 Sawyer, Visualizing the Racial Disparities
in Mass Incarceration (July 27, 2020), Prison
Policy Initiative (as of Apr . 26, 2022) .
300 Furman v. Georgia (1972)
408 U .S . 238, 251 .
301 Ibid .
302 Id. at p . 239 .
303 Death Penalty Information Center,
State by State (as of Apr . 26, 2022) .
304 Ibid .
305 Ndulue, Enduring Injustice: The
Persistence of Racial Discrimination in
the U.S. Death Penalty (Sept . 2020),
Death Penalty Information Center,
pp . 28-29 (as of Apr . 26, 2022) .
306 Baumgartner et al .,
#BlackLivesDon’tMatter: Race-of-Victim
Effects in US Executions, 1976-2013
Politics, Groups, and Identities
(2015), at p . 4 (as of Apr . 26, 2022).
307 The California Civil Practice Act, Stats .
1851, ch . 1, § 394, p . 113; The
California Criminal Act of 1850,
Stats . 1850, ch . 99, § 14, p . 230 .
308Semel et al . , Whitewashing the Jury Box:

How California Perpetuates the
Discriminatory Exclusion of Black and Latinx
Jurors (June 2020), Berkeley Law Death
Penalty Clinic (as of Apr . 26, 2022) .

401
Chapter 11 An Unjust Legal System
309 Id. at p . v .
310 Id. at p . 23 .
311 Id. at p . viii .
312 Id. at p . 23 .
313 Ridolfi and Possley, Preventable Error: A
Report on Prosecutorial Misconduct
in California 1997-2009 (Oct . 1,
2010), Northern Cal . Innocence
Project, Santa Clara Univ . School
of Law, p . 2 (as of Apr . 26, 2022) .
314 Ibid .
315 Couzens and Bigelow, The Amendment
of the Three Strikes Sentencing Law
(May 2017), California’s Three
Strikes Sentencing Law, California
Courts, p . 5 (as of Apr . 16, 2022);
see also Stanford Law School, Three
Strikes Basics (as of Apr . 26, 2022) .
316 Lockyer v. Andrade (2003) 538 U .S . 63;
see generally Chemerinsky, Cruel
and Unusual: The Story of Leandro
Andrade (2003) 52 Drake L .Rev
1, 2 (as of Apr . 26, 2022) .
317 Lockyer, supra, at p . 66 .
318 Ibid .
319 Ibid .
320 Id. at p . 67 .
321 Id. at pp . 68-69 .
322 Sutton, Symbol and Substance: Effects of
California's Three Strikes Law on Felony
Sentencing (2013) vol . 47, No . 1, Law &
Society Rev. 37–71 (as of Apr . 26, 2022) .
323 Gius, The Unintended Consequences of
the Three Strikes Laws: The Impact of
Long Term Imprisonments on Family
Structures (2017) vol . 43, Nos . 1-2,
Internat . J . of Sociology of the
Family 17–24 (as of Apr . 26, 2022) .
324 Langan, Race of Prisoners Admitted to
State and Federal Institutions, 1926-86
U .S . Department of Justice, Office
of Justice Programs (1991), pp . 1-54
(as of Apr . 26, 2022) (Langan) .
325 Id. at p . 5 .
326 Gramlich, Black imprisonment rate in the
U.S. has fallen by a third since 2006
(May 6, 2020), Pew Research
Center (as of Apr . 26, 2022) .
327 Widra and Herring, States of
Incarceration: The Global Context
2021 (Sept . 2021), Prison Policy
Initiative (as of Apr . 26, 2022) .
328 American Civil Liberties Union
(ACLU), Smart Reform is Possible: States
Reducing Incarceration Rates and Costs
While Protecting Communities (Aug . 2011),
ACLU, pp . 6, 9 (as of Apr . 26, 2022) .
329 See, e .g ., Ghandnoosh, U.S. Prison
Population Trends: Massive Buildup and
Modest Decline (Sept . 17, 2019), The
Sentencing Project (as of Apr . 26, 2022) .
330 Ibid .
331 U .S . DOJ Office of Justice Programs,
Prisoners in 2019 (Oct . 2020), pp .
1, 16 (as of Apr . 26, 2022) .
332 Federal Bureau of Prisons, Inmate Race
(last visited Apr . 26, 2022) .
333 Federal Bureau of Prisons, UNICOR
(trade name for Federal Prison Industries):

Program Details (as of Apr . 26, 2022) .
334 See, e .g ., Selby, How the 13th
Amendment Kept Slavery Alive: Perspectives
From the Prison Where Slavery Never
Ended (Sept . 17, 2021), The Innocence
Project (as of Apr . 26, 2022) .
335 Ibid .
336 Angola Museum at the Louisiana State
Penitentiary, History of Angola (as of
Apr . 26, 2022) (History of Angola);
see also Cardon, “Less Than Mayhem”:

Louisiana's Convict Lease, 1865-1901 (2017)
vol . 58, No . 4, La . History: The J . of
the La . Historical Assn . 417–441 (as of
Apr . 26, 2022) (Less Than Mayhem) .
337 History of Angola, supra; see also Less
Than Mayhem, supra .
338 History of Angola, supra .
339 History of Angola, supra; see also Less
Than Mayhem, supra .
340 History of Angola, supra .
341 Prison Enterprises, Agriculture, (as of
Apr . 16, 20
342 Hardy, Angola inmates make sugar cane
syrup the old-fashioned way (Dec . 23, 2014),
The Advocate (as of Apr . 26, 2022) .
343 Schrift, Angola Prison Art: Captivity,
Creativity, and Consumerism (2006) The
Journal of American Folklore, Vol .  119,
no . 473 at pp . 257–74 (as of Apr . 26, 2022) .
344 Louisiana Dept . of Corrections, LA
DPS&C Website (as of Apr . 26, 20
345 Federal Bureau of Prisons, Federal
Prison Industries Program Details
(as of Apr . 26, 2022) .
346 See generally Hammad, supra, at p . 66 .
347 Poole and Regoli, Race, Institutional Rule
Breaking, and Disciplinary Response: A Study
of Discretionary Decision Making in Prison
(1980) Law & Society Review Vol . 14, no .
4, pp . 931–946 (as of Apr . 26, 2022) .
348 Association of State Correctional
Administrators and the Liman Center
for Public Interest Law at Yale Law
School, Reforming Restrictive Housing:

The 2018 ASCA-Liman Nationwide
Survey of Time-in Cell (October
2018) (as of Apr . 26, 2022) .
349 Blad and Harwin, Black Students More
Likely to Be Arrested at School
(January 24, 2017), Education
Week (as of Apr . 26, 2022) .
350 Riddle and Sinclair, Racial disparities in
school-based disciplinary actions are
associated with county-level rates of
racial bias (April 2, 2019) Proceedings
of the National Academy of
Sciences (as of Apr . 26, 2022) .
351 National Center for Juvenile Justice,
Easy Access to Juvenile Populations
(EZAPOP) (as of Apr . 26, 2022) .
352 Ibid .
353 Ibid .
354 Pennington, Engaging Parents As A
Legitimacy-Building Approach in
Juvenile Delinquency Court (2012)
16 U .C . Davis J . Juv L . & Pol'y 481,
486 (as of Apr . 26, 2022) .
355 Gilore, Golden Gulag: Prisons, Surplus,
Crisis, and Opposition in Globalizing
California, (2007) .
356 Hernández, City of Inmates: Conquest,
Rebellion, and the Rise of Human Caging
in Los Angeles, 1771-1965 (2017) .
357 Id. at pp . 172-173 .
358 U .S . Census Bureau, Quick Facts:

California (as of Apr . 26, 2022) .

402
Chapter 11 An Unjust Legal System
359 See generally Goodman, “It’s Just Black,
White, or Hispanic”: An Observational
Study of Racializing Moves in California’s
Segregated Prison Reception Centers (Dec .
2008) Law & Society Rev . Vol . 42, no .
4, at pp . 735–770 (as of Apr . 26, 2022);
see also Goodman, Race in California’s
Prison Fire Camps for Men: Prison Politics,
Space, and the Racialization of Everyday Life
(2014) Journal .of Sociology Vol . 120, no .
2, at pp . 352–94 (as of Apr . 26, 2022) .
360 Plata v. Brown (2011) 563 U .S . 493 .
361 See generally Bachrach and Sexton,
The End of Mass Incarceration in
California: What Comes Next? (2016)
Boom: A Journal of California Vol . 6,
no . 2 pp . 4–7 (as of Apr . 26, 2022) .
362 California State Legislature, Assembly
Bill 2542 (2019-2020) (as of Apr . 26,
2022); see also Office of Governor
Gavin Newsom, Governor Newsom
Signs Landmark Legislation to Advance
Racial Justice and California’s Fight Against
Systemic Racism & Bias in Our Legal System
(Sep . 30, 2020) (as of Apr . 26, 2022) .
363 Cal . Prison Industry Authority,
Strategic Business Plan 2021-2024
p . 3 (as of Apr . 26, 2022) .
364 Ibid .
365 Cal . Dept . of Corrections and
Rehabilitation, Conservation (Fire)
Camps (as of Apr . 26, 2022) .
366 See, e .g . Stygar, Thinking Outside the
Box: A Point-Based System of
Reintegration for California's Inmate
Firefighters (2020) 56 Cal . Western
L .Rev . 455, 456 (as of Apr . 26, 2022) .
367 Macallair, After the Doors Were Locked: A
History of Youth Corrections in
California and the Origins of the Twenty-
First-Century Reform, (2013) .
368 Ibid .
369 Ibid .
370 Ibid .
371 Ibid .
372 Sen . Bill No . 823 (2019-
2020 Reg . Sess .) .
373 California Task Force to Study and
Develop Reparation Proposals
for African Americans (Oct .
12, 2021), Testimony of Jacob
Jackson, (as of Apr . 25, 2022) .
374 The Sentencing Project, Locked Out
2020: Estimates of People Denied Voting
Rights Due to a Felony Conviction (Oct .
30, 2020) (as of Apr . 26, 2022) .
375 See generally Joshi and Kline, Lack of
Jury Diversity: A National Problem with
Individual Consequences American Bar
Association (Sep . 1, 2015) (as of Apr .
26, 2022); Jackson-Gleich, Rigging
the Jury: How Each State Reduces Jury
Diversity By Excluding People with Criminal
Records (Feb . 18, 2021), Prison Policy
Initiative (as of Apr . 26, 2022) .
376 Bor et al ., Police Killings and their
Spillover Effects on the Mental Health of
Black Americans: a Population-based,
Quasi-Experimental Study (June 21, 2018),
The Lancet (as of Apr . 26, 2022) .
377 See generally Burks, African American
Men’s Negative Personal Experiences
With and Trust in Police (2021), Walden
University Dissertations and Doctoral
Studies (as of Apr . 26, 2022) .
378 Colin, It’s Never Too Late to Go to College
and Rewrite Your Story (Dec . 7, 2021),
N .Y . Times (as of Apr . 26, 2022) .
379 Ibid .
380 Johnson, supra, at pp . 583-605 .
381 Western et al ., Stress and Hardship after
Prison (2015) American J . of
Sociology Vol . . 120, no . 5 pp .
1525–1528 (as of Apr . 26, 2022) .
382 Couloute, Nowhere to Go: Homelessness
Among Formerly Incarcerated People
(Aug . 1, 2018), Prison Policy
Initiative (as of Apr . 26, 2022) .
383 Ibid .
384 Wildeman, Parental Incarceration, Child
Homelessness, and the Invisible Consequences
of Mass Imprisonment (2014) The
Annals of the American Academy
of Political and Social Science, Vol .
651, pp . 74–96 (as of Apr . 26, 2022) .
385 Couloute and Kopf, Out of Prison & Out
of Work: Unemployment Among Formerly
Incarcerated People [summarizing and
analyzing data from the Bureau of
Justice Statistics and scholarly sources]
(Jul . 1, 2018), Prison Policy Initiative (as
of Apr . 26, 2022); Gurusami, Working for
Redemption: Formerly Incarcerated Black
Women and Punishment in the Labor Market
(2017) Gender and Society Vol . 31, no .
4, pp . 433–56 (as of Apr . 26, 2022) .
386 Sykes and Maroto, A Wealth of
Inequalities: Mass Incarceration,
Employment, and Racial Disparities
in U.S. Household Wealth 1996 to 2011
(2016) The Russell Sage Foundation,
Journal of the Social Sciences Vol . 2,
pp . 129–152 (as of Apr . 26, 2022) .
387 U .S . Equal Employment Opportunity
Com ., Enforcement Guidance on the
Consideration of Arrest and Conviction
Records in Employment Decisions un-
der Title VII of the Civil Rights Act of 1964
(Apr . 25, 2012) (as of Apr . 26, 2022) .
388 See generally American Bar
Association, Lack of Jury Diversity:

A National Problem with Individual
Consequences (Sept . 1, 2015), ABA (as of
Apr . 26, 2022); see generally Jackson-
Gleich, Rigging the jury: How each state
reduces jury diversity by excluding people
with criminal records (Feb . 18, 2021), Prison
Policy Initiative (as of Apr . 26, 2022) .
389 Behrens et al ., Ballot Manipulation and
the “Menace of Negro Domination”: Racial
Threat and Felon Disenfranchisement
in the United States, 1850-2002 (2003)
Am . Journal of Sociology Vol . 109,
pp . 559-605 (as of Apr . 26, 2022).
390 Uggen and Manza, Democratic
Contraction? Political Consequences of
Felon Disenfranchisement in the United
States (2002) Am . Sociological Review
Vol . 67, pp . 777-803; Harvey, Ex-Felon
Disenfranchisement and Its Influence on
the Black Vote: The Need for a Second
Look (1994) 142 Univ . of Pa . L . Rev .
1145–89 (as of Apr . 26, 2022) .
391 The Sentencing Project, Locked Out
2020: Estimates of People Denied Voting
Rights Due to a Felony Conviction (Oct .
30, 2020) (as of Apr . 26, 2022) .
392 Ibid .
393 Assari et al ., Discrimination Fully
Mediates the Effects of Incarceration
History on Depressive Symptoms and
Psychological Distress Among African

403
Chapter 11 An Unjust Legal System
American Men, Journal of Racial and
Ethnic Health Disparities (2018)
pp . 243-252 (as of Apr . 26, 2022) .
394 Office of the Assistant Secretary for
Planning and Evaluation, The
Psychological Impact of Incarceration:

Implications for Post-Prison
Adjustment (Nov . 30, 2001), The U .S .

Department of Health and Human
Services (as of Apr . 26, 2022) .
395 Bor et al ., Police killings and their spillover
effects on the mental health of black
Americans: a population-based, quasi-exper-
imental study (June 21, 2018), The Lancet
Vol 392, pp . 302-210 (as of Apr . 26, 2022) .
396 Ibid .
397 See, e .g ., Burks, African American Men’s
Negative Personal Experiences with and
Trust in Police (Feb . 2021), Walden
University Dissertations and Doctoral
Studies (as of Apr . 26, 2022) .
398 Roberts, The Social and Moral Cost of
Mass Incarceration in African American
Communities (2004) Univ . of PA
Carey Law School, Penn Law:

Legal Scholarship Repository
1271, 1287 (as of Apr . 26, 2022) .
399 Durose and Langton, Requests for Police
Assistance, 2011 U .S . Department of
Justice, Office of Justice Programs
Bureau of Justice Statistics, (2013)
p . 4 (as of Apr . 26, 2022) .
400 National Advisory Commission on
Civil Disorders, Report of The National
Advisory Commission on Civil Disorders
(1968) (as of Apr . 26, 2022) .
401 The Civil Practice Act, Stats . 1851, ch . 1,
§ 394, p .
402 California Task Force to Study and
Develop Reparation Proposals for
African Americans (September 23,
2021), Testimony of Stacey Smith, [cit-
ing Smith, Freedom’s Frontier) (2014)
pp . 71-72] (as of Apr . 26, 2022) .
403 Greene, supra, at pp . 1270; DeVito, Of
Bias and Exclusion: An Empirical Study
of Diversity Jurisdiction, Its Amount-in-
Controversy Requirement, and Black
Alienation from U.S. Civil Courts (2021)
13 Geo . J . L . & Mod . Critical Race
Persp . 1 (as of Apr . 26, 2022) .
404 Judicial Council of Cal ., Advisory
Com . on Racial and Ethnic Bias, Final
Report on the California Judicial Council
Advisory Committee on Racial and Ethnic Bias
in the Courts (1997) (as of Apr . 26, 2022) .
405 Id . at p . 4 (as of Apr . 26, 2022); see also
Judicial Council of Cal ., Advisory Com .
on Racial and Ethnic Bias, Fairness in
the California State Courts: A Survey of the
Public, Attorneys, and Court Personnel
(1993) (as of Apr . 26, 2022) .
406 Gov . Code § § 12264-12271; see also
Assembly Bill No. 1241 (“Ban the Box
Housing Act”) (2021-2022 Reg. Sess.)
(Mar . 25, 2021) which may change
the law (as of Apr . 26, 2022) .
407 See generally Judicial Council of Cal .,
Clean Your Record (as of Apr . 26, 2022) .
408 Pen . Code § 1170 .18 .
409 Cal . Const ., art . 1, § 32 .
410 Pen . Code § 851 .93, § 1203 .045 .
411 Gov . Code § 12952 .
412 Pen . Code § 851 .91 .
413 Pew Charitable Trusts, Rickard, Many
U.S. Families Faced Civil Legal Issues in
2018 (2019), Pew (as of Apr . 26, 2022) .
414 Dred Scott v. Sandford (1857) 60 U .S . 393 .
415 Plessy v. Ferguson (1896) 163 U .S . 537 .
416 The Civil Rights Cases (1883) 109 U .S . 3 .
417 The Slaughter-House Cases
(1873) 83 U .S . 36 .
418 See, e .g ., The Civil Practice Act, Stats .
1851, ch . 1, § 394, p . 113; The Criminal Act
of 1850, Stats . 1850, ch . 99, § 14, p . 230 .
419 Greene, supra, at pp . 1266–67 .
420 DeVito, Of Bias and Exclusion: An
Empirical Study of Diversity Jurisdiction,
Its Amount-in-Controversy Requirement,
and Black Alienation from U.S. Civil
Courts (2021) 13 Geo . J . L . & Mod . Critical
Race Persp . 1, 3 (as of Apr . 26, 2022) .
421 See generally Podgers, In Defense of the
Courts: A Symposium Finds Consensus on
the Need, but No Easy Path to Restoring
Court Funding (2011, ABA Journal 97,
no . 11, 56–57 (as of Apr . 26, 2022);
Greenberg and McGovern, An Early
Assessment of the Civil Justice System After
the Financial Crisis: Something Wicked This
Way Comes? (2012) RAND Corporation,
pp . 5-12 (as of Apr . 26, 2022); Graetz,
Trusting the Courts: Redressing the State
Court Funding Crisis Daedalus, 143
(3), 96–104 (as of Apr . 26, 2022) .
422 Legal Services Corporation, The Justice
Gap: Measuring the Unmet Civil Legal
Needs of Low-income Americans (2017),
LSC, p . 60 (as of Apr . 26, 2022) .
423 Id . at 21 .
424 Id . at 30 .
425 See generally Corbett, Stunted Growth:

Assessing the Stagnant Enrollment
of African-American Students at the
Nation's Law Schools, (2008) 18
Temp . Pol . & Civ . Rts . L . Rev . 177;
Weatherspoon, The Status of African
American Males in the Legal Profession: A
Pipeline of Institutional Roadblocks and
Barriers, (2010) 80 Miss . L .J . 259, 264 .
426 See, e .g ., Pearson v. Murray (Md . 1936)
169 Md . 478; State of Missouri ex rel.

Gaines v. Canada (1938) 305 U .S . 337;
Sweatt v. Painter (1950) 339 U .S . 629 .
427 American Bar Association, 1912- ABA
Restricts Membership to White Lawyers
ABA (as of Apr . 26, 2022) .
428 National Bar Association, History of the
National Bar Association (as
of Apr . 26, 2022) .
429 American Bar Association , 1912 - ABA
Restricts Membership to White Lawyers ABA
(as of Apr . 26, 2022); see also Shepherd,
No African-American Lawyers Allowed: The
Inefficient Racism of the ABA’s Accreditation
of Law Schools (Mar . 5, 2001) 53 J . Legal
Educ . 103 (as of Apr . 26, 2022) .
430 Taylor, The Marginalization of Black
Aspiring Lawyers (2019) Florida
International University L . Rev .

Vol . 13 No . 3 (as of Apr . 26, 2022) .
431 American Bar Association, ABA
National Lawyer Population Survey
(2021), p . 4 (as of Apr . 26, 2022) .
432 American Bar Association, ABA Profile
of the Legal Profession (2020), p .
33 (as of Apr . 26, 2022) .
433 American Bar Association, Summary
Bar Pass Data: Race, Ethnicity, and

404
Chapter 11 An Unjust Legal System
Gender 2020 and 2021 Bar Passage
Questionnaire (as of Apr . 26, 2022) .
434 Ibid .
435 U .S . Census Bureau, Quick Facts: U.S.
(as of Apr . 26, 2022) .
436 American Bar Association, Model Rules
Prof. Conduct: Preamble: A Lawyer’s
Responsibilities (as of Apr . 26, 2022) .
437 State Bar of California, Rule 1.0 Purpose
and Function of the Rules of
Professional Conduct, Comment
5 (as of Apr . 26, 2022) .
438 See Shepherd, No African-American
Lawyers Allowed: The Inefficient Racism
of the ABA’s Accreditation of Law Schools
Journal (Mar . 5, 2001) 53 J . Legal
Educ . 103 (as of Apr . 26, 2022) .
439 King, Race, Identity, and Professional
Responsibility: Why Legal Services
Organizations Need African American
Staff Attorneys (2008) 18 Cornell L .

Rev . 1, at p . 1 (as of Apr . 26, 2022) .
440 See generally Judicial Council of Cal .,
The Road to Independence: A History
of Trial Court Funding California
Courts Review (Winter 2009) (as of
Apr . 26, 2022); Judicial Council of Cal .,
Special Rep.: Trial Court Funding,(1997)
(as of Apr . 26, 2022); Trial Court
Presiding Judges Advisory Committee,
Memorandum of Trial Court Presiding
Judges’ Advisory Committee’s Summary
of Impacts from “Instant Survey” (March
11, 2013) (as of Apr . 26, 2022) .
441 Judicial Council of Cal ., Judicial
Branch Budget Com . Rep . COVID-19
Backlog Funding Data, Materials for January
5, 2021 Meeting, Judicial Branch Budget
Committee (as of Apr . 26, 2022) .
442 The State Bar of Cal ., 2019 California
Justice Study Gap, Executive Report
p . 6 (as of Apr . 26, 2022) .
443 Id . at p . 7 .
444 Id . at p . 11 .
445 See generally American Bar
Association Standing Committee on
Legal Aid and Indigent Defendants,
Directory of Law Governing Appointment
of Counsel in State Civil Proceedings:

California (2016) (as of Apr . 26, 2022) .
446 Libgober, supra .
447 Id . at p . 26 .
448 Judicial Council of Cal ., Demographic
Data Provided by Justices and Judges
Relative to Gender, Race/Ethnicity, and
Gender Identify/Sexual Orientation
Gov . Code, § 12011 .5, subd . (n)))
(2020) (as of Apr . 26, 2022) .
449 State Bar of California, First Annual
Report Card on the Diversity of California’s
Legal Profession (2020), Appendix
Table 1 (as of Apr . 26, 2022)
450 Id . at p . 7 .

THIS PAGE INTENTIONALLY LEFT BLANK

Mental and Physical Harm and NeglectCHAPTER 12
I . Introduction
Scholars have stated that Europeans developed a racial
hierarchy in which Black people were relegated to the
bottom of humanity, and often placed outside of it al-
together, in order to justify the enslavement of African people . 1 The United States is no exception to this global reality . This chapter will describe how federal, state, and local governments subjected enslaved people and their
descendants to brutal and dehumanizing conditions,
policies, and practices . The United States has treated African Americans as subhuman and engaged in prac-
tices harmful to the health of African Americans through forced labor, racial terror, oppression, torture, sexual violence, abusive medical experimentation, discrimi-
nation, harmful neglect, and more, as will be explained throughout this chapter . Scholars have stated that rac- ism and enslavement are, at least in part, responsible
for the fact that African Americans have had the worst
healthcare, health status, and health outcomes of any
racial or ethnic group in the United States . 2
During enslavement, enslaved people were treated like
animals, and physicians provided healthcare only to the extent necessary to profit from enslaved peoples’ bod-
ies . 3 After the end of slavery in 1865 and a short-lived period of reconstruction, federal, state, and local gov- ernment officials worked with private citizens to segre- gate African American communities—damaging Black
health, creating unequal healthcare services for Black
people; depriving African American communities of safe
sanitation and adequate sewage systems; and sacrificing Black health for medical experiments . 4 During the 20th century, federal and state sponsored corporatization of healthcare resulted in rising healthcare costs, the sepa- ration of Black doctors from Black patients, and further inequality between white and African Americans . 5
Centuries of exposure to racism has contributed to a
serious decline in African American physical and men-
tal health . 6 African Americans die at disproportionately higher rates from preventable health problems . 7 Doctors are more likely to misdiagnose African Americans, lead- ing to disparate outcomes in mental health . 8 African American women face high rates of maternal death and
adverse birth outcomes—even Black women with the
highest education attainment have the worst birth out-
comes across all women in America . 9 African American

COURTESY OF LIBRARY OF CONGRESS/CORBIS/VCG VIA GETTY IMAGES Black men receiving intravenous treatment in Georgia. (1937)

407
Chapter 12 Mental and Physical Harm and Neglect children face poverty, malnutrition, and worse health
than that of white American children . 10 The mismanage- ment of public health crises by county, state, and federal governments has resulted in an undue burden of dis-
ease and death in African American communities—par-
ticularly during the COVID-19 pan-
demic . 11 Despite this, in the face of
overwhelming oppression, African
American healthcare providers, pa-
tients, and community members,
nonetheless, have worked to build
healthy communities and fight for a
more equitable healthcare system . 12
Section III of this chapter discusses
the racist theories developed and
perpetuated by doctors and sci-
entists about African Americans . Section IV describes
the health conditions of African Americans during en-
slavement . Sections V, VI, and VII discuss how system- ic discrimination and segregation was established and
how it continues in the American health care system .

Sections VIII and IX describe the history of medical
experimentation on Black bodies throughout American
history, and how medical research and technologies
harm African Americans . Section X describes the history of racism in mental health and the effects of 400 years of racial oppression on the mental health of African
Americans . Sections XI and XII discuss reproductive,
gender identity-responsive healthcare, and child health .

Section XIII discusses public health crises . Section XIV describes the effects of racial oppression on the physical health of African Americans .

II . Pseudoscientific Racism as Foundation of Healthcare During the enslavement era, scientific racism de-
fined race as an innate biological and genetic trait . 13 Pseudoscientific definitions of Blackness were based on differences in skin color, facial features, hair texture, lip size, and false beliefs about “brain size” and immu- nity to diseases . 14 Pseudoscientists invented “phrenolo- gy”—the baseless “science” of measuring the size of the skull as evidence of intelligence in different races . 15 This pseudoscience was influential across the United States
throughout the 1800s . 16 During the slavery era, medical researchers tried to prove that Black people were bio-
logically suited to slavery . 17
In the 1880s and 1890s, the decades following
Reconstruction, false medical theories explained the
poverty that African Americans experienced as justified by their “inherent inferiority,” instead of as the result of almost three centuries of enslavement . 18 Doctors pub- lished influential studies stating that African Americans’ “immorality” was responsible for the syphilis and tuber- culosis they suffered . 19 In 1880, the New Orleans public health agency claimed that African Americans’ naturally weaker immune system and “irregular habits,” were the
reason that so many African Americans died, rather than inadequate access to sanitation, drinking water, food,
and overcrowded uninhabitable housing due to racial
segregation . 20 During Congressional debates over the establishment of the Freedmen’s Bureau, a program
which included government-funded healthcare for
newly freed Americans, white legislators argued that
healthcare assistance to free Black people would result in dependence . 21 Consequently, federal and state gov- ernments relied on racist theories to justify slavery and racist neglect in public policy . 22
In the 20th century, the federal and state governments
supported the eugenics movement, which sought to
eliminate nonwhite populations, considered to have
undesirable traits . 23 Eugenics is based upon the white supremacist ideology that white Anglo-Saxon people
are an inherently superior race . 24 Eugenicists enacted laws resulting in the forced sterilization of undesirable “races,” including Black people, to create and maintain a white supremacist nation . 25 By 1931, 30 states had eu- genics laws that targeted vulnerable groups across the
nation for involuntary sterilization in federally-funded programs . 26 It was not until 1979 that federal sterilization regulations required voluntary consent of the person
being sterilized . 27
Today, studies have found that a significant number of
white medical students and residents hold false beliefs about biological differences between African Americans
and white Americans, such as the belief that African
Today, studies have found that a significant number of white medical students and residents hold false beliefs about biological differences between African Americans and white Americans, such as the belief that African Americans have a higher pain threshold than white Americans

408
Chapter 12 Mental and Physical Harm and Neglect Americans have a higher pain threshold than white
Americans . 28 Black patients are especially vulnerable to harmful biases and stereotypes, including the under-
treatment of their pain . 29 Physicians widely hold racist beliefs that African Americans feel less pain or exagger- ate their pain . 30 These beliefs result in racial bias in pain perception and treatment . 31 Consequently, anti-Black pseudo-scientific racism that justified enslavement
continues to adversely affect Black health today, as a
vestige of enslavement . Despite centuries of pseudo-
scientific racism and anti-Blackness in the healthcare
system, Black doctors, nurses, and healthcare workers
have worked tirelessly to provide anti-racist culturally responsive healthcare to Black communities . 32
California
California civic leaders were some of the most in-
fluential proponents of eugenics in the nation and
around the world—including in Nazi Germany . 33 They
played a key role in popularizing the eugenics move-
ment . 34 The Human Betterment Foundation was
a private think tank based in Pasadena, California
that promoted sterilization from 1926 to 1943 . 35 The Human Betterment Foundation shaped public policy in
California by working with state officials, representing the eugenics movement to the public, and collecting
data on sterilizations nationwide . 36 The foundation
hoped that public support would result in state leg-
islation that would increase the number of steriliza-
tions performed each year . 37 The foundation’s mem-
bers included many prominent leaders of Californian
institutions such as David Starr Jordan, Stanford
University’s first president; Los Angeles Times publish- er Harry Chandler; Nobel Prize-winning physicist and
head of the California Institute of Technology, Robert
A . Millikan; and University of Southern California
President Rufus B . von KleinSmid . 38
Thousands of mental health patients were forcibly
sterilized across California due to the eugenicist ef-
forts of the Human Betterment Foundation . 39 Black
patients were more likely to be sterilized than white
patients . 40 Paul Popenoe, a self-
trained biologist hired by the
Human Betterment Foundation,
stated that this was not surprising
because “studies show that the rate
of mental disease among Negroes
is high .” 41 Hundreds of thousands
of studies, pamphlets, and books
written by the Human Betterment
Foundation were distributed to
policymakers, schools, and librar-
ies . 42 In 1937, one of Nazi Germany’s
leading eugenicists wrote to Ezra S .

Gosney, the financier who started
the Human Betterment Foundation,
saying, “You were so kind to send…
new information about the sterilization particulars in
California . These practical experiences are also very
valuable for us in Germany . For this I thank you .” 43 III . Health and Healthcare during Slavery
Scholars have stated that the institution of slavery has had a lasting legacy in the discriminatory healthcare
system that would later emerge in the United States . 44 During the enslavement era, enslavers kept enslaved
people in overcrowded, dilapidated living areas, which
contributed to the spread of infectious and parasitic
diseases . 45 Enslaved people were denied treatment in hospitals and access to mental healthcare . 46 Enslavers freely and openly tortured enslaved people, raped and
abused women, and trafficked children with no legal
consequence . 47 Physicians used enslaved people for
dangerous experimental surgeries and procedures
without repercussion . 48 Federal, state, and local gov- ernments used the law to further damage the health of
enslaved people and dehumanize them, while neglect-
ing to provide public health and healthcare services . 49 Dr . Carolyn Roberts stated during a hearing before the California Task Force to Study and Develop Reparation
Proposals for African Americans that, “[t]his was a form of healthcare where medical violence against African
and African descended people became an acceptable,
normative, and institutionalized practice .” 50
Thousands of mental health patients were forcibly sterilized across California due to the eugenicist efforts of the Human Betterment Foundation. In 1937, one of Nazi Germany’s leading eugenicists wrote to Ezra S. Gosney, the financier who started the Human Betterment Foundation, saying, “You were so kind to send…new information about the sterilization particulars in California. These practical experiences are also very valuable for us in Germany. For this I thank you.”

409
Chapter 12 Mental and Physical Harm and Neglect Physical Health
Slavery had disastrous health consequences for en-
slaved people due to lack of public health regulations
and harsh working conditions that led to widespread
infectious and nutritional diseases . 51 Infectious and par- asitic diseases thrive in poor living conditions and over- crowding . 52 So, they were among the major causes of
illness and death for enslaved people . 53 Worm infections were common among enslaved people due to contact
with polluted food and soil . 54 Hookworm infestation re- sulted in low birth weights and high infant mortality . 55 Contagious respiratory diseases were prevalent in the
winter months due to the overcrowded quarters and un-
inhabitable living conditions . 56 Malaria led to low birth weights and high infant mortality . 57
The lack of federal or state public health regulations
resulted in contaminated food and water, nonexistent
sanitary facilities or sewage disposal, wastewater leak- age, and poor garbage disposal, which contributed to
diseases and infections that were more likely to affect enslaved people . 58 There was no government-funded
healthcare, or regulations regarding water treatment,
sewage disposal, or vaccination and the prevention of
disease . 59 Sexually transmitted infections were major public health problems affecting the lives of enslaved
people disproportionately due to forced breeding,
overcrowded quarters, and lack of access to treat-
ment . 60 Diseases, like pellagra, caused by a lack of nu- trition in the diet, weakened the immune systems of
enslaved people . 61
The health of enslaved people was worse than that of
white people, because there were hardly any hospitals
where they could be treated for disease . 62 With few ex- ceptions, enslaved people and free Black people were
not allowed to access hospitals, almshouses, and facil- ities for the deaf and blind . 63 The welfare of enslaved people was left to enslavers, while free Black people were forced to fend for themselves . 64 In 1798, Congress estab- lished a loose network of marine hospitals to care for
sick and disabled seamen, however, the U .S . Treasury
Department did not allow Black sailors to be treated at these hospitals . 65
White enslavers tortured enslaved people openly, in-
flicting cruel punishment upon them without any legal
consequences and often permanently damaged their
health . 66 Enslavers deprived enslaved people of food and water, whipped them to inflict serious pain, and abused them . 67 The brutal violence of enslavers and the harsh la- bor conditions they imposed resulted in branding, dog
bites, assaults with fists and rods, burns, lacerations, muti- lated body parts, and bone fractures for enslaved people . 68 Gashes from chains and iron restraints resulted in inju- ries, infections, and permanent disability for enslaved people . 69 Enslaved people were routinely murdered by white enslavers and white people who stabbed, shot, and whipped them to death with impunity . 70 The lack of pro- tections from extreme climates, in addition to harsh la- boring conditions, resulted in illness, injury, and disease . 71 Mental Health
The first public mental hospital in the United States was founded in 1773, in Williamsburg, Virginia . 72 Eventually, a few public mental asylums opened in Maryland,
Kentucky, and South Carolina during the antebellum
period . 73 Initially, Black patients were only admitted to the asylum in Williamsburg, Virginia—the other public
mental health institutions did not allow Black patients to be admitted . 74 There, free Black patients were funded The forehead of Wilson Chinn, a formerly enslaved person from Louisiana, was branded with the initials of his enslaver. Chinn is wearing a punishment collar and posing with other equipment used to punish slaves. (1863)

COURTESY OF ADOC-PHOTOS/CORBIS VIA GETTY IMAGES

410
Chapter 12 Mental and Physical Harm and Neglect by the state at much lower rates than whites, so patients received less care and services . 75 Some enslaved peo- ple were diagnosed with fictitious mental illnesses, as will be further discussed in Section X of this chapter . 76 Numerous “diseases” that allegedly affected enslaved
people were invented by southern doctors, including
“drapetomania,” the “irrational” desire to run away, and “dysesthesia,” a supposed laziness that caused enslaved people to mishandle enslaver property . 77 Doctors rec- ommended torturing enslaved people as “treatment” for
these false diseases . 78
Generally, antebellum mental asylums were segregat-
ed or closed to Black patients . 79 If admitted, Black pa- tients were housed in poorer accommodations and
forced to work at the asylums under harsher conditions
than white patients . 80 They were assigned the dirtiest and most difficult jobs, including meal preparation,
and handling the personal hygiene of ill patients . 81 In “Central Lunatic Asylum” in Virginia, enslaved people
were forced to labor, frequently on a plantation while
being mechanically restrained . 82 In the North, state and local governments typically denied African Americans
access to mental healthcare in asylums . 83 For mentally ill free African Americans in the North, the poorhouse and
the jail were the only social “welfare” institutions open to them in the antebellum era . 84 Free African Americans did work as janitors in northern mental hospitals and
medical schools, but were not allowed to work as direct caregivers . 85 Consequently, enslaved people and free African Americans were deprived of adequate mental
healthcare by federal and state governments during the
slavery era .

Enslaved Women and Children
Enslavers held unrestrained reproductive control over
enslaved women using rape and livestock breeding tech-
niques sanctioned by law . 86 The en-
slaver, President Thomas Jefferson,
wrote in his journal of plantation
management, “I consider a wom-
an who brings a child every two
years as more profitable than the
best man of the farm . [W]hat she
produces is an addition to the cap-
ital .” 87 Jefferson was commenting
on the enslaver’s practice of using
enslaved women to reproduce, like
livestock . Enslavers used a variety of
tactics to induce enslaved women
to bear children—such as punishing and selling women
who did not bear children, committing sexual assault,
manipulating the marital choices of enslaved people,
and forced breeding . 88 State laws stated that children born to enslaved mothers and white men were legal-
ly considered to be enslaved, leading enslaved women
to be vulnerable to sexual violence inflicted by white
men . 89 Furthermore, state laws did not recognize the rape of enslaved women as a crime . 90
White enslavers were legally allowed to economical-
ly profit from raping enslaved women because rape
generated a larger workforce of enslaved people—and
enslavers could rape freely, without consequence . 91
White women married to enslavers often whipped and
tortured enslaved women after they were sexually as-
saulted by white men . 92 Enslavers inflicted psychological and physical punishment on enslaved women if they did
not bear children . 93 Enslavers forced enslaved women to submit to being raped by men and castrated enslaved
men who were not fit for “breeding .” 94
The health of enslaved mothers and their babies was
greatly damaged due to the treatment of enslaved
women as objects to be raped, bred, or abused . 95 On
average, enslaved women became mothers earlier than
white women due to pressure to reproduce . 96 Enslavers treated enslaved women who did not bear children
as “damaged goods”—pawning them off on other en-
slavers . 97 Southern courts even established rules for sellers of enslaved women who misrepresented their
fertility, which were akin to rules governing the sale of commodities—i .e ., imposing some sort of fine or con-
sequence for misrepresenting their “merchandise .” 98
Mother-child bonding was shattered as white enslav-
ers trafficked children for labor to other plantations or sold them . 99 Records show that expectant mothers only received work relief after the fifth month of pregnan-
cy and often returned to heavy labor within the first
month of the infant’s life . 100 Enslaved mothers were forced to labor in fields and to breastfeed white chil- dren, while neglecting their own . 101
Pregnant enslaved women were whipped routinely by
white enslavers . 102 Enslavers dug holes in the ground, forced women to lie face down so that their stomachs
would fit inside the holes, and whipped their backs . 103 Numerous “diseases” that allegedly affected enslaved people were invented by southern doctors, including “drapetomania,” the “irrational” desire to run away, and “dysesthesia,” a supposed laziness that caused enslaved people to mishandle enslaver property. Doctors recommended torturing enslaved people as “treatment” for these false diseases.

411
Chapter 12 Mental and Physical Harm and Neglect This was done to punish enslaved women without dam-
aging the fetus, which was legally considered to be the enslaver’s future property . 104 Women became pregnant during winter months when labor was reduced, con-
sequently giving birth during the summer—the time of
highest labor demand and greatest sickness—leading to
high infant mortality rates . 105 Enslaved women had rich cultural knowledge of natural birth control from their
indigenous cultures, which they were forced to conceal
from enslavers . 106 Black midwives assisted pregnant en- slaved women with inducing and hiding abortions . 107
Children born into slavery suffered from mortality rates that were double the free population, consumed con-
taminated and less nutritious food, and experienced
stunted growth and health problems throughout child-
hood . 108 Two-thirds of infants died within their first month of life—due in part to the
hard labor enslaved mothers were
forced to do . 109 Children were
forced to work by the time they
turned seven or eight years old . 110
Medical Experimentation
Courts neglected to protect the
health and safety rights of enslaved
people, who were rendered legal-
ly invisible under the institution
of slavery . 111 In many hiring contracts concerning en- slaved people, references to medical care of enslaved
people were omitted . 112 In legal disputes concerning enslaved people hired out to others, state courts ruled that the hirers need not provide medical care to the
enslaved people . 113 Because enslavers wished to avoid paying medical expenses, enslavers often only called
physicians as a last resort, when the enslaved person
was nearly dead . 114 Physicians actively exploited en- slaved people—practicing dangerous experimental
procedures on them and using their cadavers for dis-
section without consent . 115
White southern doctors were hired by enslavers and
insurance companies to accurately determine the mar-
ket value of Black bodies . 116 Physicians used slavery for economic security and experimented on Black people
using dangerous procedures that harmed them, but
furthered the physician’s professional advancement . 117 Black bodies filled dissecting tables, operating the-
aters, and experimental facilities . 118 An enslaved person named Sam was experimented on by multiple doctors;
he had his lower jaw bone removed without anesthesia
for medical research . 119
James Marion Sims, the “founder of modern gynecol-
ogy,” and an enslaver, experimented upon enslaved
women and performed vaginal surgeries upon them
against their will . 120 Sims used enslaved women’s bod- ies to perfect surgical instruments and advance his pro- fessional status . 121 Sims’ enslaved patients worked as his enslaved nurses and surgical assistants, though they did not receive recognition for doing so . 122 After being ex- perimented upon by Sims, the enslaved patients were
returned to their enslavers . 123 After it was perfected through medical experimentation upon enslaved wom-
en, Sims received numerous invitations to perform the
vaginal procedure for European royalty . 124
Enslaved people were used to test experimental caesare- an sections and vaccines . 125 Surgeons often used enslaved people for surgical experiments and experimentation in
medication and dosages . 126 Enslaved people’s bodies were dissected after death to advance medical knowledge and
their remains were found at Virginia Commonwealth
University in 1994—findings such as these have occurred in numerous medical schools across the country . 127
California
During the period of enslavement, white southerners
flocked to California with hundreds of enslaved Black
people when the Gold Rush began in 1848, forcing them
to toil in gold mines and hiring them to cook, serve, and perform manual labor . 128 Some enslaved people were
forced to work in the gold fields to make money for their enslavers, despite illness—and if they could not do so, would lose their chance at freedom . 129 Black newspapers described brawls between enslaved people and white
enslavers across California . 130
In 1851, the U .S . Congress created a U .S . Marine Hospital in San Francisco, which was completed in 1853 . 131 Marine hospitals were set up to care for sick and disabled seamen by the U .S . Treasury Department . 132 The U .S . Treasury Department distributed strict guidelines specifying that the “Negro slaves” could not receive treatment at these James Marion Sims, the “founder of modern gynecology,” and an enslaver, experimented upon enslaved women and performed vaginal surgeries upon them against their will. Sims used enslaved women’s bodies to perfect surgical instruments and advance his professional status.

412
Chapter 12 Mental and Physical Harm and Neglect hospitals . 133 African Americans were relegated to the segregated sections of state hospitals in San Francisco and Sacramento . 134
In the 1850s, Biddy Mason, moved to California with
her enslaver . 135 She lived for five years in California as an enslaved woman, until she challenged her enslaver
for her freedom in court . 136 She later became a midwife and nurse, running her own midwifery business and
saving enough money to purchase land and establish a
church . 137 She donated to many charities, helped feed and shelter the poor, and founded an elementary school
for Black children . 138
IV . Reconstruction Era
The Civil War resulted in large-scale death, destruction, and casualties for formerly enslaved people—30,000
formerly enslaved people died from infectious dis-
eases . 139 Sick Black soldiers died five times more of- ten than their white counterparts . 140 After the war, African Americans lived in large, segregated refugee
camps called “contraband camps” because there was
nowhere else for them to go . 141 Hospitals, dispensaries, and military camps were unable to serve the masses
of enslaved people, Black soldiers, and other refugees
who entered the North due to the Civil War . 142 Escaped and abandoned formerly enslaved people settled near
or within the Union Army’s military camps and battle
lines . 143 The camps did not have adequate sanitation, nutrition, or medical care . 144 One out of every four African Americans who lived in the camps died . 145
Following the Civil War, due to segregation, African
Americans were forced to live in overcrowded, unven-
tilated tenements and unsanitary shacks . 146 Excessive mortality rates in Black communities were caused by
poor living conditions, lack of access to nutritious food, and lack of access to healthcare . 147 Epidemics such as cholera and smallpox broke out often where African
Americans lived . 148
From 1865 to 1868, Congress created the Bureau of
Refugees, Freedmen, and Abandoned Lands, common-
ly known as the “Freedmen’s Bureau,” to provide for
the welfare of formerly enslaved African Americans,
including through “issues of provisions, clothing, and
fuel, as [necessary] for the immediate and temporary
shelter and supply of destitute and suffering refugees
and freedmen and their wives and children,” accord-
ing to the statute . 149 The Freedmen’s Bureau included a short-lived attempt to provide medical aid to formerly
enslaved people in need . 150 The Bureau was hampered
by cities and counties that focused on the health of white people and refused to provide healthcare for formerly
enslaved people . 151 The Freedmen’s Bureau was poorly equipped to provide mental health services to formerly
enslaved people . 152
The Freedmen’s Bureau dispensaries did provide thou-
sands with annual treatment and prescriptions . 153
However, many of the white physicians affiliated with
the bureau were racist to their Black patients, and some- times refused to treat them . 154 After two years of oper- ation, with southern legislators claiming the costs were too high, Congress ended the Freedmen’s Bureau med-
ical services—just as demand for services was increas-
ing . 155 When the Bureau’s medical services ended, for- merly enslaved people continued to suffer from illness, destitution, and racial discrimination from physicians
and were left with little to no access to medical care . 156 The Freedmen’s Bureau failed to provide for the health
and welfare of newly-freed African Americans, despite
the promises made by the federal government . 157
V . Racial Segregation Era
Following the Freedmen’s Bureau’s failed attempts to
provide healthcare to African Americans, the Jim Crow
era of racial segregation and discrimination greatly de- graded the health of Black communities . White hos-
pitals discriminated against Black doctors and nurses
and treated Black patients only in “colored wings .” 158 Black hospitals suffered from underfunding and re-
source constraints, such as struggles with licensing
accreditation, and developing links with municipal
hospitals . 159 In 1946, Congress passed the Hill-Burton Act, which provided federal funding to segregated
healthcare facilities—further entrenching discrimina-
tion and segregation in the healthcare system . 160 The racial segregation of the Jim Crow era was a vestige of enslavement during which African Americans suffered
dire health consequences . 161

413
Chapter 12 Mental and Physical Harm and Neglect Black Patients and Medical Professionals
During the Jim Crow era, Black hospitals and segregat-
ed units within predominantly white hospitals were
the only viable sources for medical services for African Americans, due to pervasive racial discrimination, pov- erty, and lack of geographic accessibility . 162 Some white hospitals operated small wards for Black patients, but
they were in the worst areas of hospitals—in basements
or crowded “colored wings .” 163 These white hospitals did not hire Black doctors, and white doctors often treated Black patients with disdain . 164
During World War I and after, millions of African
Americans living in southern states migrated to the urban Northeast and Midwest in the Great Migration . 165 During this time, underfunded and under-resourced Black
hospitals were not able to provide care for local African Americans and newly arriving migrants . 166 In northern cities, Black patients who sought treatment in large city hospitals were forced to compete for healthcare resources with poor European immigrants . 167 Private doctors were unaffordable for most African Americans . 168
From the 1880s to 1964, southern states segregated Black people from white Americans in every aspect of life, in- cluding healthcare . 169 The Hill-Burton Act allocated sepa- rate funds for Black and white hospitals, resulting in a dis- parity in hospital beds available for Black patients . 170 Black women often could not afford to have physicians deliver babies in hospitals, and were instead treated by Black mid- wives in the rural regions of the South . 171 White patients refused to be treated next to Black patients and by Black doctors or nurses . 172 Most poor African Americans could not afford hospital care . 173 Some Black doctors could have their Black patients admitted to white hospitals—however, the Black doctors themselves were barred from working
as physicians at those white hospitals . 174
White doctors refused to treat Black patients—like the
son of scholar W .E .B . Du Bois, Burghardt, who suffered from diphtheria . 175 Du Bois tried in vain to find a Black physician, but his son died when he was about one and
a half years old . 176 Baby Burghardt’s death mirrored the many deaths of enslaved children from the same
disease . 177 While white public health leaders and pro- fessionals ignored the needs of the Black community,
Black physicians and health leaders traveled to church- es, schools, and community meetings to give healthcare
education presentations . 178
Because African Americans were denied medical edu-
cation, they founded their own medical schools . The
first Black medical school, Howard University Medical
Department, was founded in 1867 . 179 It was the first of 14 Black medical schools founded between 1868 and
1900 . 180 In 1910, the Carnegie Foundation commissioned a report to evaluate every medical school in the U .S . and Canada . 181 In the wake of the report, most Black medical schools closed . 182 By 1915, five of the eight Black medical schools established in the 1880s and 1990s had closed . 183 By 1923, only two training sites were left for black doctors and other medical professionals—Howard University
in Washington, D .C . and Meharry
Medical College in Tennessee . 184
At the time, there was intense pres-
sure in the medical field to modern-
ize and redesign medical facilities
with higher clinical and operation-
al standards . 185 Black hospitals thus
faced greater problems—adhering
to these new modernized standards
without the funds or institutional
support of major industrialists, pre-
mier academic institutions, and political leaders, while also caring for growing healthcare needs of African
Americans in the Jim Crow era . 186 Due partly to racism, Black medical schools were not able to link with mod-
ernized hospitals to train their students . 187 Without a means of training students, and a lack of teaching and
White hospitals received public and private funds to establish models of care based on the newest scientific developments, while Black hospitals had to rely on their own small community of patients for funding. Black hospitals were forced to open in older, outdated hospital structures that were abandoned by prior white founders.

A waiting room in a Black hospital in Chicago in 1941. Black hospitals were the only viable sources for healthcare for Black Americans because many white hospitals did not admit Black patients or provided discriminatory care. As late as 1945, Chicago only had one hospital operated by Black healthcare providers that served roughly 270,000 Black residents.

COURTESY OF RUSSELL LEE/LIBRARY OF CONGRESS

414
Chapter 12 Mental and Physical Harm and Neglect funding resources, Black medical schools were no longer viable institutions for a medical education . 188 From 1900 to 1980, only about two percent of medical professionals were Black . 189 As of 2018, just five percent of physicians were Black . 190 Consequently, Black medical schools shut down, in part, due to systemic racial discrimination and lack of government support—resulting in the underrep-
resentation of African Americans in the medical field .

Black professionals experienced constant racial dis-
crimination and exclusion from medical institutions
and professional associations during legal segrega-
tion . 191 Black doctors were not allowed to treat Black patients in some white southern hospitals . 192 Black
interns, residents, and registered nursing personnel
were excluded from white hospitals in the South . 193
Black pharmacists were limited to employment in “col-
ored drugstores .” 194 Many Black women who entered
the nursing profession were discriminated against and
not allowed to enter the nation’s major government
and charitable health agencies . 195
Black hospitals were the only viable
sources for healthcare for African
Americans because many white
hospitals did not admit Black pa-
tients or provided discriminatory
care . 196 As late as 1945, Chicago only
had one hospital operated by Black
healthcare providers that served
roughly 270,000 Black residents . 197
Philadelphia had two Black hospi-
tals . 198 Southern Black women relied on private physi- cians and hospitals for maternity care . 199 Even in 1949, when an increasing number of white women were as-
sisted by physicians during birth, most Black women had no physician present for birth . 200
Until 1954, when the Veterans Administration announced
the end of segregation in agency hospitals, Black veter- ans received worse treatment than white veterans due
to separate and unequal facilities . 201 White hospitals re- ceived public and private funds to establish models of
care based on the newest scientific developments, while Black hospitals had to rely on their own small communi- ty of patients for funding . 202 Black hospitals were forced to open in older, outdated hospital structures that were abandoned by prior white founders . 203
The American Medical Association (AMA) is the most
powerful umbrella organization for physician advo-
cacy and lobbying in the United States . 204 The AMA
actively discriminated against Black medical profes-
sionals and supported state-sanctioned discrimina-
tion . 205 From about 1846 to 1888, the AMA did not allow Black doctors to join . 206 This policy of tolerating racial exclusion was pivotal in creating a two-tier system of
medicine in the United States . 207 In response to the AMA’s racial discrimination, in 1895, Black physicians
formed their own professional association, the National Medical Association . 208
From the 1870s through the late 1960s, the AMA exclud-
ed and discriminated against Black physicians, hinder-
ing their professional advancement, and creating dis-
criminatory barriers to adequate healthcare for Black
patients . 209 During this period, the AMA was made up of local physician societies . 210 Societies that were in seg- regationist states freely denied Black physicians entry, yet remained part of the national AMA . 211 Consequently, Black physicians were denied membership in state,
county, and municipal medical societies throughout
the South and in many border states . 212 Exclusion from these medical societies restricted access to training and limited professional contacts . 213 Since membership in a state medical society was required by most south-
ern hospitals, this policy resulted in the denial of ad- mitting privileges, which meant that Black physicians
could not admit Black patients to southern hospitals . 214 This, in turn, created barriers to healthcare for African Americans and barriers to professional advancement for
Black physicians . 215 Furthermore, the AMA was silent in debates over the Civil Rights Act of 1964 and did not sup- port efforts to amend the “separate but equal” provision of the Hill-Burton Act . 216
The Hill-Burton Act (1946)
In 1946, Congress passed the Hill-Burton Act, which pro- vided federal construction grants and loans to states that needed health care facilities . 217 However, the Hill-Burton Act allowed “separate but equal” healthcare facilities . 218 In congressional debates, northern Senators William
Langer and Harold Burton called for nondiscrimination
in the use of federal funds . 219 Southern Senators, such as Lister Hill from Alabama, claimed that state legislatures and local hospital authorities had the right to set policy without federal interference . 220 Ultimately, Congress In 1946, Congress passed the Hill-Burton Act, which provided federal construction grants and loans to states that needed health care facilities. Ultimately, Congress included the “separate but equal” provision in the Hill-Burton Act to appease the southern states.

415
Chapter 12 Mental and Physical Harm and Neglect included the “separate but equal” provision in the Hill- Burton Act to appease the southern states . 221
Southern states received a significant portion of the fed- eral funds allotted through the Hill-Burton Act . 222 Because Hill-Burton Act funds were disbursed through regional,
state, and local offices, states that were highly segregat- ed continued to engage in racial exclusion . 223 By 1962, 98 hospitals in the South banned Black
patients outright, while others only
allowed Black patients in segregated
areas . 224 The Hill-Burton Act allowed
patients to be denied admittance
into hospitals on account of race . 225
The Hill-Burton Act thus permitted
racial segregation and discrimina-
tion in healthcare, a legacy of the
racism that existed during slavery
and continued through the legal
segregation era .

Healthcare During Legal
Segregation Era
Due to discrimination and segregation instituted and al- lowed by federal and state governments during the legal segregation era, African Americans suffered from inade- quate care . 226 Studies conducted on the Black communi- ty in the mid-20th century, revealed high rates of syph- ilis, tuberculosis, maternal and infant mortality, and
disparities in life expectancy—healthcare concerns that continue . 227 Communicable childhood diseases such as whooping cough, measles, meningitis, diphtheria, and
scarlet fever were twice as frequent among Black chil-
dren than white children—reflecting inadequate access
to modern medical treatment . 228 The infant death rate for Black children was twice that of white children in the late 1950s . 229 The Black maternal mortality rate was four times greater than the white maternal mortality rate . 230 Compared to white Americans, African Americans died
at earlier ages of heart disease and respiratory cancer . 231 A contributing factor to premature death for African
Americans was that the federal government prohibit-
ed African Americans from accessing antipoverty pro-
grams . 232 As a result, they could not afford or access quality healthcare . 233 Government-sanctioned racial
segregation and discrimination extended the legacy of
slavery, impacting the healthcare system far into the
20th century and until today .

California
In the late 1940s, Fresno lost its only Black doctor, Dr .

Henry C . Wallace . 234 At the time, young Earl Meyers, a Black teenager in Fresno, was impressed by Dr . Wallace . 235 “Dr . Wallace inspired him . . . He was Earl’s mother’s doctor and he healed her,” Mattie Meyers, Earl Meyers' former
wife, said . “At that time, there weren’t any black doc- tors here . Dr . Wallace was Earl’s mentor,” she said . Earl Meyers then left Fresno to receive his medical degree at Tennessee’s Meharry Medical College—one of the only
Black medical schools left in the United States . 236
Many of the Black residents of Fresno described the
difficulty they had in getting medical care from white
doctors and asked Dr . Meyers to return to his home-
town . 237 Dr . Meyers did return home to Fresno, where he established a medical clinic . 238 He also established a dis- pensary and made prescriptions available at wholesale
cost—often refusing to charge impoverished patients for his services . 239
Hospitals in California that received Hill-Burton Act
funds 240 discriminated against Black patients and phy- sicians . From 1947 to 1971, Hill-Burton Act funds contrib- uted to 427 projects at 284 facilities in 165 communities in California . 241 A 1950 survey of Los Angeles hospitals found that 11 of the 17 hospitals racially segregated pa- tients . 242 A separate, 1956 study found that only 24 .8 per- cent of Black physicians in Los Angeles served at pre-
dominately white hospitals . 243 The legacy of this discrim- ination carries through today . In 2021, a nonpartisan
health organization found that Los Angeles tied Atlanta for the highest number of “least inclusive hospitals .” 244 Communicable childhood diseases such as whooping cough, measles, meningitis, diphtheria, and scarlet fever were twice as frequent among Black children than white children—reflecting inadequate access to modern medical treatment. The infant death rate for Black children was twice that of white children in the late 1950s. The Black maternal mortality rate was four times greater than the white maternal mortality rate.

In 1950 65%of hospitals
in Los Angeles racially segregated
Black patients

416
Chapter 12 Mental and Physical Harm and Neglect Consequently, California has a history of healthcare dis- crimination against Black Californians, due to the seg- regation of hospitals in California and the inadequacy
of access to healthcare for Black Californians, which is a legacy of slavery that carries through to today .

VI . Post-Civil Rights Act Era
The Civil Rights Act brought marked improvements in
addressing healthcare discrimination . 245 However, the United States healthcare system was built upon a foun-
dation of enslavement and segregation, which has never
been dismantled . Scholars have stated that the legacy of enslavement and segregation persists in the legal bar-
riers to medical education for African Americans, the
anti-Black discrimination in the healthcare profession, and the transformation of hospitals and healthcare into a high profit industry that has neglected to provide care for African Americans . 246 This legacy of enslavement continues to harm African Americans today, as some
scholars have stated, resulting in continued inequities in medical treatment and health outcomes . 247
Medical Education
The U .S . Supreme Court’s ban on race-based quotas in
affirmative-action programs for medical schools led to
a dearth of Black doctors . 248 In the 1960s, white medi- cal and dental schools began efforts to increase Black
enrollment through affirmative action programs to
recruit and graduate higher numbers of Black medical
students . 249 Affirmative action programs increased the number of Black medical school students from 783—or
2 .2 percent of all medical students in 1969—to 3,456—
or 7 .5 percent of all medical students by 1975 . 250 Of all those who treated Black communities and patient pop-
ulations, Black physicians provided the most care . 251 The University of California, Davis opened a medical
school with an affirmative action program in 1966 . 252 However, in 1978, the U .S . Supreme Court ruled that
the racial quotas used in this program were unconsti-
tutional in Regents of the University of California v. Bakke . 253 This ruling reduced the number of Black students ad-
mitted in the nation’s medical schools—particularly mid- dle- and lower-ranked schools, where the percentage of
Black students admitted dropped to miniscule levels . 254 There were fewer Black men in U .S . medical schools in 2014 than in 1978 . 255 Medical education began to use a “colorblind” model of selecting and training Black pro- fessionals based upon the Bakke ruling, which has con-
tributed to racial health disparities that exist today . 256 Major growth of the medical sector eventually led the
bulk of the nation’s hospitals to be operated by the
government, large corporations, and not-for-profit
healthcare businesses . 257 Due to the transformation of healthcare from a largely government provided service
to a for-profit industry, Black physicians were separated from Black patient populations . 258 Black hospitals were closed and taken over by large corporate entities . 259 Black hospitals were not funded by government, cor-
porate, and non-profit economic circles and conse-
quently could not afford to remain open . 260 They closed, merged into larger hospital systems, or were renovated
into nursing homes by the mid-1980s . 261 The mainstream medical establishment was unorganized, and spread out
geographically . 262 Black doctors who used to serve Black patients concentrated in Black geographic areas were
consequently scattered and unable to continue serving
Black patient populations in clinics and hospitals . 263 Research has shown that diversi-
ty among physicians leads to bet-
ter outcomes for Black patients . 264
Non-Black medical students’ explic-
it racist attitudes are associated with
decreased intent to practice with
underserved or minority popula-
tions . 265 One study found that Black
patients assigned to a Black doctor
increased their demand for preven-
tive care, brought up more medical
issues, and were more likely to seek
medical advice . 266
Racism by white doctors has led to unconscious bias
that has resulted in African Americans receiving inferior medical care as compared to white Americans . 267 Higher implicit bias scores among physicians are associated with Racism by white doctors has led to unconscious bias that has resulted in African Americans receiving inferior medical care as compared to white Americans. Across virtually every type of diagnostic and treatment intervention, African Americans receive fewer procedures and poorer-quality medical care than white Americans.

417
Chapter 12 Mental and Physical Harm and Neglect biased treatment recommendations for the care of Black
patients . 268 Providers’ implicit bias affects their nonver- bal behavior, which is associated with poorer quality of patient-provider communication . 269 Across virtually
every type of diagnostic and treatment intervention,
African Americans receive fewer procedures and poor-
er-quality medical care than do white Americans . 270
Discrimination in Healthcare
Prior to the Civil Rights Act of 1964, federally-funded hospitals refused to provide care to Black patients . 271 Barriers to equality in care for Black patients remained even after the passage of the Civil Rights Act . 272 Due to insufficient government-funded healthcare services,
as well as the disempowerment and neglect of Black
patients by healthcare institutions, Black communities
suffered major gaps in healthcare delivery in the im-
poverished neighborhoods where
they lived . 273 Black residents who
lived in urban poverty received
medical care from crowded emer-
gency rooms and outpatient ser-
vices at overburdened public hospi-
tals, or at small practices of private
Black physicians . 274
In 1960, there was only one Black doctor for every 5,000 Black patients, compared to the national average of one doctor for every 670 Americans . 275 Poor Black women
could not afford safe abortions through private doctors and could not receive adequate care at the hospitals and clinics in their communities . 276 Hospitals in Black neigh- borhoods were older than public general hospitals . 277 They were usually administered by nonprofit bodies
and funded by voluntary contributions and paying pa-
tients . 278 They were insufficiently staffed and were in too poor of a physical condition to provide the medical ser- vices needed by the Black communities around them . 279 As a result, between 1950 to 1970, life expectancy
for African Americans remained almost a decade
shorter than that of white Americans . 280 Death rates from pneumonia, influenza, and tuberculosis were two
to three times higher for African Americans than white
Americans due to lack of access to hospital care . 281
Similarly, maternal mortality rates for Black mothers
remained four times higher than that of white moth-
ers . 282 Black mortality from sexually transmitted infec- tions and tuberculosis remained much higher than that
of white Americans . 283 African Americans also contin- ued to suffer from chronic illness at higher rates than white people . 284
In the 1950s and 1960s, the National Association for
the Advancement of Colored People brought several
lawsuits to force government funded hospitals to hire
Black doctors, treat Black patients, and desegregate fa- cilities . 285 The federal government filed a brief in sup- port of Black patients in Simkins v. Moses H. Cone Memorial Hospital; however, the government did not always strictly enforce the Civil Rights Act against medical segregation, sometimes leaving Black medical professionals to fight
case by case in the courts for desegregation . 286
Health` Insurance
Insurance status predicts the quality of care a patient will receive . 287 Health insurance is necessary to pay for healthcare procedures, such as preventive care,
screenings, disease management, and prescription
drugs . 288 In the United States, health insurance is de- pendent upon employment . 289 In 1942, during World
War II, rising prices and competing wages led the fed-
eral government to put a cap on wages . 290 Health insur- ance was an exception to that wage cap and employer
contributions to health insurance premiums were tax-
free . 291 Employers began paying for health insurance to lure employees . 292 Eventually, this led employees with higher-paying jobs to receive more benefits from
their health coverage than those with lower incomes . 293 Healthcare became a privilege for those with good jobs, rather than a right for all . 294 As discussed in Chapter 10, African Americans have historically not been able
to access jobs that provide medical insurance through
employers due to barriers to education, employment,
and discrimination . 295 Due to employment discrimina- tion, private, job-based, health care systems excluded
As a result, between 1950 to 1970, life expectancy for African Americans remained almost a decade shorter than that of white Americans.

In 1960, there was only 1 Black doctor
per 5,000 African Americans
compared to 1 white doctor for
every 670 Americans

418
Chapter 12 Mental and Physical Harm and Neglect African Americans . 296 Consequently, as of 2018, only 46 percent of African Americans are covered by employ-
er-sponsored health insurance . 297
In the 1960s, President Lyndon B . Johnson’s Great Society legislation and the Civil Rights Act and Voting Rights Act contained the seeds for creating a nationwide health
care system for all citizens . 298 However, the Medicaid and Medicare programs did not eliminate racial inequality
in healthcare . 299 Medicare and Medicaid are health in- surance programs paid for by the federal government . 300 Medicare serves people with disabilities and people who are 65 years or older . 301 Medicaid serves people who are low-income . 302
Before Medicaid and Medicare, southern states were re-
sistant to a nationwide health insurance system for all, due to desegregation brought about by the civil rights
legislation . 303 They wanted limited federal involvement while continuing to run their own health programs for
low-income residents . 304 Before Medicaid’s enactment, states had control over federal health insurance pro-
grams for low-income residents, which disproportion-
ately included African Americans . 305 These programs
were underfunded, and states with large populations
of African Americans—Texas, Arkansas, Louisiana,
Tennessee, Mississippi, Alabama, Florida, Georgia, South Carolina, and North Carolina, referred to as the “Black Belt” states—refused to participate in federal health in- surance programs . 306 A state-run Medicaid program
would limit federal involvement while allowing states
to determine eligibility for health insurance programs
on their own . 307
The enactment of Medicaid as a program implement-
ed by state governments allowed states to dispropor-
tionately exclude Black, low-income populations who
otherwise would have qualified for the program . 308
Medicaid provided insurance to low-income and un-
employed people—about one-fifth of the Black pop-
ulation was considered poor enough to qualify for
Medicaid . 309 Consequently, in the 1970s, 25 percent
of the African American popula-
tion was uninsured, while only 12
percent of the general population
was uninsured . 310
However, in the 1990s, the Black
Belt states changed their income
criteria, lowering the threshold
income for Medicaid so much that
many poor Black families were
not considered poor enough to qualify for Medicaid . 311 Reimbursement policies established by government
and health insurance regulators limited hospitals and
physicians in the type and number of patients they
could treat . 312 Consequently, private physicians and hospitals preferred not to treat Medicaid recipients,
who lacked the funds to access care in a wide range of
hospitals . 313 Due to this, throughout the 1990s, about 20 percent of the nation’s Black population lacked health
insurance, while 17 percent of all Americans lacked
health insurance . 314
The Affordable Care Act, passed in 2010, greatly re-
duced the number of uninsured people in the United
States . 315 Three million Black people previously un- insured obtained insurance . 316 However, the U .S .

Supreme Court made expansion of Medicaid eligibil-
ity under the Affordable Care Act optional to states
rather than mandatory . 317 The expansion of Medicaid
eligibility would have increased access to screening
and preventive care, resulted in earlier diagnosis of
chronic conditions, and improved mental health . 318
However, the states that chose not to expand Medicaid
were primarily the Black Belt states—Alabama, Florida,
Georgia, Mississippi, North Carolina, South Carolina,
Tennessee, Texas . 319 African Americans are among the most likely to be uninsured compared to other pop-
ulations, further inhibiting African Americans from
accessing quality healthcare . 320
Medicare does not cover all healthcare services that an individual may need, and often supplemental coverage
is needed . 321 This coverage is sold by private insurance companies, or may be provided by employer-spon-
sored retiree benefits . 322 However, due to the low lev- els of employer-sponsored health coverage for African
Americans and the expense of private insurance, old-
er African Americans are far more likely than white
Americans to rely solely on the Medicare program, or
may supplement it with Medicaid . 323 About a quarter of African Americans lack supplemental coverage, while
only 10 percent of white Americans lack supplemental
coverage . 324 The lack of supplemental insurance expos- es African Americans to higher out of pocket costs and
delayed medical care . 325 Discrimination in Medicare
extends to the quality of medical services . Ten percent of African Americans receiving Medicare report un-
wanted delays in getting an appointment and problems
In early 1970, the Black Panther Party published in its newspaper an account of “the disrespectful, unprofessional, and even authoritarian encounters between physicians and their patients at San Francisco General.”

419
Chapter 12 Mental and Physical Harm and Neglect finding a new specialist, while only six percent of white Americans report similar problems . 326 Consequently,
the discriminatory health insurance system has result-
ed in worse health for older African Americans who
rely on Medicare .

California
To address the lack of healthcare services and medical
discrimination experienced by Black Californians, the
Black Panther Party attempted to provide free health-
care clinics to administer basic healthcare services . 327 In early 1970, the Black Panther Party published in its newspaper an account of “the disrespectful, unprofes-
sional, and even authoritarian encounters between phy-
sicians and their patients at San Francisco General .” 328 Shortly after, the Black Panther Party established a few free, community-based clinics, known as People’s Free
Medical Clinics . 329 At the clinics, medical professionals trained health workers to administer basic services . 330 However, local governments retaliated against the Black Panther Party’s clinics . The Oakland Police Department, on the order of the Federal Bureau of Investigation,
hounded the Black Panther Party for soliciting clinic
funds without proper permits . 331 In 1969, police in Los Angeles raided the local Black Panther Party chapter’s
headquarters, where the party was planning to open
the Bunchy Carter People’s Free Medical Clinic . 332 The raid severely damaged the clinic building enough that
its forthcoming opening was postponed . 333
Today, discrimination against Black Californians in
healthcare is exacerbated by the fact that there are not enough Black physicians in California to meet the needs of California’s Black population . In California, Black physicians are less than three percent of the entire med- ical profession, despite African Americans making up
six percent of the state’s population . 334 The passage of Proposition 209 in 1996 in California, prohibited the con- sideration of race, ethnicity, or national origin in public education, employment, and con-
tracting . 335 As a result, in California’s
private medical schools, the propor-
tion of Black students matriculating
fell from six percent in 1990 to five
percent in 2019 . 336
Black physicians in California have
alleged that the Medical Board of
California disciplines Black doc-
tors more than white doctors . 337
Research shows that Black physi-
cians in California were more like-
ly to receive complaints and have
their complaints escalated to investigations than white physicians, but these investigations were not more likely to result in disciplinary action . 338 Black physicians have been historically underrepresented in California’s med- ical field and continue to be underrepresented and dis- criminated against today .

Black Californians continue to face discrimination in
healthcare and disparities in health outcomes . 339 In 1965, in the Watts neighborhood of Los Angeles, an area with
a large Black population, only 106 doctors were serving over 250,000 residents—a doctor to patient ratio of one to 2,377 . 340 The United States today has a doctor to pa- tient ratio of about one doctor per 384 patients . 341 Today, Black Californians experience racism in their interac-
tions with the healthcare system and many have wanted
more access to Black physicians . 342 In a study conducted in 2021 where 100 Black Californians were interviewed,
some recounted experiences of delayed or missed di-
agnoses due to inattentive healthcare providers . 343 One Black man from the Central Valley said, “I couldn’t hold down any food . I couldn’t walk . I couldn’t eat, do any- thing . So, I went to a clinic and I told them what was wrong . And they prescribed naproxen, which is generic
for Midol and Advil . [So] I went to the hospital and had dual kidney infections… I just don’t think they take me seriously…I don’t think they take me as seriously as they would a white man or a white woman .” 344
Black physicians in California have alleged that the Medical Board of California disciplines Black doctors more than white doctors.

Research shows that Black physicians in California were more likely to receive complaints and have their complaints escalated to investigations than white physicians, but these investigations were not more likely to result in disciplinary action.

420
Chapter 12 Mental and Physical Harm and Neglect VII . Medical Experimentation
Federal and state governments have allowed doctors
and scientists to experiment on the bodies of African
Americans and have at times conducted dangerous med-
ical experiments on African Americans . In 1932, the U .S .

Public Health Service began its study of syphilis, known as the Tuskegee Syphilis Study, which promised free
medical care to hundreds of poor Black sharecroppers
in Alabama . 345 Over the course of 40 years, the govern- ment did not treat the subjects, though treatment was
available, and sought to ensure that the subjects of the study did not receive treatment from other sources . 346 Forty of the wives of the Black sharecroppers and at least 19 children contracted syphilis during the study . 347 The government did not prosecute anyone for the deaths
and injuries that were caused . 348
African American bodies have been used for major
medical advancements and experimentation, without
any compensation given to those who were involved,
or to their families . For instance, scientists at Johns Hopkins University were treating Henrietta Lacks, a
Black woman, for cervical cancer in the 1950s . 349 Without compensation to her family or permission from them,
her cells were used extensively in scientific research
to develop modern vaccines, cancer treatments, in vi-
tro fertilization techniques, among other medical ad-
vancements . 350 Doctors and scientists repeatedly failed to ask her family for consent as they revealed her name publicly and gave her medical records to the media . 351 Like so many enslaved people, Lacks’ body was used
for medical experimentation without her consent and
without compensation .

The U .S . Food and Drug Administration approved
contraceptives, such as Norplant, which were dispro-
portionately distributed to poor Black women and
young girls in schools . 352 States offered poor women financial incentives for using Norplant—however, due
to concerns about complications and effectiveness,
Norplant’s distributor eventually discontinued it in
2002 . 353 Similarly, in 1973, many Black women had filed lawsuits alleging that they were coerced into steriliza- tion, often under the threat that their welfare bene-
fits would be taken away if they did not submit to the
procedure . 354 The coercive use of contraception and
sterilization by the legal system and welfare system has forced Black women to choose between financial free-
dom or prison time . 355
African Americans have also been subjected to harm-
ful experiments conducted, facilitated, or allowed by
the government . In the 1950s, the Central Intelligence Agency reportedly attempted to test biological weap-
ons by breeding millions of mosquitos and releasing
them in Black housing developments in Florida and
Georgia . 356 Residents living in these areas showed
symptoms of dengue fever and yellow fever and
some died from these illnesses . 357 In Pennsylvania’s Holmesburg Prison, Dr . Albert M . Kligman conducted
numerous experiments on mostly Black incarcerated
Americans throughout the 1960s . 358 Incarcerated indi- viduals filed lawsuits for their injuries due to this abu- sive experimentation . 359 Dr . Kligman was temporarily banned from experimentation by the Food and Drug
Administration in 1966, however, clinical research on
incarcerated people was not banned by the government
until decades later . 360 In the 1990s, the New York State Psychiatric Institute and Columbia University conduct-
ed experiments on Black boys by giving them doses of
the now-banned drug fenfluramine to test a theory
that violent or criminal behavior may be predicted by
levels of certain brain chemicals . 361 Consequently, fed- eral and state governments allowed or participated in
abusive experimentation on Black children and incar-
cerated people throughout the nation .

California
Home to an extensive eugenics movement, California
had the highest number of sterilizations in the United
States . 362 In the 1920s Black people constituted just over one percent of California’s population, but they account- ed for four percent of total sterilizations by the State of California . 363 By 1964, the State of California sterilized over 20,000 people—one-third of all sterilizations in the Subjects of the Tuskegee Syphilis Study. In 1932, the U.S. Public Health Service began its study of syphilis, known as the Tuskegee Syphilis Study, which promised free medical care to hundreds of poor Black sharecroppers in Alabama. Over the course of 40 years, the government did not treat the subjects, though treatment was available, and sought to ensure that the subjects of the study did not receive treatment from other sources.

COURTESY OF NATIONAL ARCHIVES

421
Chapter 12 Mental and Physical Harm and Neglect U .S . and more than any other state . 364 The sterilizations were authorized by law and performed in state institu-
tions, hospitals, and prisons . 365
Dr . Leo Stanley, a eugenicist, performed forced steriliza- tions at San Quentin State Prison and was responsible for further segregation of the prison medical facilities . 366 He also used the testicular glands of an executed Black man for his experiments, without obtaining the consent of
the man’s family because his body was not “claimed .” 367 In 2018, the California Department of Corrections and
Rehabilitation glowingly described Dr . Stanley as a doctor who “push[ed] prison medicine into [the] 20th century .” 368 Between 2006 and 2010, almost 150 people imprisoned
in California’s women’s prisons were sterilized without proper authorization while giving birth . 369 Many of the women subjected to forced sterilization were Black and
Latina . 370 Kelli Dillon was forcibly sterilized while in- carcerated at the Central California women’s facility in Chowchilla when she was told she needed a surgery to
treat an ovarian cyst . 371 She was not aware of the ster- ilization until she requested her medical records with
the help of a lawyer . 372 Dillon said, “It was like my life wasn’t worth anything,” she said . “Somebody felt I had nothing to contribute to the point where they had to
find this sneaky and diabolical way to take my ability to have children .” 373 After her release from prison, Dillon founded Back to Basics, an organization fighting for jus- tice for survivors of forced sterilizations in California . 374 In 2021, California became the third state to offer repa- rations payments, setting aside $7 .5 million for victims of forced sterilization . 375
In the State of California, Elmer Allen was illegally in- jected with plutonium at the University of California,
San Francisco medical hospital in San Francisco—he was
likely never informed of the consequences of this . 376 The university later acknowledged that the injection was not of therapeutic benefit to him, which was a requirement
for medical experiments on people . 377 The federal gov- ernment created a committee to investigate the govern-
ment-sponsored radiation experiments, after which
President Clinton issued an apology . 378
VIII . Medical Therapies, and Technology
The history of experimentation and discrimination has
led to the exclusion of African Americans from modern
clinical trials, due to the mistrust this has sowed among African Americans—resulting in continuing health dis-
parities that harm African Americans . 379 Prior to modern research, there has been a long history of Black bodies being stolen for dissection and anatomical investigation without informed consent . 380 The Freedman’s Cemetery in Dallas, excavated in the 1990s, contained the remains of African Americans, which were illegally used for dis- section or stolen . 381 Today, African Americans are less likely to be in clinical trials for the development of med- ication, vaccines, or other treatment, which can exacer- bate health disparities . 382 For example, although sickle cell disease primarily affects African Americans, there is a great disparity in research funding and attention paid to this genetic condition . 383
Algorithms are widely used in U .S . hospitals to refer people to health programs that improve a patient’s
care—however, at least one widely-used algorithm
was found to systematically discriminate against Black
By 1964, the State of California
sterilized over 20,000 people
which accounts for 1/3
of all sterilizations in the U.S.

Students at the University of Maryland School of Medicine, 1898. The English sociologist Harriet Martineau wrote in 1838 that “…the bodies of coloured people exclusively are taken for dissection because the whites do not like it, and the coloured people cannot resist.” COURTESY OF DISSECTION: PHOTOGRAPHS OF A RITE OF PASSAGE IN AMERICAN MEDICINE, 1880-1930, PAGE 101

422
Chapter 12 Mental and Physical Harm and Neglect patients . 384 This algorithm led to Black patients receiving less referrals for programs that provided personalized
care—despite being just as sick as white patients . 385 African Americans are less likely to be treated for skin diseases due to the lack of medical research and train- ing for diagnosing skin conditions for those with dark- er skin . 386 Most medical textbooks and journals that assist dermatologists in diagnosing skin disorders do
not include images of skin conditions as they appear on African Americans . 387 Images of darker skin with skin conditions caused by COVID-19, skin cancer, psoriasis,
rosacea, and melanoma often do not appear in medical
textbooks and journals . 388 Doctors routinely miss these diagnoses for Black patients because they are not trained to identify or treat skin conditions for Black patients . 389 Consequently, discriminatory medical research and
technology has resulted in worsening health disparities that harm African Americans .

IX . Mental Health
Steve Biko, the South African anti-apartheid activist ob- served that “the most potent weapon in the hands of the oppressor is the mind of the oppressed .” 390 Historically, the dehumanization of African Americans has grown
into structural, institutional, and individual racism
today . 391 Poor mental health among Black youth and
adults must be understood in the context of historical
race-based exclusion from access
to resources . 392 The harsh impact of
multigenerational racism on Black
mental health and inherent racism
within the discipline of psychol-
ogy has contributed to disastrous
mental health consequences for
African Americans .

History of Racism in
Mental Health
The federal government and state governments, in-
cluding the State of California, have historically dis- criminated against African Americans in the provision
of mental healthcare . Established in 1773, the Public
Hospital for Persons of Insane and Disordered Minds in
Williamsburg, Virginia, was the first public psychiatric hospital in the United States . 393 However, the asylum prioritized white people over enslaved people for ad-
mission . 394 The asylum used enslaved labor to operate and accepted enslaved people as payment for care and
treatment of white people . 395
Psychiatric hospitals in the first half of the 19th centu- ry were some of the United States’ first officially segre- gated institutions . 396 One of the American Psychiatric Association’s founding members refused to admit
Black patients to his mental hospital . 397 He influenced the design of the Government Hospital for the Insane
in Washington, D .C ., which housed Black patients in a separate building—far away from the better facilities for the white patients . 398 Before 1861, Black patients were rarely admitted into southern asylums because they sup- posedly did not suffer from severe mental illness . 399 The racist notion that only white people suffered from men- tal illness was written into the law in Virginia . 400 Black patients experienced outright denial of services, and
when they were admitted, they were housed in worse
circumstances than white patients . 401
By the 1960s and 1970s, African Americans were left
with a mental health system that proved ineffective at
addressing the root causes of mental illness—such as
racism and poverty . 402 In 1970, African Americans were 52 percent more of the population in mental health
institutions than white Americans . 403 However, there were nine times more African Americans than white
Americans in correctional settings . 404
White mental health staff at federally-funded clinics
and hospitals often diagnosed Black patients as schizo- phrenic, when they should have been diagnosed with
depression . 405 In the 1970s, due to systemic racism, psychiatrists were taught that clinical depression was
nonexistent among African Americans . 406 Black mil-
itary personnel under conditions of intense racial
discrimination received higher rates of severe mental
illness diagnoses, such as paranoid schizophrenia . 407 Studies of the diagnoses of Black patients at Veterans
Affairs facilities have also shown that misdiagnosis
has remained a problem for Black communities due
In the 1970s, due to systemic racism, psychiatrists were taught that clinical depression was nonexistent among African
Americans. Black military personnel under conditions of intense racial discrimination received higher rates of severe mental illness diagnoses, such as paranoid schizophrenia.

423
Chapter 12 Mental and Physical Harm and Neglect to clinicians’ prejudice and misinterpretation of Black patients’ behaviors . 408
The American Psychological Association
and the Discipline of Psychology
The American Psychological Association (APA), in con-
junction with federal and state governments, played a
significant role in the ongoing oppression of African
Americans . 409 In 2020, the APA issued an apology for its role in promoting, perpetuating, and failing to challenge racism in the U .S . 410 The APA helped establish racist sci- entific theories, opposition to inter-racial marriage, and support of segregation and forced sterilization . 411 The APA also promoted the idea that racial difference is bi- ologically-based, created discriminatory psychological
tests, and failed to take action to end racist testing prac- tices . 412 For centuries, the APA has failed to represent the approaches, practices, voices,
and concerns of African Americans
within the field of psychology and
within society . 413
Throughout American history, the
field of psychology has also influ-
enced federal and state eugenics
policies . 414 In 1895, an article pub-
lished in an APA journal argued that white people had
a superior, more evolved intelligence . 415 In 1913, a study reported the inferiority of school performance among
Black children in integrated schools in New York . 416
Racial difference was used to argue against improved
schooling opportunities for Black children . 417 One psy- chologist, Raymond Cattell, argued that race-mixing
was dangerous and would lead to a society of “lower in- telligence” through the early 1990s . 418
In 1917, the federal government conducted psycholog-
ical tests on nearly two million soldiers . 419 Due to cul- turally-biased questions, the study labeled 89 percent
of Black recruits as “morons .” 420 Throughout the 1930s, Black psychologists conducted studies countering the
racist findings of white psychologists . 421 Their studies suggested that environment plays a central role in shap- ing intelligence scores and outlined the impact white
examiners have on the test scores of Black test takers . 422 However, these studies were often dismissed . 423 The APA continued to support the use of testing to validate theo- ries about innate racial hierarchy . 424
From the 1950s on, psychologists received funding from
white supremacist organizations to support segregation
and other racist projects . 425 In 1952, former APA presi- dent, Henry E . Garrett, testified in support of segrega- tion in Davis v. County School Board, one of five federal court cases combined into Brown v. Board of Education . 426 He testified that segregation would not harm Black stu- dents, and the three-judge panel that ruled in favor
of segregation agreed . 427 Garrett also testified before Congress in opposition to the passage of the Civil Rights Act of 1968 . 428 He argued that African Americans could not reach the intelligence levels of white Americans . 429 Garrett promoted the idea of an innate racial hierarchy and worked with racial extremist and neo-Nazi groups . 430 In 1968, 75 Black psychologists left the APA in protest and formed the Association of Black Psychologists . 431 However, published articles in top psychological jour-
nals continued to be overtly racist and neglect issues
and topics beneficial to African Americans . Between
1970 and 1989, just 3 .6 percent of published articles
focused on African Americans . 432 Most of the work is focused on standardized testing and none on healthy
personality development and the competent intellectu-
al functioning of African Americans . 433 As late as 1985, white psychologists published articles arguing that
African Americans evolved to have lower intelligence,
have more children, care for them poorly, and commit
more crime . 434 The legacy of the discriminatory prac- tices of the APA and the discipline of psychology is evi- dent in the underrepresentation of African Americans
in the psychology workforce, as will be discussed in the next subsection .

Racism in Mental Health Today
Structural racism continues to be embedded in the men-
tal health system . Studies document continued and con- sistent patterns of misdiagnosis, mistreatment, and dis- parities in quality of and access to mental healthcare for African Americans . 435 Black patients are more likely to receive higher doses of antipsychotics despite evidence that they have more adverse side effects . 436
There is a dearth of Black psychologists and culturally appropriate treatment for African Americans . 437 As of 2014, only four percent of the psychology workforce in
the United States is Black . 438 White psychology curricu- lums dominate higher education—and seven percent of
psychology doctoral students are Black, though 14 per-
cent of Americans are Black . 439
In 1917, the federal government conducted psychological tests on nearly two million soldiers. Due to culturally-biased questions, the study labeled 89 percent of Black recruits as “morons.”

424
Chapter 12 Mental and Physical Harm and Neglect Black clients’ experiences of microaggressions from
white therapists have negatively impacted their satisfac- tion with both counselors and counseling in general . 440 Many African Americans feel worse after their counsel-
ing experiences . 441 Racial bias and stereotypes by clini- cians have led to misdiagnoses of African Americans in
some cases . 442 This leads to further disparities in quality of mental healthcare for Black patients due to the im-
plicit biases of mental health providers . 443
African Americans face barriers to accessing mental
healthcare today . 444 These barriers include stigma from mental health professionals, unavailability of treat-
ment, overdiagnosis and misdiagnosis, being unable
to afford the cost of healthcare, lacking insurance, and being unable to access transportation . 445 Due to these barriers, Black men who are depressed underutilize
mental health treatment and have depression that is
more persistent, disabling, and resistant to treatment
than white men . 446 This extends to youth . Mental
health problems among Black youth often result in
school punishment or incarceration, rather than men-
tal healthcare . 447 Overall, African
Americans are less likely to receive
care than white Americans for
mood and anxiety disorders, which
may contribute to chronic mental
health issues . 448 Consequently,
African Americans face institu-
tional and individual racism in the
mental health system, which is the
legacy of historical anti-Black discrimination, and is
especially harmful to Black mental health today .

Impact of Anti-Black Racism on Black
Mental Health
For centuries, nearly every institution of the Western
world has—explicitly and implicitly—reinforced the mes- sage that African Americans are to be devalued . 449 Within this context, it is inevitable that African American men- tal health and well-being has suffered . 450 The psychic effects of this anti-Black narrative include cultural trau- ma, cultural imperialism, and internalized racism . 451 Cultural trauma is “a dramatic loss of identity and mean- ing, a tear in the social fabric affecting a group of people that has achieved some degree of cohesion[ .]” 452 Cultural imperialism is when the culture of one society is forced onto another society or group of people . 453 Internalized racism is “the process of accepting the racial stereotypes of the oppressor .” 454
Anti-Black racism leads to racial
stress, which causes adverse psy-
chological effects . 455 This can pro-
foundly affect Black children by
undermining their emotional and
physical well-being and their ac-
ademic success . 456 African American women identify
racial discrimination as a persistent stressor occurring throughout their lives . 457 These experiences having
long-lasting effects on their identities and on how they perceive encounters with others, particularly white
Americans . 458 Many Black women describe ruminating
on past experiences, developing defense mechanisms
in anticipation of future threats, and feeling the need to overcompensate for negative stereotypes . 459 They may work harder to prove themselves, suppress emotions,
and code switch . 460 African American women may feel
an obligation to present an image of strength, suppress emotions, resist being vulnerable or dependent on oth-
ers, determined to succeed despite limited resources,
and feel an obligation to help others . 461 This may lead to chronic psychological distress, which is associated with physiological processes, such as chronic inflammation,
abdominal obesity, and heart disease . 462
The overwhelming amount of racial stress caused by
racism can result in trauma . 463 Racial trauma, a form of race-based stress, is defined by psychologists as per- sistent psychological injury caused by racism . 464 This trauma may produce mental illnesses or psychological
wounds tied to historical traumatic experiences, like
slavery . 465 Studies have shown that racial and ethnic discrimination may play an important role in the de-
velopment of Post-Traumatic Stress Disorder (PTSD)
for Black people . 466 Racial trauma can cause symptoms similar to PTSD, including hypervigilance, flashbacks,
nightmares, avoidance, suspiciousness, and physical
symptoms such as headaches, heart palpitations, and
other such symptoms . 467 Studies have also shown that Mental health problems among Black youth often result in school punishment or incarceration, rather than mental healthcare.

Cultural trauma is “a dramatic loss of identity and meaning, a tear in the social fabric affecting a group of people that has achieved some degree of cohesion[.]”

425
Chapter 12 Mental and Physical Harm and Neglect public racial discrimination against African Americans
is linked to an increase in depressive symptoms . 468
Historical trauma is the legacy of numerous traumatic
events inflicted on a group of people and experienced
over generations . 469 The health consequences of histor- ical racism and discrimination can be passed down psy-
chologically, socially, and emotionally from one gener- ation to the next resulting in intergenerational harm to Black mental health due to racism . 470 Long-term adverse health impacts linked to legal segregation laws illustrate the long reach of institutional racism . 471 Historical trau- ma studies show that children of Black parents who have been affected by trauma, also exhibit symptoms of PTSD, or “historical trauma response .” 472
Traumatization can occur at a community level as well .

Highly publicized police killings of unarmed African
Americans affect the mental health of African Americans in the region where the killing occurs . 473 In one study, the impact was felt for months afterwards, whereas no
negative effects were found for white Americans in those same localities . 474 A 2013-2016 study on the mental im- pacts of killings of African Americans in certain states found that African Americans had more poor mental
health days, whereas white people were not affected in
the same way . 475
California
Psychological institutions have contributed to over-
incarceration, forced sterilization, and denial of edu- cational opportunities for Black Californians . In 1915, psychologists leading the California Bureau of Juvenile Research at Whittier State School oversaw some of the
earliest eugenics projects, examining family trees and
conducting psychological testing of boys confined at the institution . 476 The results of this project harmed Black youth in California by increasing incarceration rates
and promoting sterilization . 477 Psychological tests were used by the state’s public education system to block ed- ucational and economic opportunities for Black youth
in California . 478 In 1979, the Federal District Court of Northern California ruled in favor of five Black students who had been placed in special education classes due to their performance on psychological tests . 479
The mental health system in California has discrim-
inated against Black Californians through inaccu-
rate diagnoses, use of involuntary
force, high cost, and a lack of cul-
turally-competent services . 480 In
comparison to other racial and
ethnic groups, it takes longer for
Black Californians to be removed
from inpatient mental health care
settings to a less restrictive level of
care . 481 Despite higher rates of in-
patient treatment, over 50 percent
of Black Californians must wait
more than eight days to step down
from an inpatient setting to a low-
er level of care . 482 It takes twice as
long for Black Californians than it does for most oth-
er racial or ethnic groups, despite no evidence of less need . 483 These racial disparities also exist in California’s small counties, despite fewer numbers of people from
nonwhite communities . 484
Many Black Californians suffer from high rates of se-
rious psychological distress, depression, suicidal ide- ation, dual diagnoses, and other mental health issues . 485 Unmet mental health needs are higher among Black
Californians, as compared with white Californians . 486 This includes being unable to access mental healthcare
and substance abuse services . 487 Across racial groups, the highest percentage of serious psychological dis-
tress and attempted suicide was found among Black
Californians . 488 Black Californians had the highest per- centage of missed days of days of work and daily activi- ties due to mental health concerns . 489 Black people are over-represented in vulnerable groups at risk for mental illness, such as unhoused people; current and formerly
incarcerated people; children in foster care; and veter- ans . 490 These groups have an increased risk for develop- ing Post-Traumatic Stress Disorder . 491
California budget cuts in funding for indigent care have disproportionately affected Black communities, who are
more likely to be indigent and in need of mental health services . 492 The lack of recruitment and retention of Black psychiatrists in Los Angeles has negatively affect- ed Black Californians, who are more likely to seek ser- vices from someone with the same racial background . 493 Studies have shown that racial and ethnic discrimination may play an important role in the development of Post-Traumatic Stress Disorder (PTSD) for Black people. Racial trauma can cause symptoms similar to PTSD. Studies have also shown that public racial discrimination against African Americans is linked to an increase in depressive symptoms.

426
Chapter 12 Mental and Physical Harm and Neglect Black mentally ill incarcerated Californians are over-
represented in Los Angeles County jails . 494 Records indi- cate that they receive more mental
health services while incarcerated
than while they are out in the com-
munity, which is illustrative of how
poor community mental health ser-
vices are for Black Californians . 495
Black Californians represent only 11
percent of Alameda County’s pop-
ulation, but make up 47 percent of
the county’s unhoused population,
48 percent of the jail system’s population, and 53 percent of people who cycle in and out of both the criminal and hospital systems . 496 The State of California has repeat- edly awarded state and county contracts to agencies that continually fail to meet a minimum level of culturally
relevant care for African Americans . 497
X . Reproductive and Gender Identity Responsive Health The federal and state governments have historically
policed the childbearing practices of African American
women and denied reproductive rights and health-
care . 498 Black women have been used as tools of repro- duction for capitalist profit—or forcibly sterilized and denied reproductive freedom . 499 Black Lesbian, Gay,
Bisexual, Transgender, and Queer (LGBTQ) Americans
are less likely to access healthcare . 500 As a result, Black women and LGBTQ Americans have suffered, in part,
due to the legacy of enslavement .

Maternal Health
Black women were denied autonomy over their repro-
duction during the slavery era and denied their rights
as mothers . 501 State and federal governments forcibly sterilized Black women in 19th and 20th centuries . 502 Later, state policies included plans to distribute experi- mental birth control, like Norplant, in Black communi-
ties . 503 States criminalized and sterilized Black women for giving birth if traces of controlled substances were found in them or their babies . 504 Coercive welfare poli- cies mandated long-term contraceptive insertion, with
harmful health consequences, as a condition for receiv- ing welfare benefits . 505
Historically, state and federal governments have refused to subsidize reproductive care, such as abortion for poor women . 506 This especially harms Black women’s access to reproductive care . Black women rely on publicly funded clinics in higher numbers, due to lack of access to private health insurance or income for a private physician . 507 Black women are also less likely to have access to infor- mation about informed consent,
sterilization, and side effects of
contraceptives . 508 Forced steriliza-
tion, mentioned earlier, was used
in conjunction with these policies,
to deny Black women autonomy
over their own bodies and their
reproductive health . 509
Studies show that Black women
suffer from disproportionate in-
fertility in comparison to other
groups . 510 This disparity stems from untreated sexually transmitted infections, nutritional deficiencies, com-
plications from childbirth and abortion, and environ-
mental hazards . 511 Black women are treated as infertile by doctors who underdiagnose endometriosis in Black
women . 512 Many reproductive technologies are unaf-
fordable or inaccessible to Black women experiencing
fertility issues . 513
One of the most harmful legacies of slavery is the dispro- portionate maternal and infant death of Black women
Across racial groups, the highest percentage of serious psychological distress and attempted suicide was found among Black Californians.

Black Californians had the highest percentage of missed days of days of work and daily activities due to mental health concerns.

Expecting and new Black mothers often find that their reports of painful symptoms are overlooked or minimized by medical practitioners. Black women must wait longer for prenatal appointments and are ignored, scolded, demeaned, and bullied into having C-sections.

427
Chapter 12 Mental and Physical Harm and Neglect and children today due to lack of access to adequate
reproductive healthcare . 514 Black women experience
disproportionate racial discrimination in access to and quality of prenatal care . 515 Expecting and new Black mothers often find that their reports of painful symp-
toms are overlooked or minimized by medical practi-
tioners . 516 Black women must wait longer for prenatal appointments and are ignored, scolded, demeaned, and
bullied into having C-sections . 517 Even wealthier Black women suffer the racist disregard of medical provid-
ers . 518 Serena Williams, the renowned tennis champi- on, was ignored by medical providers who dismissed
her concern regarding a post-pregnancy blood clot . 519 After insistence by Williams that she undergo a CT scan, doctors found a clot in her lungs . 520
Black women disproportionately experience ad-
verse birth outcomes and adverse maternal health . 521
Researchers have found evidence that this may be in-
fluenced by the uniquely high level of racism-induced
stress experienced by Black women, as discussed
above . 522 Structural racism is a stressor that harms Black women at both physiological and genetic lev-
els . 523 Structural racism contributes to maternal and infant death disparities . In the United States, preg-
nancy-related mortality is three to four times high-
er among Black women than among white women . 524
Adequate prenatal care does not reduce racial dispar-
ities for African American women, who are still at el-
evated risk for preterm birth . 525 Hypertension, which has been linked to the stress of living in a racist society, contributes to racial disparities in pregnancy-related
complications, such as eclampsia . 526 Black mothers
are less likely to breastfeed their babies than white
mothers due to numerous historical factors, including
predatory marketing practices . 527 Lower breastfeed-
ing rates are associated with higher risk of medical is- sues before and after childbirth, and maternal mental
health issues . 528
Health of Black LGBTQ Americans
Black Lesbian, Gay, Bisexual, Transgender, and Queer
(LGBTQ) Americans experience discrimination in
healthcare . 529 They are also more likely to be unin- sured . 530 For Black transgender Americans, this results in difficulties in seeing healthcare providers and receiv- ing gender-affirming care due to cost . 531 Studies have indicated that Black LGBTQ Americans experience as-
sumptions, judgment, stigma, and discrimination in the
healthcare system . 532 It is difficult for them to establish a personal bond, trust, and familiarity with providers, who do not often meet their needs with respect to their sexual and gender identities . 533
Black LGBTQ Americans suffer from especially poor
health outcomes . Black LGBTQ people who identify as
women have higher diagnoses of hypertension, stroke,
and diabetes . 534 Many Black LGBTQ Americans are at
higher risk for HIV when compared with white cisgen-
der, heterosexual Americans . 535 As of 2015, Black trans- gender women had HIV at the rate of 19 percent, while
1 .4 percent of the transgender population at large had HIV . 536 Black LGBTQ Americans have also been found to have higher rates of asthma, heart attacks, and cancer . 537 A large proportion of Black LGBTQ Americans have suf-
fered verbal insults or abuse, threats of violence, phys- ical or sexual assault, and robbery or property destruc- tion . 538 Black LGBTQ Americans are almost twice as likely to report a diagnosis of depression compared to African American non-LGBTQ adults . 539 Researchers posit that such mental and physical health outcomes are linked
to a combination of anti-Black racial discrimination,
and anti-LGBTQ prejudice . 540 Stigma and discrimina-
tion can create a stressful social environment that may lead to mental and physical health problems for African Americans in the LGBTQ community . 541
California
In California, as well as nationally, Black women are sub- stantially more likely than white women to suffer severe health complications during pregnancy, give premature
birth, die in childbirth, and lose their babies . 542 From 2014 to 2016, the pregnancy-related mortality ratio for Black women in California was four to six times great-
er than the mortality ratio for other ethnic groups . 543 In fact, Black women were overrepresented for preg-
nancy-related deaths for all causes, but most notably
for deaths during pregnancy or during hospitalization
post-delivery . 544 Over the past decade, Black babies died at almost five times the rate of white babies in San Francisco . 545 In a comprehensive study of 1 .8 million hospital births, it was found that when a Black doctor is the primary charge on these cases, the infant mortality rate is cut in half . 546
The high rates of preterm birth and maternal mortality
for Black women are due, in part, to complications from Compared to all transgender Americans,
Black transgender Americans are
to be infected with HIV 5x MORE LIKELY

428
Chapter 12 Mental and Physical Harm and Neglect underestimated or undiagnosed health conditions . 547
In 2006, in Los Angeles, Bettye Jean Ford gave preterm
birth to a baby who did not survive . 548 “Giving birth was horrible,” she said . “It was just
an awful experience emotionally,
physically .” 549 Black people giving
birth experience the highest rates
of postpartum depression and
mortality during childbirth . 550
California passed the Dignity in
Pregnancy and Childbirth Act in
2019, which aims to address im-
plicit bias in healthcare and col-
lect data on maternal health . 551
However, experts state that the bill
is difficult to enforce, since physicians contract with hospitals and are not subject to the same oversight as
ordinary employees . 552 It is left to healthcare facilities to implement practices to address implicit bias—which
is not likely to occur . 553
A survey in California found that Black women dispro-
portionately reported unfair treatment, harsh language, and rough handling during their hospital stay, as com-
pared to white women . 554 Doulas are trained profession- als who provide physical, emotional, and informational
support to mothers . 555 Evidence shows that women
who had the support of doulas were less likely to have
C-sections and have healthier babies . 556 Doulas play an important role as advocates for Black women in the
medical system when medical providers do not believe
Black women or address their needs . 557 However, during the COVID-19 pandemic, the California state legislature failed to pass an initiative to provide doula care for preg- nant and postpartum people in the 14 California coun-
ties with the highest birth disparities . 558
In the American West, Black LGBTQ Americans are more
likely to be uninsured, diagnosed with depression, and
diagnosed with asthma, diabetes, high blood pressure,
high cholesterol, heart disease, and cancer . 559 A 2021 study of transgender women in the San Francisco Bay
Area revealed that Black transgender women are at a
higher risk for suffering from hate crimes because of
the intersectional effects of racism and transphobia . 560 Black transgender women had a higher tendency to be
the victim of battery with a weapon, a potentially fatal form of violence, compared to white transgender wom-
en who participated in the study . 561
XI . Child and Youth Health
Some scholars have stated that the legacy of slavery, and the segregation and racial terror that occurred in the
years after, has resulted in high rates of infant mortality and damaged health . 562 Discriminatory care has contin- ued through the centuries—resulting in lasting health
disparities affecting Black children and youth . 563 As will be discussed in this section, the public school, foster care, and carceral systems further damage the health of Black youth due to the discriminatory and violent treatment
Black youth receive at the hands of state and local officials .

Pediatric Care
Racial segregation in hospitals has resulted in lower
quality care for Black babies, contributing, in part to low birth weight and premature birth for Black infants . 564 The infant death rate for Black babies is the highest in the nation . 565 Black infants are twice as likely to die as white infants—11 .3 per 1,000 Black babies die, compared with 4 .9 per 1,000 white babies . 566 This racial disparity is wider than that of 1850, when African Americans were
enslaved . 567 Studies show that education does not miti- gate this problem . Black women with advanced degrees
are more likely to lose their babies than white women
with less than an eighth-grade education . 568 Federal and state governments have not addressed this prob-
lem, since, as of March 2022, only nine states investigate racial disparities when conducting reviews of pregnan-
cy-related deaths . 569 Racial disparities in infant mortali- ty and low birth weight have been associated with racial Over the past decade, Black babies died at almost five times the rate of white babies in San Francisco. In a comprehensive study of

1.8 million hospital births, it was found that when a Black doctor is the primary charge on these cases, the infant mortality rate is cut in half.

In California, compared to all women,
Black women were
to die during or after
pregnancy or and birth4-6x MORE LIKELY

429
Chapter 12 Mental and Physical Harm and Neglect discrimination and maternal stress . 570 Studies show that Black physician care of Black newborns significantly re- duces the Black infant death rate; however, Black phy-
sicians are disproportionately underrepresented in the
field of medicine . 571
The American Academy of Pediatrics has stated that
racism is a social determinant of health which has a
profound impact on the health of children . 572 African American children experience worse health outcomes
than white American children, due to unequal access to
care, in part, because of parental unemployment and
lower household net worth . 573 (For a more detailed dis- cussion of wealth disparities, please see Chapter 13 on the Wealth Gap .) The impact of racism has been linked to birth disparities and health problems in Black children and adolescents . 574 Chronic stress leads to increased and prolonged levels of exposure to stress hormones,
which lead to inflammatory reactions that predispose
children to chronic disease . 575 Increased stress related to racial discrimination experienced by Black children
has been associated with increased asthma risk and se-
verity . 576 African American children are more likely to die from asthma . 577 Children’s exposure to discrimina- tion has also been linked with higher rates of attention deficit hyperactivity disorder, anxiety, depression, and decreased general health . 578
Black youth disproportionately suffer from obesity and
being overweight due to social and environmental cir-
cumstances that produce psychological stress—including
less access to education and more exposure to racial dis- crimination . 579 Black children are referred less quickly for kidney transplants than white children . 580 They are also more likely to die following surgery . 581 The underdi- agnosing of Black children is linked to the lack of Black pediatricians, which has resulted in inadequate access
to pediatric care for Black children . 582
School, Foster Care, and Carceral Systems
Black youth are overrepresented in the foster care system and suffer disproportionately worse health outcomes
in the system . 583 Black youth suffer
from greater rates of child abuse
and neglect as well as negative im-
pacts on mental health in state-run
foster care systems . 584 They may be
placed on psychotropic drugs which
alter behavior patterns and increase
the risk for suicide and illness . 585
Black students experience dispa-
rate health outcomes and discrim-
ination in public school systems . 586 Racial disparities in educational access and attainment, along with racism
experienced in schools, affect the trajectory of academic achievement for Black youth and ultimately harm their
health . 587 (For a more detailed discussion of discrimina- tion in education, please see Chapter 6 on Separate and Unequal Education .) Black students are 2 .9 times more likely to be labeled with a disability than white students, resulting in disproportionate placement of Black stu-
dents in special education, where they are less likely than white students to return to regular instruction and are prescribed unnecessary psychotropic medications . 588
In public schools, despite health screenings and low aca- demic scores that indicate mental illness, a learning dis- ability, or developmental delay— Black youth are over-di- agnosed for conduct disorder and under-diagnosed for
depression . 589 The closure of public schools during the COVID-19 pandemic resulted in missed meals, nega-
tively impacting Black children’s health, nutrition, and food security because Black students are more likely to be eligible for free or reduced-price meals . 590
Black youth are overrepresented at every level of the
juvenile justice system, from initial contact with law
enforcement to sentencing and incarceration, which
has led to worsening health . 591 Among youth who are
arrested, Black youth are three times as likely to be in- carcerated in the juvenile justice system and less likely to be diverted to non-carceral settings than white youth . 592 African American youth involved in the carceral system
have worse mental and physical health, during and after incarceration . 593 This is due to communicable diseases, which spread in juvenile facilities, physical and sexu- al trauma, as well as erosion of mental health . 594 Black youth are overprescribed psychotropic medication and
misdiagnosed by the carceral system, when compared
with white youth . 595 Within juvenile justice settings, African American boys are 40 percent more likely to
be diagnosed with conduct disorder than white youth,
while African American girls are 54 percent more like-
ly—even when controlling for trauma, behavioral indi-
cators, and criminal offense charges . 596
Black students are 2.9 times more likely to be labeled with a disability than white students, resulting in disproportionate placement of Black students in special education, where they are less likely than white students to return to regular instruction and are prescribed unnecessary psychotropic medications.

430
Chapter 12 Mental and Physical Harm and Neglect California
Malnutrition rates are higher for Black children in
California, when compared with other racial groups . 597 For instance, 20 .2 percent of Black Californian households reported having children who did not have enough to eat, which is higher than the 15 .9 percent of all Californian households that reported not having enough food to
eat . 598 According to data from 2018, almost three times as many Black Californian children
live in poverty when compared with
white children . 599 Poverty results in
worse cognitive, socio-emotional,
and physical health . 600 This is par-
ticularly prevalent for Black children
in California, due to their overrep-
resentation among poor children
at large . 601
In California, Black youth are more
likely to be incarcerated than their
white peers, and have likely had pri-
or exposure to toxic stress . 602 The
poor living conditions among incar-
cerated youth intensify health problems . 603 The carcer- al system inadequately serves the health needs of Black incarcerated youth . 604 Tanisha Denard, a Black teenager, was in high school when she violated her probation due
to unpaid truancy tickets and was sent to juvenile hall . 605 Her time in juvenile hall severely harmed her mental
health . 606 “Being locked down make you feel that you are worthless to society,” she said . “You start to think about any way to escape, even if it means suicide .” 607 While in- carcerated she was subjected to solitary confinement,
not allowed to use the restroom, and forced to sleep on bedsheets stained with urine, blood, and feces . 608 The ju- venile justice system lacks policies, practices, and inter- ventions specific to serving Black youth like Denard . 609 XII . Public Health Crises
Scholars have theorized that the federal and state gov- ernments’ racist public health practices, along with
centuries of slavery, segregation, and white oppression have resulted in entrenched systemic racism, which has
harmed African American health . 610 The public health crises described in this section are not an exhaustive list of the mismanagement of health crises; rather, they are selected illustrative examples . Today, African Americans continue to be at the highest risk for negative health im- pacts from public health crises . 611
Infectious Diseases
In 1793, anti-Black racism on the part of state officials in Pennsylvania resulted in the death of hundreds of African Americans during the yellow fever epidemic . 612 At the time, medical historians and prominent white leaders,
assuming Black people were immune to the disease, en-
couraged African Americans to assist with managing the
epidemic . 613 Many Black residents remained in the city, instead of fleeing, participating in the epidemic relief ef- fort, caring for the ill and burying the dead . 614 In the end, hundreds of African Americans died from yellow fever . 615 In the post-Reconstruction era, tuberculosis was a
deadly health problem for African Americans . 616 In
1900, there were large disparities in tuberculosis rates between white and Black populations because segre-
gated Black neighborhoods were impoverished, had
congested housing, and could not access basic health-
care information . 617 In the early 1900s, state and local public health agencies, hospitals, and physicians por-
trayed Black people as a hazardous population to the
white public . 618
In 1964, Black tuberculosis rates were two to three times higher than for white Americans . 619 Substandard and
segregated housing, in addition to concentrated pov-
erty, contributed to high HIV and tuberculosis rates in the 1980s and 1990s . 620 The disease spread widely in pris- ons, hospitals, cramped housing, and homeless shelters, leading tuberculosis rates to increase among African
Americans . 621 Due to a combination of government ne- glect and systemic racism, African Americans have been
harmed by the spread of infectious diseases .

Black youth are three times as likely to be incarcerated in the juvenile justice system and less likely to be diverted to non-carceral settings than white youth. African American youth involved in the carceral system have worse mental and physical health, during and after incarceration. This is due to communicable diseases, which spread in juvenile facilities, physical and sexual trauma, as well as erosion of mental health.

431
Chapter 12 Mental and Physical Harm and Neglect Drug Addiction
Internationally, public health officials have recognized that drug addiction should be treated as a health disor- der and not as a criminal behavior . 622 The federal gov- ernment has chosen to respond to rising drug addiction
as a criminal justice issue, instead of as a public health issue . 623 This has resulted in state action against Black people in need of substance abuse services . 624 According to healthcare providers and experts, the government
should treat drug addiction as a public health issue . 625 Drug addiction is a medical condition, not a flaw in char- acter . 626 Punishment for substance abuse disorders does not treat addiction—it leads to high-
er risk of drug overdose . 627
By the 1980s, the government em-
barked upon a rigorous crackdown
on the usage of crack, a crystalized
type of cocaine which is highly
addictive and relatively cheap . 628
During the 1970s, hospital emergen-
cy rooms began testing pregnant women for suspected
drug use and reporting them to police authorities . 629 In many cases, hospitals imprisoned women, shackled
them while they gave birth, or took temporary or per-
manent custody of their children . 630 Hospitals reported Black pregnant women 10 times more frequently to gov-
ernment health authorities than white women . 631
State policy leaders did not address the need for in-
creasing preventive mental illness and rehabilitation
resources . 632 Nor did they address the psychosocial or- igins for the demand for crack . 633 Police crackdowns and incarceration for drug possession did not relieve
the social conditions that spawned the crack cocaine
epidemic, but rather created harmful consequences for
African Americans . 634 State actions exacerbated them by treating drug addiction as a crime, as opposed to a
public health issue . 635 By the year 2000, over 80 percent of those charged with crack-related crimes were Black,
while less than six percent were white . 636 Throughout the course of the crack epidemic, sentencing disparities caused African Americans to receive excessive sentences in prison, and many continue to serve such excessive
sentences today . 637

HIV/AIDS
During the 1980s, AIDS harmed Black communities se-
verely, especially LGBTQ Black populations and intra-
venous Black drug users, who were overrepresented
among AIDS victims . 638 Today, the prevalence of HIV
is especially high within the African American LGBTQ
community . 639 Black gay and bisexual men are infected by HIV more than any other group in the United States
today and have the highest HIV death rate . 640 Between 2010 and 2019, the number of HIV infections among
white gay men decreased significantly while the num-
ber of infections among African American gay men did
not decrease . 641 Longstanding inequities in access to and delivery of healthcare to African Americans has led to
this disparity . 642 Black women accounted for the largest share of women living with an HIV diagnosis in 2017 . 643 Due to the lack of federal or state-funded healthcare
resources for the AIDS epidemic, Black healthcare lead- ers and organizers worked to connect AIDS victims to
medical services, benefits, and health education . 644
Churches and community organizations formed to
educate African Americans about sexual health and
AIDS prevention . 645 They worked with Black LGBTQ
populations to educate them about safe sex practices
and to provide outreach and health services to people
with AIDS . 646 Despite this work by African American
communities, the Centers for Disease Control and
Prevention planned to cut funding from dozens of
groups operating AIDS services . 647
Nutrition
African Americans are more likely to live in food des-
erts—areas with limited access to healthy, affordable
food . 648 (For a more detailed discussion of discrimina- tion in infrastructure, please see Chapter 7 on Racism
in Environment and Infrastructure .) Tobacco products,
such as menthol cigarettes, have been historically mar- keted to Black communities by tobacco companies at
higher rates than white communities . 649 Despite reg- ulating and banning other products, the federal gov-
ernment did not consider banning menthol flavored
tobacco products until 2021 . 650 Additionally, the over- concentration of liquor stores in African American
From 1991-2016, compared to
whites, Black crack users were
to be sent to federal
prison for their offense 7x MORE LIKELY
Black gay and bisexual men are infected by HIV more than any other group in the United States today and have the highest HIV death rate.

432
Chapter 12 Mental and Physical Harm and Neglect neighborhoods is correlated to African American
health problems . 651
The makers of sugar sweetened beverages, fast foods,
and other products also often target Black commu-
nities in marketing schemes . 652 These food products
contribute to overconsumption, leading to diabetes,
obesity, and other health problems . 653 Between 2005
and 2008, Black adults consumed nearly nine percent
of their daily calories from sugar drinks, compared to
about five percent for white adults . 654 Black children and teens see more than twice as many ads for certain
sugar drinks than their white peers . 655 Lower-income Black neighborhoods have disproportionately more
outdoor ads on billboards, bus benches, sidewalk
signs, murals, and store window posters for sugar
drinks . 656 Sugar has had disproportionately negative consequences for Black people, and is linked to diabe-
tes, obesity, and hypertension . 657 Marketing companies are protected by law under the First Amendment, while
Black youth are not protected from the harmful conse-
quences of their actions . 658
Natural Disasters
The federal government has engaged in the racist mis-
management of natural disasters like hurricanes—a
prime example is Hurricane Katrina . Racial health
disparities among Black communities in New Orleans
existed prior to Hurricane Katrina . 659 This was due
to lack of health insurance for low-income residents,
high levels of infant mortality, and high levels of chron- ic disease . 660 Charity Hospital, a state hospital in New Orleans, had been the center of hospital care for poor
African Americans prior to Hurricane Katrina . 661 Three quarters of its patients were Black, with incomes below $20,000 . 662 The hospital provided care for HIV/AIDS, drug abuse, psychiatric care, and trauma care . 663 After the hurricane, the state did not reopen Charity Hospital— leaving poor African Americans in New Orleans without
medical care . 664
Following Hurricane Katrina, Black communities re-
ceived diminished medical care that amplified health
disparities, while white communities were restored to
even better conditions than they had lived in before
the hurricane hit . 665 By 2010, 34 percent of the Black population in New Orleans was living in poverty, com-
pared to 14 percent of white people . 666 Black youth in New Orleans were four times more likely to die from
any cause than their white counterparts . 667 There were increased death rates for African Americans from kid-
ney disease and HIV . 668 From 2009 to 2011, one-third of Black residents lacked health insurance, double that of white Americans . 669 The federal government directed
funding to repair the buildings, bridges, and streets
of New Orleans . 670 However, the government did not
address the rampant poverty and health disparities
among Black people that had been exacerbated by
Hurricane Katrina . 671
COVID-19
Today, African Americans are disproportionately at risk for COVID-19 infection and death due to structural fac- tors such as healthcare access, density of households,
employment, and pervasive discrimination . 672 As of
March 2022, African Americans are 1 .1 times more like- ly to contract COVID-19, 2 .4 times
more likely to be hospitalized due
to COVID-19, and 1 .7 times more
likely to die from COVID-19 than
white Americans . 673 The feder-
al government suggests that long
standing racial inequities contrib-
ute to worse COVID-19 outcomes
for Black people . 674 Factors that
increase COVID-19 risk for African
Americans include: unaffordable
housing, lack of healthy food, en-
vironmental pollution, poor qual-
ity healthcare, poor health insur-
ance, essential worker jobs, lower
incomes, greater debt, and poorer
access to high quality education . 675
All of these factors disproportion-
ately harm African Americans due
to systemic racism .

COURTESY OF JAMES NIELSEN/AFP VIA GETTY IMAGES
National Guardsmen stand watch at barricades outside the Superdome as emotional refugees driven from their homes by Hurricane Katrina await evacuation from the flooded city of New Orleans, La. Following Hurricane Katrina, African Americans in New Orleans received worse medical care than white Americans, which made pre-existing disparities worse. Living conditions for white Americans in New Orleans were restored or improved upon when compared with conditions before the hurricane hit. (Sept. 1, 2005)

433
Chapter 12 Mental and Physical Harm and Neglect California
The State of California has also engaged in the mis-
management of public crises in ways that have harmed
African Americans . In California, the criminal justice system excessively targeted African Americans during
the crack cocaine epidemic . In Los Angeles, Black
Californians would receive up to a 10-year federal sen- tence, while white Americans prosecuted in state court
faced a maximum of five years and often received no
more than a year in jail . 676 From 1987 to 1992, a University of California Los Angeles study found there were no
white Americans among the 71 defendants prosecuted
federally by the U .S . attorney’s office in Los Angeles . 677 This discriminatory prosecution occurred even though
studies showed that white Americans accounted for
the majority of people who used crack cocaine in
Los Angeles . 678
As of 2017, California incarcerated African American
men at 10 times the rates of white American men, re-
sulting in devastating health impacts for the African
American community . 679 Black women are imprisoned
at a rate that is more than five times that of white women in California . 680 Black Californians are also overrepre- sented among California’s unhoused . 681 The overrep-
resentation of Black Californians among the unhoused
and incarcerated populations, both of which are vul-
nerable to COVID-19, means that Black Californians are
consequently at higher risk of contracting COVID-19 and other illnesses . 682
California is also home to many food deserts that harm
African American health . In South Los Angeles, many
Black Californians do not have enough grocery stores,
access to organic produce, thriving small businesses,
affordable housing, or medical services . 683 In View Park area, a majority Black South Los Angeles neighborhood,
the nearest grocery store is an Albertsons more than a
mile away . 684 Black residents have been forced to engage in urban micro-farming, building community gardens,
and mini markets to compensate for the lack of healthy
available food . 685
The trifecta of liquor stores, smoke
shops, and marijuana dispensaries
in Black neighborhoods in California
has resulted in inadequate access to
healthy foods . 686 Maria Rutledge, a
Black resident of South Los Angeles,
said, “We are in desperate need of
a real grocery market in the area
that is welcoming to families, pro-
vides healthy food choices, and that
supports a safer environment .” 687 In addition to the lack of grocery stores, there is an overabundance of liquor
stores . 688 During the early 1990s, there were 728 liquor stores in a 54-square-mile radius encompassing South Los Angeles . 689 While that number has decreased, South Los Angeles communities are still overrun by liquor stores, with approximately 8 .5 liquor stores per square mile
compared to 1 .97 liquor stores per square mile in West Los Angeles, a majority white neighborhood . 690 The trifecta of liquor stores, smoke shops, and marijuana dispensaries
in Black neighborhoods have indirectly resulted in sexual harassment, violence, and a climate of fear—leading to
poor mental and physical health for Black Californians . 691 In California, COVID-19 infections disproportion-
ately affect African Americans . As of March 2022, the
death rate for Black Californians due to COVID-19 is
18 percent higher than the COVID-19 death rate for all
Californians . 692 According to a survey conducted by the Association of Black Psychologists, about 40% of Black
Californians wished they had more support during the
COVID-19 pandemic . 693
XIII . Impact of Racism on Black Health
Systemic racism has culminated over centuries in
severely damaged physiological health for African
Americans . 694 Some scholars have argued that medi-
cal discrimination in the United States against African Americans is so severe that it is a form of biological ter- rorism . 695 Low life expectancy, lack of access to health insurance, and high rates of disease have resulted in
great physiological harm to African Americans . 696 State- sanctioned systemic racism has led to environmental
racism, urban poverty, and over-incarceration—all of
which have harmed the health of African Americans . 697 The cumulative effect of institutional racism by federal As of March 2022, African Americans are 1.1 times more likely to contract COVID-19, 2.4 times more likely to be hospitalized due to COVID-19, and 1.7 times more likely to die from COVID-19 than white Americans.

434
Chapter 12 Mental and Physical Harm and Neglect and state governments has led to racial trauma that has had intergenerational impacts on the mental health of
African Americans . 698
Health Outcomes
African Americans have higher rates of morbidity and
mortality than white Americans for almost all health
outcomes in the United States, an inequality that in-
creases with age . 699 African Americans suffer dispropor- tionately from cardiovascular disease relative to white people . 700 In surveys of hospitals across the country, Black patients with heart disease receive older, cheap- er, and more conservative treatments than their white
counterparts . 701 They also suffer from higher rates of diabetes, hypertension, hyperlipidemia, and obesity . 702 These are all risk factors for cardiovascular disease . 703 This is linked to the fact that African Americans suffer from weathering—constant stress from chronic expo-
sure to social and economic disadvantage, which leads
to accelerated decline in physical health . 704 Social envi- ronments that pose a persistent threat of hostility, den- igration, and disrespect lead to chronically high levels of inflammation . 705 Studies have shown that Black youth who are exposed to discrimination and segregation have
worse cases of adult inflammation due to race-related
stressors . 706 In fact, race-related
stress has a greater impact on health
among African Americans than
their diet, exercise, smoking, or be-
ing low income . 707 Cortisol, which
is a stress hormone, locates itself in
bodies in response to racism—con-
sequently African American adults
have higher rates of cortisol than
their white counterparts, and this is
linked to cardiovascular disease . 708
Therefore, exposure to racism as a
child or adolescent lays the foundation for inflammation and subsequent health disparities . Even middle- and
upper-class African Americans manifest high rates of
chronic illness and disability . 709
Discriminatory attitudes and behaviors by healthcare
professionals may also contribute to misdiagnosis and
mismanagement of cardiovascular disease among
Black patients . African Americans disproportionately
lack access to renal transplants due to racial bias ex- hibited by physicians, as well as institutionalized rac- ism . 710 African Americans are less likely to be identified as transplant candidates, referred for evaluation, be
put on the kidney transplant waitlist, receive a kidney transplant, and receive a higher-quality kidney from
a living donor . 711 Black patients with sickle cell disease are discriminated against by medical providers who
display racist attitudes and accuse people with sickle
cell disease of faking their pain . 712 This results in inad- equate treatment . 713 There are many reports of Black children with sickle cell disease who do not receive
screening tests and treatment necessary to prevent
strokes that can occur due to the disease . 714
Racial disparities in Black health outcomes occur today as a culmination of historical racial inequality, discrim- inatory health policy, and persistent racial discrim-
ination in many sectors of life in the United States . 715 Discriminatory health systems and healthcare provid-
ers contribute to racial and ethnic disparities in health- care . 716 The U .S . Office for Civil Rights within the U .S .

Department of Health and Human Services is charged
with enforcing several relevant federal statutes and
regulations that prohibit discrimination in healthcare, such as Title VI of the 1964 Civil Rights Act . 717 However, the agency is under-resourced and has not been proac-
tive in investigating healthcare related complaints from the public, conducting compliance reviews of health-
care facilities, or initiating enforcement proceedings
for civil rights violators . 718 For example, the Office for Civil Rights could identify examples of discriminatory
practices, require the collection and reporting of demo- graphic data, and conduct investigations . 719
Policing and Incarceration
Policing and incarceration have clear adverse conse-
quences for the health of African Americans . Racial in- equality and racial bias occur in all aspects of the criminal legal system, with federal and state governments over-
incarcerating and disproportionately punishing African
Americans . 720 (For a more detailed discussion of discrimi- nation in the criminal justice system, please see Chapter 11 on An Unjust Legal System .) Police violence kills hundreds of African Americans and injures thousands each year . 721 Incarcerated people—who are disproportionately Black—
face a high risk of death after they are released from pris- ons and jails due to poor health as a result of incarcera- tion . 722 Prisons and jails have been major sites of disease transmission . 723 The churn in and out of incarceration Studies have shown that Black youth who are exposed to
discrimination and segregation have worse cases of adult inflammation due to race-related stressors. In fact, race-related stress has a greater impact on health among African Americans than their diet, exercise, smoking, or being low income.

435
Chapter 12 Mental and Physical Harm and Neglect can result in community spread of sexually transmitted
infections or other infectious diseases . 724
African Americans are overrepresented in state carcer-
al facilities, are less likely to receive the latest psy- chiatric medications, and have greater difficulty in
achieving successful community integration once they
leave carceral facilities—further harming their mental
health . 725 State prisons often force incarcerated African Americans into solitary confinement at higher rates . 726 Solitary confinement has serious documented harmful
mental health effects . 727
Anti-Black government action harms the mental health
of Black communities . Police violence can harm men-
tal and physical health for Black communities through
constant surveillance and threats of violence . 728 Studies have shown that African Americans who view racist
materials experience an increase in blood pressure . 729 Scientific evidence shows that police killings of unarmed African Americans have adverse effects on mental health among Black adults in the general population . 730 Mental health screening tools used in state and federal carceral facilities reproduce racial disparities, resulting in few- er African Americans screening positive for mental ill- ness . 731 Thus, African Americans remain under-referred and undetected in the jail population . 732
Environment
State and federal underfunding of medical resources
combined with unhealthy physical environments, un-
employment, and poverty in Black communities has
led to a public health crisis . 733 Urban neighborhoods have the highest rates of preventable diseases, and lack health insurance and adequate housing . 734 By 1980, ur- ban neighborhoods were where 60 percent of the na-
tion’s Black population lived due
to redlining and historical housing
segregation . 735 Black communities
continue to experience dispro-
portionately high rates of chronic
diseases linked to environmental
racism . 736 (For a more detailed dis-
cussion of environmental racism,
please see Chapter 7 on Racism in
Environment and Infrastructure .)
Built-up pollution from abandoned
industrial and commercial work sites resides in soil, wa- ter, structures, and air . 737 Asthma, cancer, and childhood disorders that affect Black communities are linked to
polluted environmental conditions such as toxic waste
exposure and lead poisoning . 738
Segregation adversely affects the availability and afford- ability of care—creating a lack of access to high-quality primary and specialty care, as well as pharmacy ser-
vices . 739 A review of nearly 50 empirical studies gener- ally found that government-facilitated segregation was
associated with poorer health . 740 The state-perpetrated discriminatory practice of redlining officially ended in 1968, but it created residential segregation, which con- tinues today . 741 Segregation has been found to be pos- itively associated with later-stage diagnosis, elevated mortality, and lower survival rates for both breast and lung cancers for Black people . 742
Housing segregation excessively exposes Black com-
munities to pollution and isolates African Americans
from healthcare resources, including pharmacies, clin-
ics, hospitals, and healthy food stores . 743 Disparities in life expectancies between Black and white people are
rooted in policies that oppressed and segregated African Americans . 744 Evidence shows that gaps between white and Black life expectancy are dependent on zip codes
and housing segregation . 745
There may be other cumulative negative effects of in-
stitutional and systemic racism which have yet to be
studied by scientists . A public health study conducted in 2021, for example, revealed that repeated use of chem-
ical irritants for crowd-control by local and federal law enforcement during racial justice protests in the U .S . likely harmed people’s mental and physical health . 746 California
Black Californians experience the shortest life expectan- cy than any other race or ethnicity . 747 In the San Francisco Bay Area, life expectancy is more than five years greater in white neighborhoods (84 years) than highly segregat- ed Black neighborhoods (79 years) . 748 Black Californians have the highest mortality rate in nine out of the top ten causes of death in San Francisco . 749 A high number of Black Californians live in Southwest Fresno, an area with lower life expectancy than the affluent neighborhoods
Housing segregation excessively exposes Black communities to pollution and isolates African Americans from healthcare resources, including pharmacies, clinics, hospitals, and healthy food stores.

436
Chapter 12 Mental and Physical Harm and Neglect of Fresno . 750 Black Californians suffer from the highest cancer rates among all races in colorectal, prostate, and lung cancer . 751 Black men are dying of prostate cancer at almost five times the rate of white men in California . 752 In 2015, Black Californians had the highest rate of pre- ventable hospitalizations for diabetes, heart disease,
asthma, and angina . 753 Black youth suffer from the high- est number of asthma cases in California . 754 Black chil- dren in California tend to live in areas with higher levels of traffic related pollution, which contributes to higher levels of asthma . 755 Historically redlined census tracts in California have significantly higher rates of emergency department visits due to asthma . 756 This evidence sug- gests that redlining might be contributing to racial and ethnic asthma health disparities . 757
Black Californians are the most disproportionately af-
fected by the HIV epidemic due to racism, in part . 758 In 2018, Black Californians were approximately six percent of California’s population, but they were 18 percent of California’s HIV positive population . 759 Among wom-
en newly diagnosed with HIV, 31 percent were Black
Californians . 760 Black transgender people were for 14 percent of those who were newly diagnosed with HIV . 761 Consequently, Black Californians are overrepresented
among the HIV population .

Police violence and incarceration have greatly damaged
the health of Black Californians . Black Californians ac- count for 20 percent of serious injuries and fatalities due to police use of force, even though they are only
six percent of the population . 762 More than four in 10 Californians shot by police were identified as suffering from a mental health condition, having an alcohol- or
drug-related disorder, or both, according to hospital da- ta . 763 In Brown v. Plata, the Ninth Circuit Court of Appeals ordered the State of California to reduce overcrowding
in its prison population due to inadequate healthcare
for incarcerated people . 764 Black Californians in Los Angeles’ jails who have mental health conditions report receiving harsher sentences and less alternative treat- ment programs than their white counterparts . 765 Due to the overrepresentation of Black Californians in the pris- on and jail systems, inadequate prison healthcare greatly diminishes the overall health of Black Californians . 766 XIV . Conclusion
The legacy of slavery has destroyed the health of Black communities through segregation, racial terror, abu-
sive experimentation, systemic racist oppression, and
harmful racist neglect . Today, African Americans face
racial discrimination from healthcare providers across
the entire healthcare system, which has contributed to
the overall destruction of African American health . 767 African Americans suffer from low life expectancy and
high mortality rates across virtually every category of health . 768 Due to historical and contemporary trauma- tization from racist violence, racist microaggressions, and institutional racism, African Americans often suf-
fer from serious psychological distress . 769 The misman- agement of public health crises by state and federal
governments has resulted in additional adverse health
consequences and deaths in Black communities—most
recently during the COVID-19 pandemic . 770 In some cas- es, the racial health disparities between Black and white Americans are worse today than they were during the
period of enslavement . 771
The racist dehumanization of African Americans in the
United States began with the institution of enslavement and its degradation of African American health . Since
then, this racist dehumanization has been sustained by a healthcare system that destroys Black health through overt and covert discrimination by medical providers, public
policies that neglect African Americans’ health needs,
hospital systems that continue to be segregated, medical schools that systematically exclude African Americans,
and a health insurance system designed to be inaccessible to poor African Americans . 772 The United States’ healthcare system was designed during the time of enslavement to
keep enslaved people alive for profit, but not to take care of their health . 773 After slavery was abolished in name, this healthcare system continued to operate in the same man- ner—segregating, excluding, harming, abusing, experi-
menting upon, and slowly degrading African American
health . 774 To atone for the violence of slavery and its de- structive impact on Black health, health-based reparations must be awarded to African Americans . 775
Compared to white Californian men,
Black Californian men are
to die from
prostate cancer 5x MORE LIKELY

THIS PAGE INTENTIONALLY LEFT BLANK

438
Chapter 12 Mental and Physical Harm and Neglect Endnotes
1 Grills et al ., African Psychology and the
Global Movement for Freedom from
the Lie of Black Inferiority (2020) 27
Alternation 170, 172, 170-206 .
2 Byrd & Clayton, Race, Medicine, and
Health Care in the United States: A Historical
Survey (2001) 93 J . of the Nat . Medical
Assn . 11, 11-34 (Byrd & Clayton 2001) .
3 Id. at p . 19 .
4 See generally McBride, Caring for
Equality: A History of African American
Health and Healthcare (2018) .
5 See generally Ibid .
6 Byrd & Clayton 2001, supra, at p . 24;
Goosby & Heidbrink, Transgenerational
Consequences of Racial Discrimination
for African American Health (2013) 7
Sociology Compass 630, 630-643 .
7 Forde et al ., The Weathering Hypothesis as
an Explanation for Racial Disparities in
Health: A Systematic Review (2019) 33
Annals of Epidemiology 1, 1-18 .
8 Woods et al ., “WE AIN’T CRAZY! Just
Coping With a Crazy System”: Pathways
into the Black Population for Eliminating
Mental Health Disparities (May 2012)
Cal . Reducing Disparities Project,
pp . 28-30 (as of Mar . 16, 2022) .
9 Smith et al ., Fighting at Birth: Eradicating
the Black-White Infant Mortality Gap
(Mar . 2018) Duke University’s
Samuel DuBois Cook Center on
Social Equity and Insight Center for
Community Economic Development,
p . 4 (as of Mar . 9, 2022) .
10 See Heard-Garris et al ., Structuring
Poverty: How Racism Shapes Child Poverty
and Child and Adolescent Health (2021),
21 Academics Pediatrics 108, 108-115 .
11 See generally Grills, et al ., Applying
Culturalist Methodologies to Discern
COVID-19's Impact on Communities of
Color (Jan . 31 2022) J . of Community
Psychology (as of Mar . 29, 2022);
see generally McBride, supra .
12 See generally McBride, supra .
13 Bailey et al ., How Structural Racism Works
— Racist Policies as a Root Cause of U.S.

Racial Health Inequities (Feb . 25, 2021)
384 New England J . of Medicine 768 .
14 See Morton, Crania Americana (1839) .
15 See Greenblatt, Phrenology in the Science
and Culture of the 19th Century (1995)
37 Neurosurgery 790, 790-804 .
16 Ibid .
17 Roberts, The Most Shocking and Inhumane
Inequality: Thinking Structurally About
Persistent Poverty and Racial Health
Inequities (2018) 49 University of
Memphis L . Rev . 167, 178 (Roberts 2018) .
18 McBride, supra, at pp . 21-22 .
19 Id. at p . 23 .
20 Id. at pp . 22-23 .
21 Schnapper, Affirmative Action and the
Legislative History of the Fourteenth
Amendment (1985) 71 Va . L . Rev . 753, 763-
764; Interlandi, Why Doesn’t the United
States have Universal Health Care? (Aug . 14,
2019) N .Y . Times (as of Mar . 8, 2022) .
22 See generally McBride, supra, at pp . 20-
24; Interlandi, supra .
23 McBride, supra, at pp . 57-58; see gener-
ally Lombardo, Medicine, Eugenics,
and the Supreme Court: From Coercive
Sterilization to Reproductive Freedom (1997),
13 J . Contemp . Health L . & Pol'y 1 .
24 McBride, supra, at pp . 57-58; see
Bouche & Rivard, America’s Hidden
History; The Eugenics Movement (Sept .
18, 2014) Nature (as of Mar . 9, 2022) .
25 McBride, supra, at 57-58 .
26 Raine, Federal Sterilization Policy:

Unintended Consequences (2012)
14 Am . Med . Ass . J . of Ethics
152 (as of Mar . 9, 2022) .
27 Ibid .
28Sabin, How We Fail Black Patients in Pain
(Jan . 6, 2020), Assn . Of Am . Medical
Colleges (as of Mar . 8, 2022) .
29 Ibid .
30 Ibid.
31 Ibid .
32 See McBride, supra, at pp . 17-36 .
33Stern, From Legislation to Lived
Experience: Eugenic Sterilization in California
and Indiana, 1907-79 (2011) A Century of
Eugenics in America: From the Indiana
Experiment to the Human Genome
Era, p . 110; Anton, Forced Sterilization
Once Seen as Path to a Better World (July 16,
2003) L .A . Times (as of Mar . 8, 2022) .
34 Stern, supra, at p . 110 .
35 Spicer, “A Nation of Imbeciles”: The
Human Betterment Foundation's
Propaganda for Eugenics Practices
in California (2015) Vol . 7 Voces
Novae: Chapman University
Historical Rev . 109, 109, 124 .
36 Spicer, supra, at pp . 112-114, 117, 124;
Anton, supra .
37 Spicer, supra, at p . 109 .
38 Spicer, supra, at p . 114; Anton, supra .
39 Spicer, supra, at p . 112 .
40 Kaelber, Eugenics: Compulsory
Sterilization in 50 American States—
California (2010), Univ . of Vermont
(as of Mar . 8, 2022); Anton, supra.
41 Anton, supra .
42 Spicer, supra, at p . 120; Anton, supra .
43 Anton, supra.
44 Byrd & Clayton 2001, supra, at p . 25 .
45 See generally Savitt, Medicine and
Slavery: The Diseases and Health
Care of Blacks in Antebellum Virginia
(2002), pp . 49-82 (Savitt 2002) .
46 See generall y Gonaver, The Peculiar
Institution and the Making of Modern
Psychiatry 1840-1880 (2019), pp . 1-18 .
47 See generall y Roberts, Killing the
Black Body: Race, Reproduction,
and the Meaning of Liberty (1997),
pp . 22-55 (Roberts 1997) .
48 See generally Savitt, The Use of Blacks for
Medical Experimentation and Demonstration
in the Old South (1982) 48 J . of Southern
History, 331, 331–348 (Savitt 1982) .
49 See generally McBride, supra, at pp .
1-16; Roberts 1997, supra, at pp . 22-55 .

439
Chapter 12 Mental and Physical Harm and Neglect 50 California Task Force to Study and
Develop Reparation Proposals for
African Americans (January 27,
2022) Testimony of Carolyn Roberts
(as of February 8, 2022) .
51 McBride, supra, at pp . 1-3 .
52 Savitt 2002, supra, at pp . 37, 50 .
53 Savitt 2002, supra, at p . 49 .
54 Savitt 2002, supra, at p . 71 .
55 McGuire & Coelho, Slavery and Diseases
in the Antebellum American South (Apr .
8, 2020) Parasites, Pathogens, and
Progress (as of Mar . 8, 2022) .
56 Savitt 2002, supra, at p . 37 .
57 McGuire & Coelho, supra .
58 Savitt 2002, supra, at pp . 73-83 .
59 Ibid .
60 Ibid .
61 McBride, supra, at p . 3; Savitt 2002,
supra, at pp . 88-89 .
62 Rabinowitz, From Exclusion to
Segregation: Health and Welfare Services
for Southern Blacks, 1865-1890 (1974),
48 Social Service Rev . 327, 327-354 .
63 Ibid .
64 Byrd & Clayton 2001, supra, at p . 18 .
65 Rao, Administering Entitlement:

Governance, Public Health Care,
and the Early American State (2012),
37 Law & Social Inquiry 627, 648 .
66 McBride, supra, at pp . 4, 11-12 .
67 Ibid .
68 Ibid .
69 Ibid .
70 Ibid .
71 Ibid .
72 Gonaver, supra, at p . 3 .
73 Ibid .
74 Id. at pp . 3-7 .
75 Ibid .
76 Ibid .
77 Ibid ..
78 Ibid .
79 Ibid .
80 Ibid .
81 Id. at p . 14 .
82 Id. at p . 10 .
83 Id. at p . 5 .
84 Ibid .
85 Ibid .
86 Roberts 1997, supra, at pp . 27-28
87 Jefferson, Extract from Thomas Jefferson
to John Wayles Eppes Monticello (June
30, 1820), Jefferson Quotes &
Family Letters, Thomas Jefferson
Foundation (as of Mar . 11, 2022) .
88 Owens, Medical Bondage: Race,
Gender, and the Origins of American
Gynecology (2017), pp . 43, 74 (Owens
2017); Roberts, supra, at pp . 25-31 .
89 Roberts 1997, supra, at pp . 29, 33-34 .
90 Id. at pp . 25-31 .
91 Ibid .
92 Owens 2017, supra, at p . 74; Roberts
1997, supra, at p . 33 .
93 Roberts 1997, supra, at p . 26 .
94 Id. at pp . 27-28 .
95 Id. at p . 23 .
96 Id. at pp . 26-27 .
97 Ibid .
98 Ibid ..
99 Ibid .
100 Ibid .
101 Id. at p . 282 .
102 Id. at pp . 39-41 .
103 Ibid .
104 Ibid .
105 Id. at pp . 41-42 .
106 Id. at p . 47 .
107 Ibid .
108 Lambert, Infectious Disease Among
Enslaved African Americans at Eaton’s
Estate, Warren County, North Carolina, ca.
1830-1850 (Dec . 2006), 101 Memorias do
Instituto Oswaldo Cruz 107, 107-109; see
generally Steckel, A Peculiar Population:

The Nutrition, Health, and Mortality of
American Slaves from Childhood to Maturity
(1986), 46 J . of Economic History 721 .
109 Lambert, supra, at p . 109 .
110 Williams, How Slavery Affected African
American Families, National Humanities
Center (as of Mar . 11, 2022) (NHC) .
111 Savitt 2002, supra, at pp . 188-90; Savitt
1982, supra, at pp . 332, 337 .
112 Savitt 2002, supra, at pp . 188-90 .
113 Savitt 2002, supra, at pp . 188-90 .
114 McBride, supra, at pp . 5, 10-11 .
115 Savitt 1982, supra, at pp . 331, 337-339,
345-346 .
116 Owens & Fett, Black Maternal and Infant
Health: Historical Legacies of Slavery (Oct .
2019) 109 Am . J . of Pub . Health 1342 .
117 Savitt 1982, supra, at pp . 342-44 .
118 Savitt 1982, supra, at p . 331 .
119 California Task Force to Study and
Develop Reparation Proposals
for African Americans (January
27, 2022), Testimony of Carolyn
Roberts (as of February 8, 2022) .
120 Owens 2017, supra, at pp . 1-3 .
121 Id. at p . 80 .
122 Id. at p . 2 .
123 Id. at pp . 1-3 .
124 Id. at p . 6 .
125 Id. at pp . 25-26 .
126 Savitt 1982, supra, 341-42 .
127 California Task Force to Study and
Develop Reparation Proposals
for African Americans (January
27, 2022), Testimony of Carolyn
Roberts (as of February 8, 2022) .
128 Anderson, California, A “Free State”
Sanctioned Slavery (April 2, 2020), Cal .

Historical Society (as of Mar . 11, 2022) .
129 Lapp, Blacks in Gold Rush California
(1977), pp . 72-73 .
130 Anderson, supra .
131 University of California San Francisco,
A History of UCSF: 1868-1898 The
Origins of the University of California and
Affiliated Colleges (as of Mar . 11, 2022) .
132 Rao, supra, at p . 627 .

440
Chapter 12 Mental and Physical Harm and Neglect 133 Id. at p . 648 .
134 San Joaquin Republican, Advertisements
(Jan . 31, 1861), p . 2 (as of Mar . 11, 2022);
Sacramento Daily Union, State Hospital
(June 13, 1851), p . 2 (as of Mar . 11, 2022) .
135 Nat . Park Service, Bridget “Biddy” Mason
(Feb . 7, 2021) (as of Mar . 8, 2022) .
136 Ibid ..
137 Ibid .; see also Am . Civil Liberties
Union of Northern Cal ., From Enslaved to
Entrepreneur (2019) (as of Mar . 8, 2022) .
138 Nat . Park Service, supra .
139 McBride, supra, at pp . 35-36 .
140 Foster, The Limitations of Federal Health
Care for Freedmen, 1862-1868 (1982) 48
J . of Southern History, 349, 351 .
141 McBride, supra, at pp . 18-19 .
142 Ibid .
143 Ibid .
144 Foster, supra, at pp . 356-57 .
145 Id. at p . 356 .
146 McBride, supra, at p . 22
147 Ibid .
148 Ibid .
149 An Act to Establish a Bureau for the
Relief of Freedmen and Refugees
(Freedmen Bureau Act), Ch . 90,
13 Stat . 507 (Mar . 3, 1865) .
150 Pearson, “There Are Many Sick, Feeble,
and Suffering Freedmen”: The Freedmen’s
Bureau Healthcare Activities during
Reconstruction in North Carolina,
1865-1868 (2002), 79 North
Carolina Rev . 141, 141-142 .
151 Id. at p . 142 .
152 Id. at pp . 173-75
153 McBride, supra, at p . 20 .
154 Pearson, supra, at pp . 147, 150-151 .
155 Id. at pp . 177-181
156 Ibid .
157 Ibid .
158 McBride, supra, at pp . 51-52 .
159 Ibid .
160 Id. at pp . 77-78 .
161 See generally id. at pp . 21, 64-65;
Krieger et al ., Jim Crow and Estrogen-
Receptor-Negative Breast Cancer:

US-Born Black and White Non-
Hispanic Women, 1992-2012 (2017)
28 Cancer Causes Control 49 .
162 McBride, supra, at p . 49 .
163 McBride, supra, at pp . 51-52 .
164 Ibid .
165 McBride, supra at pp . 44-46 .
166 Ibid .
167 McBride, supra at p . 51 .
168 Ibid .
169 McBride, supra, at p . 21; see generally
Georgetown Law Library, Civil Rights
in the United States, A Brief History (as of
Mar . 13, 2022); see also Thomas, Deluxe
Jim Crow: Civil Rights and American
Health Policy, 1935-1954 (2011), p . 73 .
170 McBride, supra, at pp . 76-77; 83-84 .
171 McBride, supra, at pp . 55-56 .
172 Id. at p . 51
173 Ibid .
174 Ibid .
175 Du Bois, The Souls of Black Folk
(Oxford 2008) p . 219 .
176 Ibid .
177 Kiple & Kiple, The African Connection:

Slavery, Disease and Racism
(1980), 41 Phylon 211, 213 .
178 McBride, supra, at pp . 38-41
179 McBride, supra, at p . 29 .
180 Id. at p . 160 .
181 Harley, The Forgotten History of Defunct
Black Medical Schools in the 19th and
20th Centuries and the Impact of the
Flexner Report (2006), 98 J . of the
Nat . Medical Assn . 1426, 1426 .
182 Id. at p . 1428 .
183 McBride, supra, at pp . pp . 43-44 .
184 Ibid .
185 Id. at p . 49-51 .
186 Ibid .
187 Id. at pp . 43-44 .
188 Ibid .
189 Byrd & Clayton, An American Health
Dilemma: A Medical History of African
Americans and the Problem of Race
(2000), p . 205 (Byrd & Clayton 2000) .
190 Assn . of Am . Medical Colleges,
Diversity in Medicine: Facts and Figures
2019 (as of Mar . 14, 2022) .
191 McBride, supra, at pp . 28-29, 51 .
192 Id. at pp . 49-51 .
193 Ibid .
194 Id. at p . 31
195 Id. at p . 33 .
196 Id. at pp . 49-51 .
197 Id. at pp . 68-70 .
198 Ibid .
199 Ibid .
200 Ibid .
201 Id. at p . 72-73 .
202 Id. at pp . 49-51 .
203 Ibid .
204 Carr, Why Doctors are Fighting Their
Professional Organization over
Medicare for All (Feb . 26, 2020) The
Nation (as of Mar . 14, 2022) .
205 Baker, The American Medical Association
and Race (Jun . 2014) 16 Am . Medical Assn .

J . of Ethics 479 (as of Mar . 14, 2022) .
206 Am . Medical Assn ., African American
Physicians and Organized Medicine,
1846-1968 (as of Mar . 14, 2022) .
207 Baker, supra .
208 Ibid .
209 Ibid .
210 Ibid .
211 Ibid .
212 Ibid ..
213 Ibid .
214 Ibid .
215 Ibid .; see also McBride, supra, at p . 73 .
216 Baker, supra .
217 Editorial, The Hospital Survey and
Construction Act (Sept . 21, 1946), 132
J . of the Am . Medical Ass n . 148 .

441
Chapter 12 Mental and Physical Harm and Neglect 218 Largent, Public Health, Racism, and the
Lasting Impact of Hospital Segregation
(2018), 133 Pub . Health Reps .
715, 715 (as of Mar . 14, 2022) .
219 Ibid .
220 Ibid .
221 Ibid .
222 Ibid .
223 Reynolds, Hospitals and Civil Rights,
1945-1963: The Case of Simkins v Moses
H. Cone Memorial Hospital (1997) 126
Annals of Internal Medicine 898,
898-899; Quadagno, Promoting Civil
Rights through the Welfare State: How
Medicare Integrated Southern Hospitals
(2000) 47 Soc . Problems 68, 74 .
224 McBride, supra, at p . 81 .
225 U .S . Com . on Civil Rights, Equal
Opportunity in Hospitals and
Health Facilities (Mar . 1965), p .6 .
226 McBride, supra, at p . 65 .
227 Id. at p 64 .
228 Ibid .
229 Ibid .
230 Ibid .
231 Ibid .
232 Id. at p . 89 .
233 Ibid .
234 Eryn Baldrica-Guy, Physician Earl
Meyers Known as Father of Black Medicine
in Fresno (Oct . 15, 2014) Merced
Sun-Star (as of Mar . 14, 2022) .
235 Ibid .
236 Ibid .
237 Ibid .
238 Ibid .
239 Ibid .
240 U .S . Dept . of Health, Education and
Welfare, Hill-Burton Progress
Report (1972), p . 72 .
241 Ibid .
242 Byrd & Clayton 2000, supra, at p . 253 .
243 Id. at p . 254 .
244 Toleos, Racial Segregation is Common in
Urban Hospital Markets, Analysis
Reveals (May 25, 2021) Lown
Institute (as of Jul . 19, 2021) .
245 McBride, supra, at p . 98 .
246 Johns Hopkins Urban Health Institute
Blog, 400 Years Later, The Legacy of
Slavery on Health Equity (Dec . 23,
2019) (as of Mar . 15, 2022) .
247 Jones, Bakke at 40: Remedying Black
Health Disparities Through Affirmative
Action in Medical School Admissions
(2019) 66 UCLA L . Rev 522, 533-534 .
248 McBride, supra, at p . 118 .
249 Id. at pp . 98-99 .
250 Id. at pp . 117-120 .
251 Ibid .
252 Ibid .
253 Ibid .
254 Ibid .
255 Gallegos, AAMC Report Shows Decline of
Black Males in Medicine (Sept .
27, 2016), Assn . of Am . Med .

Colleges (as of Mar . 15, 2022) .
256 Jones, supra, at pp . 522, 557-558 .
257 McBride, supra, at pp . 118-19 .
258 Ibid .
259 Ibid .
260 Ibid .
261 Ibid .
262 Ibid.
263 Ibid .
264 Huerto, Minority Patients Benefit From
Having Minority Doctors, But That’s a Hard
Match to Make (Mar . 31, 2020), Univ . of
Mich . Health Lab (as of Mar . 16, 2022) .
265 Phelan et al ., The Effects of Racism in
Medical Education on Students’
Decisions to Practice in Underserved
or Minority Communities (2019) 94
Academic Medicine 1178, 1178 .
266 See generally Alsan Phelan et al .,
The Effects of Racism in Medical Education
on Students’ Decisions to Practice in
Underserved or Minority Communities
(2019) Nat . Lib . Of Med; Nat . Bureau
of Economic Research (as of Mar . 16,
2022); Aslan et al . Does Diversity Matter
For Health? Experimental Evidence From
Oakland (2018) Nat . Bureau of Economic
Research (as of Mar . 16, 2022);
267 Williams et al ., Racism and Health:

Evidence and Needed Research (2019)
40 Annual Rev . of Pub . Health
105 (as of Mar . 16, 2022); Nelson,
Body and Soul: The Black Panther
Party and the Fight against Medical
Discrimination (2011) p . 78 .
268 Williams et al ., supra .
269 Ibid .
270 Ibid .
271 McBride, supra, at p . 83 .
272 Id . at p . 88 .
273 Id. at p . 92 .
274Ibid.
275 Ibid .
276 Id. at pp . 103-106 .
277 Id. at pp . 92-95 .
278 Ibid .
279 Nelson, supra, at pp. 59-60 .
280 McBride, supra, at p . 88 .
281 Id. at p . 83 .
282 Id. at pp . 88-89 .
283 Ibid .
284 Ibid .
285 Largent, supra, at pp . 715-718 .
286 Id. at pp . 718-719 .
287 Bittker, Racial and Ethnic Disparities in
Employer-Sponsored Health
Coverage (Sept . 7, 2020) Am . Bar
Assn . (as of Mar . 16, 2022) .
288 Ibid .
289 Ibid .
290 Ibid .
291 Ibid .
292 Ibid .
293 Ibid .
294 Ibid .
295 See Anderson & Bulatao, Understanding
Racial and Ethnic Differences in Health in
Late Life: A Research Agenda (2004) Nat .

Research Council (as of Mar . 16, 2022) .
296 Bittker, supra .

442
Chapter 12 Mental and Physical Harm and Neglect 297 Ibid .
298 McBride, supra, at p . 87 .
299 Id. at p . 91 .
300 U .S . Centers for Medicare & Medicaid
Services, History (2021) (as of Mar .
16, 2022) (CMS); U .S . Dept . of
Health and Human Services, What
is the Difference between Medicare and
Medicaid (as of Mar . 16, 2022) (HHS) .
301 CMS, supra; HHS, supra .
302 CMS, supra; HHS, supra .
303 Nolen, How Foundational Moments In
Medicaid’s History Reinforced Rather Than
Eliminated Racial Health Disparities (Sept . 1,
2020) Health Affairs (as of Mar . 16, 2022) .
304 Ibid .
305 Ibid .
306 Ibid .
307 Ibid .
308 McBride, supra, at p . 113; Nolen, supra .
309 McBride, supra, at p . 91; Nolen, supra .
310 McBride, supra, at p . 91; Cohen et al .,
Health Insurance Coverage Trends,
1959–2007: Estimates from the National
Health Interview Survey (2009)
U .S . Dept of Health and Human
Services, p . 5 (as of Apr . 4, 2022) .
311 McBride, supra, at p . 113 .
312 Id . at pp . 142-143 .
313 Ibid .
314 Ibid .; Cohen et al ., supra, at p . 5 .
315 McBride, supra, at pp . 152-153 .
316 Ibid .
317 Nolen, supra .
318 Ibid .
319 Ibid .; see also Kaiser Family
Foundation, Status of State Action on
the Medicaid Expansion Decision (Feb .
24, 2022) (as of Mar . 16, 2022) .
320 Nolen, supra .
321 U .S . Centers for Medicare and
Medicaid Services, What's Medicare
Supplement Insurance (Medigap)?
(as of Mar . 16, 2022) .
322 Ibid .
323 Kaiser Family Foundation, Medicare
and Minority Americans, pp .
2-3 (as of Mar . 16, 2022) .
324 Id. at p . 2 .
325 Id. at p . 3 .
326 Ochieng et al ., Racial and Ethnic Health
Inequities and Medicare (Feb .
2021), Kaiser Family Foundation,
p . 17 (as of Mar . 1, 2022) .
327 Nelson, supra, at pp . 77-78 .
328 Id. at pp . 75-76 .
329 Id. at pp . 76-77 .
330 Id. at p . 79 .
331 Id. at p . 113 .
332 Ibid .
333 Ibid .
334 Woods et al ., supra, at p . 87; U .S .

Census Bureau, Race (2020)
(as of Nov . 3, 2021) .
335 Pfeffinger et al ., Recovery with Limited
Progress: Impact of California Proposition
209 on Racial/Ethnic Diversity of California
Medical School Matriculants, 1990 to
2019 (Dec . 9, 2020), Healthforce
Center at Univ . of Cal . San
Francisco (as of Mar . 16, 2022) .
336 Ibid .
337 Rogers et al ., Demographics of
Disciplinary Action by the Medical Board of
California (2003-2013) (2017), Cal . State
Library, pp . 2-3 ; 5-6 (as of Mar . 1, 2022) .
338 Id. at pp . 13-15 .
339 Thomas et al . , Health Disparities by Race
and Ethnicity in California: Pattern of
Inequity (Oct . 2021), Cal . Health Care
Foundation, p . 2 (as of Mar . 16, 2021) .
340 McBride, supra, at p . 92 .
341 The World Bank, Physicians (per 1,000
people) (as of Apr . 4, 2022) .
342 Cummings, In Their Own Words: Black
Californians on Racism and Health
Care (Jan . 2022) Cal . Health Care
Foundation, p . 4 (as of Mar . 16, 2022) .
343 Id. at p . 15 .
344 Ibid .
345 Brandt, Racism and Research: The Case of
the Tuskegee Syphilis Study (1978) 8 The
Hastings Center Report 21, 22-24 .
346 Id. at p . 25 .
347 McVean, 40 Years of Human
Experimentation in America: The
Tuskegee Study (Jan . 25, 2019) McGill
University Office for Science and
Society (as of Mar . 17, 2022) .
348 Equal Justice Initiative, Tuskegee
Syphilis Experiment (Oct . 31,
2020) (as of Mar . 17, 2022) .
349 Johns Hopkins Medicine, The Legacy of
Henrietta Lacks (as of Mar . 17, 2022) .
350 Nat . Institutes of Health, NIH, Lacks
Family Reach Understanding to Share
Genomic Data of HeLa Cells (Aug . 7,
2013) U .S . Dept of Health and Human
Services (as of Mar . 17, 2022) .
351 Nature, Henrietta Lacks: Science Must
Right a Historical Wrong (Sept . 3, 2020),
585 Nature 7 (as of Mar . 17, 2022) .
352 Glantz et al ., Norplant Use Among Urban
Minority Women in the United States (2000)
61 Contraception 83; Jekanowski,
Voluntarily, for the Good of Society: Norplant,
Coercive Policy, and Reproductive Justice
(2018) Berkeley Pub . Policy J . (as of Mar .
17, 2022); Burrell, The Norplant Solution:

Norplant and the Control of African-
American Motherhood (1995) 5 UCLA
Women’s Law J . 401, 401-404, 439-443 .
353 Kaiser Family Foundation,
Contraceptive Implants (Oct . 1, 2019) (as
of Mar . 17, 2022); Gold, Guarding Against
Coercion While Ensuring Access: A Delicate
Balance (Sept . 2, 2014), 17 Guttmacher
Policy Rev . 8 (as of Mar . 17, 2022) .
354 Stern, Sterilized in the Name of Public
Health: Race, Immigration, and Reproductive
Control in Modern California (2005) 95 Am .

J . of Pub . Health 1128, 1134 (Stern 2005) .
355 Burrell, supra, at pp . 425, 438 .
356 Bullard & Wright, The Wrong
Complexion for Protection: How the
Government Response to Disaster
Endangers African American
Communities (2012), pp . 186-87 .
357 Ibid .

443
Chapter 12 Mental and Physical Harm and Neglect 358 Hornblum, Acres of Skin: Human
Experiments at Holmesburg
Prison (1998), pp . 167, 195 .
359 Id. at pp . 180-181 .
360 Id. at pp . 114, 189 .
361 Hilts, Experiments on Children are
Reviewed (Apr . 15, 1998) N .Y .

Times (as of Mar . 17, 2022) .
362 Kaelber, supra .
363 Stern 2005, supra, at p . 1131 .
364 Kaelber, supra .
365 Ibid .
366 Blue, The Strange Career of Leo Stanley:

Remaking Manhood and Medicine at
San Quentin State Penitentiary 1913-
1951 (2009) 78 Pac . Historical Rev .
210, 216, 220-221, 232, 235 .
367 Id. at p . 232 .
368 Chaddock, Early San Quentin Doctor
Pushes Prison Medicine into 20th Century
(Nov . 18, 2018) Cal . Dept . of Corrections
and Rehabilitation (as of Mar . 17, 2022) .
369 Johnson, Female Inmates Sterilized in
California Prisons Without Approval (July
7, 2013) Reveal (as of Mar . 17, 2022) .
370 McCormick, Survivors of California’s
Forced Sterilizations: ‘It’s Like My Life
wasn’t Worth Anything’ (July 19, 2021)
The Guardian (as of Mar . 17, 2022) .
371 Jindia, Belly of the Beast: California's Dark
History of Forced Sterilizations (June 30,
2020) The Guardian (as of Mar . 17, 2022) .
372 McCormick, supra .
373 Ibid .
374 Jindia, supra .
375Foster, California to Pay Reparations to
Victims of Forced Sterilization (July
8, 2021) U .S . News & World
Report (as of Mar . 17, 2022) .
376 Advisory Com . on Human Radiation
Experiments, Chapter 5: Human
Experimentation Continues (1994) U .S .

Dept of Energy (as of Mar . 17, 2022) .
377 Ibid .
378 Lee, Clinton Apologizes for U.S. Radiation
Tests, Praises Panel Report (Oct . 4, 1995)
Wash . Post (as of Mar . 17, 2022) .
379 See generally Scharff, et al ., More than
Tuskegee: Understanding Mistrust About
Research Participation (2010) 21 J . of Health
Care for the Poor and Underserved 879 .
380 Meier, Grave Robbing, Black Cemeteries,
and the American Medical School (Aug . 24,
2018) JSTOR Daily (as of Mar . 17, 2022) .
381 Davidson, “Resurrection Men” in Dallas:

The Illegal Use of Black Bodies as Medical
Cadavers (1900—1907) (2007) 11 Internat .

J . of Historical Archaeology 193, 193 .
382 Scharff, supra, at p . 879 .
383 Power-Hays & McGann, When Actions
Speak Louder Than Words — Racism and
Sickle Cell Disease (2020) 383 New England
J . of Medicine 1902 (as of Mar . 17, 2022) .
384 Ledford, Millions of Black People Affected
by Racial Bias in Health-Care
Algorithms (2019) 574 Nature
608 (as of Mar . 17, 2022) .
385 Obermeyer et al ., Dissecting Racial Bias
in an Algorithm Used to Manage the
Health of Populations (2019) 366
Science 447 (as of Mar . 17, 2022) .
386 Rabin, Dermatology Has a Problem with
Skin Color (Aug . 30, 2020) N .Y .

Times (as of Mar . 17, 2022) .
387 Ibid .
388 Ibid .
389 Ibid .
390 Biko, I Write What I Like (1978), p . 68 .
391 Mental Health America, Black and
African American Communities and Mental
Health (2022) (as of Mar . 18, 2022) .
392 Ibid .
393 Gonaver, supra, at p . 3 .
394 Geller, Structural Racism in American
Psychiatry and APA: Part 1 (June 23, 2020)
Psychiatric News (as of Mar . 18, 2022) .
395 Ibid .
396 Ibid .
397 Ibid .
398 Ibid .
399 Ibid .
400 Schiele, Social Welfare Policy:

Regulation and Resistance Among
People of Color (2011), p . 66 .
401 Geller, supra .
402 Neighbors, Improving the Mental Health
of African Americans: Lessons from the
Community Mental Health Movement (1987)
65 The Milbank Quarterly 348, 349-350 .
403 Cannon et al ., Being Black Is Detrimental
to One’s Mental Health: Myth or Reality?
(1977) 38 Phylon 408, 410 .
404 Ibid .
405 Id. at pp . 423-425 .
406 Ibid .
407 McBride, supra, at p . 65 .
408 Baker et al ., Issues in the Psychiatric
Treatment of African Americans
(Mar . 1, 1999) Psychiatry Online
(as of Mar . 18, 2022) .
409 Am . Psychological Assn ., Apology to
People of Color for APA’s Role in
Promoting, Perpetuating, and Failing to
Challenge Racism, Racial Discrimination,
and Human Hierarchy in U.S. (Oct .
29, 2021) (as of Mar . 18, 2022) .
410 Ibid .
411 Ibid .
412 Ibid .
413 Ibid .
414 Am . Psychological Assn ., Historical
Chronology: Examining Psychology’s
Contributions to the Belief in Racial
Hierarchy and Perpetuation of Inequality
for People of Color in U.S. (2022) (as of
Mar . 18, 2022) (APA Chronology) .
415 Ibid .
416 Ibid .
417 Ibid .
418 Ibid .
419 Ibid .
420 Ibid .
421 Ibid .
422 Ibid .
423 Ibid .
424 Ibid .
425 Ibid .
426 Ibid .
427 Ibid .

444
Chapter 12 Mental and Physical Harm and Neglect 428 Ibid .
429 Ibid.
430 Ibid .
431 Ibid .
432 Ibid .
433 Ibid .
434 Ibid .
435 Woods et al ., supra, at pp . 28-30 .
436 Id. at p . 88 .
437 Johnson, Underrepresented: The
Undeniable Link Between Race and
Diagnosis, Treatment, and Wellness (Feb .
24, 2022), Psycom (as of Mar . 18, 2022) .
438 Ibid .
439 Page et al ., Understanding the Diversity of
Students and Faculty in Health Service
Psychology Doctoral Programs (2017)
Behavioral Health Workforce
Research Center, p . 6 (as of Mar .
18, 2022); Tamir, Facts About the U.S.

Black Population (Mar . 25, 2021) Pew
Research Center (as of Mar . 19, 2022) .
440 Constantine, Racial Microaggressions
against African American Clients in Cross-
Racial Counseling Relationships (2007)
54 J . of Counseling Psychology 1 .
441 Ibid .
442 Neighbors et al ., Racial Differences in
DSM Diagnosis Using a Semi-Structured
Instrument: The Importance of Clinical
Judgment in the Diagnosis of African
Americans (2003) 44 J . of Health and
Social Behavior 237; Whaley, Ethnicity/
Race, Paranoia, and Hospitalization for
Mental Health Problems Among Men
(2004) 94 Am . J . Public Health 78 .
443 See generally Hall et al., Implicit Racial/
Ethnic Bias Among Health Care
Professionals and Its Influence on Health
Care Outcomes: A Systematic Review
(2015) 105 Am J Public Health 60 .
444 Dept . of Nursing, Understanding
Barriers to Minority Mental Health Care
(May 10, 2018) Univ . of Southern
Cal . (as of Mar . 19, 2022) .
445 Ibid .; see also Hankerson et al .,
Treatment Disparities among African
American Men with Depression: Implications
for Clinical Practice (2015) 26 J . of Health
Care for Poor and Underserved 21 .
446 Hankerson, supra .
447 Marrast et al ., Racial and Ethnic
Disparities in Mental Health Care for Children
and Young Adults: A National Study (2016)
46 Internat . J . of Health Services 810 .
448 LeCook et al ., Comparing Methods of
Racial and Ethnic Disparities Measurement
across Different Settings of Mental
Health Care (2010) 45 Health
Services Research 825, 826 .
449 See generally Grills, et al ., Breathe,
Baby, Breathe: Clearing the Way for the
Emotional Emancipation of Black People
(2016) 16 Cultural Studies-Critical
Methodologies 333 (Grills 2016) .
450 Ibid .
451 Ibid .
452 Id. at p . 336 .
453 Id. at p . 339 .
454 Id. at p . 337 .
455 Sellers et al ., Racial Identity Matters: The
Relationship between Racial Discrimination
and Psychological Functioning in African
American Adolescents (2006) 16 J .
of Research on Adolescence 187;
Fisher et al ., Discrimination Distress
During Adolescence (2000) 29 J . of
Youth and Adolescence 679 .
456 Chavous et al ., Gender Matters, Too: The
Influences of School Racial Discrimination
and Racial Identity on Academic Engagement
Outcomes among African American
Adolescents (2008) 44 Developmental
Psychology 637; Neblett et al ., African
American Adolescents’ Discrimination
Experiences and Academic Achievement:

Racial Socialization as a Cultural
Compensatory and Protective Factor (2006)
32 J . of Black Psychology 199; Smalls
et al ., Racial Ideological Beliefs and Racial
Discrimination Experiences as Predictors
of Academic Engagement Among African
American Adolescents (2007) 33 J . of
Black Psychology 299; Wong et al ., The
Influence of Ethnic Discrimination and
Ethnic Identification on African American
Adolescents’ School and Socioemotional
Adjustment (2004) 71 J . of Personality 1197 .
457 Allen et al ., Racial Discrimination, The
Superwoman Schema, and Allostatic
Load: Exploring an Integrative Stress-
Coping Model Among African American
Women (2019) 1457 Annals of the
N .Y . Academy of Sciences 104 .
458 Ibid.
459 Ibid .
460 Ibid .
461 Ibid .
462 Ibid .
463 Comas-Díaz et al ., Racial Trauma:

Theory, Research, and Healing:

Introduction to the Special Issue
(2019) 74 Am . Psychologist 1 .
464 Ibid .
465 Ibid .
466 Sibrava et al ., Posttraumatic Stress
Disorder in African American and Latinx
Adults: Clinical Course and the Role
of Racial and Ethnic Discrimination
(2019) 74 Am . Psychologist 101 .
467 Comas-Diaz, supra .
468 Seaton & Iida, Racial Discrimination and
Racial Identity: Daily Moderation Among
Black Youth (2019) 74 Am . Psychologist 117 .
469 Grills 2016, supra, at p . 336 .
470 Goosby & Heidbrink, supra .
471 Krieger et al ., Jim Crow and Premature
Mortality Among the US Black and
White Population, 1960–2009: An
Age–Period–Cohort Analysis (2014)
25 Epidemiology 494 .
472 Sotero, A Conceptual Model of Historical
Trauma: Implications for Public Health
Practice and Research Historcal Trauma
(2006) 1 J . of Health Disparities,
Research, and Practice 93, 96 .
473 Jacob Bor et al ., Police Killings and their
Spillover Effects on the Mental Health
of African Americans: A Population-
Based, Quasi-Experimental Study
(2018) 392 The Lancet 302 .
474 Ibid .
475 California Task Force to Study and
Develop Reparation Proposals
for African Americans (January

445
Chapter 12 Mental and Physical Harm and Neglect 28, 2022), Testimony of Kristee
Haggins (as of February 8, 2022) .
476 APA Chronology, supra .
477 Ibid .
478 Ibid .
479 Ibid .
480 Woods et al ., supra, at p . 6 .
481Valle, Existing Disparities in California’s
System of Specialty Mental Health Care
(May 24, 2019) Cal . Pan-Ethnic Health
Network (as of Mar . 19, 2022) .
482 Ibid .
483 Ibid .
484 Ibid.
485 Woods et al ., supra, at p . 6 .
486 Eberhart, Monitoring Californians’
Mental Health: Population
Surveillance Reveals Gender, Racial/
Ethnic, Age, and Regional Disparities
(2018) Rand Corporation, at pp .
3-8 (as of Mar . 19, 2022) .
487 Ibid .
488 Ibid .
489 Ibid .
490 Woods et al ., supra, at p . 18 .
491 Ibid .
492 Id. at p . 49 .
493 Id. at pp . 49-50 .
494 Id. at pp . 50-51 .
495 Ibid .
496Hosseini, Alameda County Violates
Rights of Mental Health Patients, Inmates,
Feds Say (Apr . 22, 2021) San Francisco
Chronicle (as of Mar . 19, 2022) .
497 Woods et al ., supra, at p . at 78 .
498 Roberts 1997, supra, at pp . 1-7 .
499 Ibid .
500 Choi et al ., Black LGBT Adults in the US:

LGBT Well-Being at the Intersection of
Race (Jan . 2021) UCLA School of Law:

Williams Institute (as of Jan . 19, 2021) .
501 Roberts 1997, supra, at pp . 6-7 .
502 Id. at pp . 4-5 .
503 Ibid .
504 Ibid .
505 Ibid .
506 Id. at pp . xii-xiv .
507 Id. at p . 233 .
508 Id. at p . 97 .
509 Id. at pp . 6-7 .
510 Wellons et al ., Racial Differences in Self-
Reported Infertility and Risk Factors
for Infertility in a Cohort of Black and
White Women: The CARDIA Women's
Study (2008) 90 Fertil Steril 1640 .
511 Roberts 1997, supra, at p . 252 .
512 Id. at p . 255 .
513 Id. at p . 288 .
514 Owens & Fett, Black Maternal and Infant
Health: Historical Legacies of
Slavery (2019) 109 Am . J . of Pub .

Health 1342 (Owens 2019) .
515 Ibid .
516 Ibid .
517 Villarosa, Why America’s Black Mothers
and Babies Are in a Life-or-Death
Crisis (Apr . 11, 2018) N .Y . Times
Magazine (as of Mar . 19, 2022) .
518 Salam, For Serena Williams, Childbirth
Was a Harrowing Ordeal. She’s
Not Alone (Jan . 11, 2018) N .Y .

Times (as of Mar . 19, 2022) .
519 Ibid .
520 Ibid .
521 Villarosa, supra .
522 Ibid .
523 Owens 2019, supra .
524 Ibid .
525 California Task Force to Study and
Develop Reparation Proposals for
African Americans (January 28,
2022), Testimony of Joan Kaufman
(as of February 8, 2022) .
526 Villarosa, supra; Fingar, Delivery
Hospitalizations Involving Preeclampsia
and Eclampsia, 2005–2014 (2017)
Healthcare Cost and Utilization
Project, p . 1-2 (as of Mar . 19, 2022) .
527 Freeman, Unmothering Black Women:

Formula Feeding as an Incident of Slavery
(2018) 69 Hastings Law J . 1545, pp .
1545-1552; Johnson et al ., Enhancing
Breastfeeding Rates Among African
American Women: A Systematic Review
of Current Psychosocial Interventions
(2015) 10 Breastfeeding Medicine 45 .
528 Johnson, supra .
529 Choi et al ., supra, at p . 5 .
530 Lassiter et al ., A Systematic Review of
African American Same Sex Couples
Research: Laying the Groundwork
for Culturally-Specific Research and
Interventions (Aug . 30, 2021) The J . of
Sex Research (as of Jan . 19, 2021) .
531 James et al ., The Report of the 2015 U.S.

Transgender Survey (2016) Nat .

Center for Transgender Equality,
p . 98 (as of Mar . 19, 2022) .
532 Salerno et al ., Health Care Experiences of
Black Transgender Women and Men
Who Have Sex with Men: A Qualitative
Study (2020) 31 J . of the Assn . of
Nurses in AIDS Care 466 .
533 Ibid .
534 Lassiter et al ., supra .
535 Salerno, supra .
536 James et al ., supra, at p . 4 .
537 Choi et al ., supra, at p . 5 .
538 Ibid .
539 Id. at p . 4 .
540 Lassiter et al ., supra .
541 Choi et al ., supra, at p . 25 .
542 Watson, A Black Mother Told Not to
Scream in Labor Asks: Can California Fix
Racism in Maternity Care? (Jul . 11, 2019)
Cal Matters (as of Apr . 5, 2022) .
543 Maternal Child and Adolescent
Health Division, California Pregnancy
Mortality Surveillance System: California
Pregnancy-Related Deaths, 2008-2016
(2021) Cal . Dept . of Pub . Health, p . 7
(as of Mar . 19, 2022) (Cal . Dept . of Pub .

Health Pregnancy Mortality Report); Cal .

Maternal Quality Care Collaborative,
CA-PAMR Background (as of Mar . 19, 2022) .
544 Maternal Child and Adolescent
Health Division, supra, at p . 7 .

446
Chapter 12 Mental and Physical Harm and Neglect 545 San Francisco Dept . of Pub . Health,
Maternal Child Adolescent Health
Vital Statistics in San Francisco: Infant
Deaths (Feb . 15, 2017) City and
County of San Francisco Dept . of
Pub . Health (as of Mar . 19, 2022) .
546 California Task Force to Study and
Develop Reparation Proposals
for African Americans (January
27, 2022), Testimony of Melissa
Jones (as of February 8, 2022) .
547 Watson, supra .
548 Ibid .
549 Ibid .
550 Cal . Health Care Foundation, Health
Disparities by Race and Ethnicity in
California: Pattern of Inequity (Oct . 2021),
pp . 43-44 (as of Mar . 19, 2022) .
551551 Health & Safety Code, § 123630 .1 .
552 Watson, supra .
553 Ibid .
554 Sakala, Listening to Mothers in California:

A Population-Based Survey of Women’s
Childbearing Experiences (2018)
Nat . Partnership for Women and
Families, p . 12 (as of Mar . 19, 2021) .
555 Nat . Health Law Program, How Can
Doulas Help Address Racial Disparities
in Care (as of Mar . 19, 2022) .
556 Nat . Health Law Program, California
Doula Push Shifts Focus Due to COVID-19
Pandemic (Apr . 30, 2020) (as of
Mar . 19, 2022) (NHLP 2020) .
557 Villarosa, supra .
558 NHLP 2020, supra .
559 Choi et al ., supra, at p . 38 .
560 Gyamerah et al ., Experiences and Factors
Associated with Transphobic Hate Crimes
Among Transgender Women in the
San Francisco Bay Area: Comparisons
Across Race (June 2, 2021) BMC
Public Health (as of Jan . 19, 2021) .
561 Ibid .
562 Owens 2019, supra .
563 Ibid .
564 Horbar et al ., Racial Segregation and
Inequality in the Neonatal Intensive Care Unit
for Very Low-Birth-Weight and Very Preterm
Infants (2019) 173 JAMA Pediatrics 455 .
565 Woods et al ., supra, at p . 55 .
566 Villarosa, supra; Reeves, 6 Charts
Showing Race Gaps within the American
Middle Class (Oct . 21, 2016) Brookings
Institution (as of Mar . 19, 2022) .
567 Villarosa, supra; Owens 2019, supra .
568 Reeves, supra .
569 Guttmacher Institute, Maternal
Mortality Review Committees
(as of Mar . 19, 2022) .
570 Trent et al ., The Impact of Racism on
Child and Adolescent Health (2019) 144
Pediatrics 1 (as of Mar . 19, 2022) .
571 Greenwood, Physician–Patient Racial
Concordance and Disparities in Birthing
Mortality for Newborns (2020) 117
Proceedings of the Nat . Academy of
Sciences 21,194 (as of Mar . 19, 2022) .
572 Trent et al ., supra .
573 Ibid .
574 Ibid .
575 Ibid .
576 Jones et al ., Chronic Stress Exposure
Among Young African American Children
with Asthma (2019) 123 Annals of
Allergy, Asthma, and Immunology
507 (as of Mar . 19, 2022) .
577 Ibid .
578 Am . Academy of Pediatrics, Study Finds
Exposure to Racism Harms Children’s Health
( May 4, 2017) (as of Mar . 19, 2022) .
579 Allport et al ., Influence of Parent
Stressors on Adolescent Obesity in
African American Youth (2019) 2019 J .
of Obesity 1 (as of Mar . 19, 2022) .
580 Amaral et al ., Disparities, Race/Ethnicity
and Access to Pediatric Kidney
Transplantation (2013) 22 Current
Opinion in Nephrology and
Hypertension 336 .
581 Nafiu et al ., Race, Postoperative
Complications, and Death in Apparently
Healthy Children (2020) 146
Pediatrics 1 (as of Mar . 19, 2022) .
582 Pawlowski, Why Racism Can Have Long-
Term Effects on Children’s Health (July
17, 2020) Today (as of Apr . 5, 2022) .
583 Children’s Bureau, Child Welfare
Practice to Address Racial Disproportionality
and Disparity (2021) U .S . Dept .
of Health and Human Services,
pp . 2-3 (as of Mar . 19, 2022) .
584 Rufa & Fowler, Kinship Foster Care
among African American Youth: Interaction
Effects at Multiple Contextual Levels (2016)
42 J . of Social Service Research 26 .
585 Woods et al ., supra, at p . 88 .
586 Id. at pp . 90-91 .
587 Ibid .
588 Ibid .
589 Ibid .
590 Kinsey, School Closures During
COVID-19: Opportunities for Innovation
in Meal Service (2020) 110 Am . J . of Pub .

Health 1635 (as of Mar . 19, 2022) .
591 Voisin et al ., Involvement in the Juvenile
Justice System for African American
Adolescents: Examining Associations with
Behavioral Health Problems (2017) 43
J . of Social Service Research 129 .
592 Cancio et al ., The Landscape of
Traumatic Justice: Youth of Color in
Conflict with the Law (2019) Alliance of
Nat . Psychological Assns . for Racial and
Ethnic Equity, p . 20 (as of Mar . 19, 2020) .
593 Barnert, How Does Incarcerating Young
People Affect Their Adult Health Outcomes?
(2017) 139 Pediatrics (as of Mar . 19, 2022) .
594 Voisin et al ., supra; Cancio et al ., supra,
at pp . 9, 31 .
595 Cancio et al ., supra, at pp . 17-18 .
596 Id. at p . 20
597 Ramos-Yamamoto, Not Enough to Eat:

California Black & Latinx Children Need
Policy Action (Sept . 2020) Cal . Budget &
Policy Center (as of Mar . 19, 2022) .
598 Ibid .
599 KidsData, Children in Poverty, by Race/
Ethnicity (2018) Population Reference
Bureau (as of Mar . 19, 2022) .
600 Blair et al ., Poverty, Stress, and Brain
Development: New Directions for

447
Chapter 12 Mental and Physical Harm and Neglect Prevention and Intervention (2016)
16 Academic Pediatrics 30 .
601 KidsData, supra .
602 Council on Criminal Justice and
Behavioral Health, Juvenile Justice
Factsheet (2020) (as of Mar . 19, 2022) .
603 Ibid .
604 Ibid .
605 Cancio et al ., supra, at pp . 12-13 .
606 Ibid .
607 Ibid .
608 Ibid .
609 Ibid .
610 Feagin & Bennefield, Systemic Racism
and U.S. Health Care (2013) 103
Social Science & Medicine 7, 7 .
611 See, e .g ., Foundation for Aids
Research, COVID-19 Racial and
Ethnic Disparities in U.S. Counties
(as of Mar . 19, 2022) (AmfAR) .
612 McBride, supra, at pp . 8-10
613 Ibid .
614 Ibid .
615 Ibid .
616 Id. at p . 38 .
617 Id. at pp . 23-24 .
618 Ibid .
619 Id. at p . 83 .
620 Id. at pp . 126-130 .
621 Ibid .
622 Volkow, Addiction Should be Treated, Not
Penalized (Apr . 27, 2021) Health Affairs
(as of Mar . 19, 2022) (Volkow 2021);
Volkow et al ., Drug Use Disorders:

Impact of a Public Health Rather than
a Criminal Justice Approach (2017) 16
World Psychiatry 213 (Volkow 2017) .
623 Volkow 2021, supra .
624 Ibid .
625 Volkow 2017, supra .
626 Volkow 2021, supra .
627 Ibid .
628 McBride, supra, at pp . 124-126 .
629 Ibid .
630 Roberts 1997, supra, at pp . 3-5, 159, 178 .
631 McBride, supra, at pp . 124-126 .
632 Ibid .
633 Ibid .
634 Wallace, Crack, Policy, and Advocacy: A
Case Analysis Illustrating the Need to Monitor
Emergent Public Health-Related Policy and
Engage in Persistent Evidence-Based Advocacy
(2014) 3 J . of Equity in Health 139, 142 .
635 Id. at p . 149
636 Id. at p . 146 .
637 Id. at p . 153 .
638 McBride, supra, at pp . 133, 146 .
639 Pitasi et al ., Vital Signs: HIV Infection,
Diagnosis, Treatment and Prevention Among
Gay, Bisexual., and Other Men Who Have Sex
with Men — United States, 2010–2019 (Dec .
3, 2021) Centers for Disease Control and
Prevention, p . 1669 (as of Mar . 19, 2022) .
640 Centers for Disease Control and
Prevention, African American Gay and
Bisexual Men (Jan . 11, 2022) (as of Mar . 19,
2022); Kaiser Family Foundation, African
Americans and HIV/AIDS: The Basics (Feb . 7,
2020) (as of Mar . 19, 2022) (KFF 2020) .
641 Pitasi et al ., supra, at p . 1669 .
642 Id. at p . 1672 .
643 KFF 2020, supra .
644 McBride, supra, at pp . 135-141 .
645 Id. at pp . 138-141 .
646 Ibid .
647 Ibid .
648 Dutko et al ., Characteristics and
Influential Factors of Food Deserts
(2012) U .S . Dept . of Agriculture,
pp . 1, 11 (as of Mar . 19, 2022) .
649 Division of Cancer Control &
Population Sciences, Themes and
Targets of Tobacco Advertising and
Promotion, Nat . Cancer Institute,
p . 160 (as of Mar . 19, 2022) .
650 Erickson, Biden Administration
Announces It Intends to Ban Menthol
Cigarettes and Flavored Cigars (Apr . 29,
2021) CBS News (as of Mar . 19, 2022) .
651 LaVeist & Wallace, Jr ., Health Risk and
Inequitable Distribution of Liquor Stores in
African American Neighborhoods (2000)
51 Social Science & Medicine 613 .
652 DiSantis et al ., Sensitizing Black Adult
and Youth Consumers to Targeted Food
Marketing Tactics in Their Environments
(2017) 14 Internat . J . of Environmental
Research and Pub . Health 1316 .
653 Ibid .
654 Ogden, Consumption of Sugar Drinks in
the United States, 2005-2008 (2011)
Centers for Disease Control and
Prevention (as of Mar . 19, 2022) .
655 Fleming-Milici et al ., Examples of Social
Media Campaigns Targeted to Teens and
Hispanic and Black Youth (2020) Univ .
of Conn . Rudd Center for Food Policy
& Obesity (as of Mar . 20, 2022) .
656 Lucan et al ., Unhealthful Food-and-
Beverage Advertising in Subway Stations:

Targeted Marketing, Vulnerable Groups,
Dietary Intake, and Poor Health
(2017) 94 J . Urban Health 220 .
657 Ibid .
658 DiSantis et al ., supra .
659 McBride, supra, at pp . 149-151 .
660 Ibid .
661 Ibid .
662 Ibid .
663 Ibid .
664Ibid .
665 Rivlin, White New Orleans Has Recovered
from Hurricane Katrina. Black New
Orleans Has Not (Aug . 29, 2016) Talk
Poverty (as of Mar . 20, 2022) .
666 McBride, supra, at pp . 149-152
667 Ibid .
668 Ibid .
669 Ibid .
670 Ibid .
671 Ibid .
672 AmfAR, supra .
673 Centers for Disease Control and
Prevention, Risk for COVID-19
Infection, Hospitalization, and Death
by Race/Ethnicity (updated Mar .
10, 2021) (as of Mar . 19, 2022) .

448
Chapter 12 Mental and Physical Harm and Neglect 674 Centers for Disease Control and
Prevention, Introduction to COVID-19
Racial and Ethnic Health Disparities
(updated Dec . 10, 2020) (as of
Mar . 20, 2022) (CDC 2020) .
675 Ibid .
676 Weikel, War on Crack Targets Minorities
Over Whites : Cocaine: Records Show Federal
Officials Almost Solely Prosecute Nonwhites.

U.S. Attorney Denies Race is a Factor (May
21, 1995) LA Times (as of Mar . 20, 2022) .
677 Ibid .
678 Ibid .
679 Hayes et al ., California’s Prison
Population (July 2019), Pub . Policy
Institute of Cal . (as of Mar . 20, 2022) .
680 Ibid .
681 Cimini, Black People Disproportionately
Homeless in California (Feb . 27, 2021)
Cal Matters (as of Mar . 20, 2022) .
682 Harris & Hayes, The Past, Present, and
Future of COVID-19 in California
Prisons (July 15, 2021) Pub . Policy
Institute of Cal . (as of Mar . 20,
2022); Bishari, As COVID Cases Surge
Among SF’s Homeless, Shelter Options
Narrow (Aug . 18, 2021) San Francisco
Public Press (as of Mar . 20, 2022) .
683 Mitchell, Liquor Stores, Dispensaries and
Smoke Shops: Our Neighborhood
Is Killing Us (Dec . 8, 2020),
KCET (as of Mar . 20, 2022) .
684 Ramsey, ‘Microfarms’ Come to South L.A.

Frontyards, Bringing Fresh Produce
to Food Deserts (May 13, 2021) L .A .

Times (as of Mar . 20, 2022) .
685 Ibid .
686 Mitchell, supra .
687 Ibid .
688 Ibid .
689 Ibid .
690 Ibid .
691 Ibid .
692 Cal . Dept . of Pub . Health, California’s
Commitment to Health Equity (March
16, 2022) (as of Mar . 20, 2022) .
693 Ass . of Black Psychologists, Mental
Health Among Black California
(July 27, 2021), at p . 3 .
694 Feagin & Bennefield, supra, at pp . 7-10 .
695 See Oeur, Fever Dreams: WEB Du Bois
and the Racial Trauma of COVID-19 and
Lynching (2021) 44 Ethnic and Racial
Studies 735; W .E .B . Du Bois, The Health
and Physique of the Negro American
(2003) 93 Am . J . of Pub . Health 272 .
696 Office of Minority Health, Profile:

Black/African Americans (Oct . 12, 2021)
U .S . Dept . of Health and Human
Services (as of Mar . 20, 2022) .
697 See Heard-Garris et al ., Structuring
Poverty: How Racism Shapes Child
Poverty and Child and Adolescent Health
(2021) 21 Academics Pediatrics 108 .
698 Goosby & Heidbrink, supra .
699 Forde et al ., supra .
700 Brewer & Cooper, Race, Discrimination,
and Cardiovascular Disease (June
2014) 16 Am . Medical Assn . J . of
Ethics 455 (as of Mar . 20, 2022) .
701 California Task Force to Study and
Develop Reparation Proposals
for African Americans (January
27, 2022), Testimony of Melissa
Jones (as of February 8, 2022) .
702 Brewer & Cooper, supra .
703 Ibid .
704 Forde et al ., supra .
705 Simons et al ., Discrimination,
Segregation, and Chronic Inflammation:

Testing the Weathering Explanation for the
Poor Health of African Americans (2018)
54 Developmental Psychology 1993 .
706 Ibid .
707 Ibid .
708 California Task Force to Study and
Develop Reparation Proposals
for African Americans (January
27, 2022), Testimony of Melissa
Jones (as of February 8, 2022) .
709 Simons et al ., supra; Geronimus et al .,
Black/White Differences in the Relationship
of Maternal Age to Birthweight: A
Population-Based test of the Weathering
Hypothesis (1996), 42 Social Science
& Medicine 589; Geronimus et al .,
Differences in Hypertension Prevalence
Among United-States Black-and-White
Women of Childbearing Age (1991)
106 Pub . Health Report 393 .
710 Arriola, Race, Racism, and Access to Renal
Transplantation among African Americans
(2017) 28 J . of Health Care for the
Poor and Underserved 30 .
711 Ibid .
712 Power-Hays & McGann, supra .
713 Ibid .
714 Kolata, These Sisters With Sickle Cell Had
Devastating, and Preventable, Strokes (May
29, 2021) N .Y . Times (as of Mar . 20, 2022) .
715 Smedley et al ., Unequal Treatment:

Confronting Racial and Ethnic Disparities in
Health Care (2003) (as of Mar . 20, 2022) .
716 Ibid .
717 Chandra et al ., Challenges To Reducing
Discrimination And Health Inequity Through
Existing Civil Rights Laws (2017) 36 Health
Affairs 1041 (as of Mar . 20, 2022) .
718 Ibid .; Bereknyei, Stopping Discrimination
Before it Starts: The Impact of Civil Rights
Laws on Health Care Disparities - A
Medical School Curriculum, U .S . Dept .
of Health and Human Services,
at p . 44 (as of Mar . 20, 2022) .
719 Allsbrook and Keith, ACA Section 1557
as a Tool for Anti-Racist Health Care (Dec . 8,
2021) Health Affairs (as of Apr . 19, 2022) .
720 Bailey et al ., supra, at p . 769-770 .
721 Ibid .
722 Ibid .
723 Ibid .
724 Ibid .
725 Cuellar et al ., Criminal Records of
Persons Served in the Public Mental
Health System (2007) 58 Psychiatry
Online 114 (as of Mar . 20, 2022) .
726 Kaba et al ., Disparities in Mental Health
Referral and Diagnosis in the New York
City Jail Mental Health Service (2015)
105 Am . J . of Pub . Health 1911 .
727 Haney, Restricting the Use of Solitary
Confinement (2017) 1 Annual Review of
Criminology 285 (as of Mar . 20, 2022) .

449
Chapter 12 Mental and Physical Harm and Neglect 728 Bailey et al ., supra, at p . 770 .
729 Harrell et al ., Physiological Responses to
Racism and Discrimination: An
Assessment of the Evidence (2003)
93 Am . J . of Pub . Health 243 .
730 Bor et al ., supra .
731 Prins et al ., Exploring Racial Disparities in
The Brief Jail Mental Health Screen (2012)
39 Criminal Justice and Behavior 635 .
732 Ibid .
733 McBride, supra, at pp . 112-113, 139-140 .
734 Id. at pp . 113-117 .
735 Ibid .
736 Id. at pp . 132-134 .
737 Ibid .
738 Id. at pp . 140 .
739 Williams et al ., supra .
740 Ibid .
741 Ibid .
742 Ibid .
743 Menendian et al ., The Roots of Structural
Racism Project: Twenty-First Century Racial
Residential Segregation in the United States
(June 30, 2021) Othering & Belonging
Institute (as of Mar . 20, 2022) .
744 Ibid .
745 Ibid .
746 Torgrimson-Ojerio, Health Issues and
Healthcare Utilization among Adults who
Reported Exposure to Tear Gas During 2020
Portland (OR) Protests: A Cross-Sectional
Survey (2021) 21 BMC Public Health 803 .
747 Cal . Health Care Foundation,
California Health Care Almanac (Oct . 2019),
p . 7 (as of July 12, 2021) (CHCF 2019) .
748 Menendian et al ., Racial Segregation in
the San Francisco Bay Area, Part 4 (Oct .
31, 2019) Othering & Belonging
Institute (as of Apr . 5, 2022) .
749 California Task Force to Study and
Develop Reparation Proposals for
African Americans (January 27,
2022), Testimony of Brett Andrews
(as of February 8, 2022) .
750 Werner et al ., Unequal Neighborhoods:

Fresno (2018) Central Valley Health
Policy Institute (as of Mar . 20, 2022) .
751 CHCF 2019, supra, at p . 25 .
752 California Task Force to Study and
Develop Reparation Proposals
for African Americans (January
27, 2022), Testimony of Tina Sacks
(as of February 8, 2022) .
753 CHCF 2019, supra, at p . 18 .
754 Id. at p . 17 .
755 Cal . Air Resources Board, Asthma & Air
Pollution (as of Mar . 20, 2022) .
756 Nardone et al ., Associations Between
Historical Residential Redlining and
Current Age-Adjusted Rates of Emergency
Department Visits Due to Asthma Across
Eight Cities in California: An Ecological
Study (2020) 4 Lancet Planet Health 24 .
757 Ibid .
758Orange County Health Care Agency,
HIV/AIDS Health Disparities (2020), p .
13 (as of Mar . 20, 2022) .
759 Ibid .
760 Ibid .
761 Ibid .
762 Premkumar et al ., Police Use of Force
and Misconduct in California (Oct .
2021) Pub . Policy Institute of
Cal . (as of Mar . 20, 2022) .
763 Ibid .
764 Committee on Causes and
Consequences of High Rates of
Incarceration et al ., Health and
Incarceration: A Workshop Summary
(2013) (as of Mar . 20, 2022) .
765 Dignity and Power Now, Impact of
Disproportionate Incarceration of and
Violence Against Black People with Mental
Health Conditions In the World’s Largest
Jail System (Aug . 2014), United Nations
Committee on the Elimination of Racial
Discrimination, p . 3 (as of Mar . 19, 2022) .
766 Graves, Racial Disparities in California’s
State Prisons Remain Large Despite Justice
System Reforms (2021) Cal . Budget &
Policy Center, p . 12 (as of Mar . 20, 2022) .
767 Feagin & Bennefield, su-
pra, at pp . 10-12 .
768 Ibid .
769 Goosby & Heidbrink, supra .
770 CDC 2020, supra .
771 Owens 2019, supra .
772 See generally McBride, supra; Woods
et al ., supra; Feagin & Bennefield,
supra; Jones supra .
773 See generally McBride, supra; Roberts
1997, supra .
774 See generally McBride, supra; Feagin &
Bennefield, supra.
775 See generally, Bassett and Galea,
Reparations as a Public Health Priority — A
Strategy for Ending Black–White Health
Disparities (Nov . 26, 2020) New England
J . of Medicine (as of Apr . 19, 2022) .

The Wealth GapCHAPTER 13
I . Introduction
Wealth—what you own minus what you owe—is the key
to economic security . 1 It is what enables families to build a better future . 2 Wealth functions in many ways . It pro- vides economic stability during lean times . It opens
doors to improving quality of life . It is a dam against the floodwaters of economic catastrophes . It provides
access to political power and it allows us to live and re- tire with dignity .

Wealth can also be passed down through generations,
allowing children to live better lives than their parents and grandparents . It allows parents to pay for their
children’s college education . It allows grandparents to help a young family buy their first home . Throughout
American history, government policies at all levels have helped white families collect these tools while prevent- ing or undermining Black families’ ability to do the same .

As a result, the wealth gap between Black and white
Americans is enormous and roughly the same today as it
had been two years before the Civil Rights Act was passed in 1964 . 3 In 2019, the median Black household had a net worth of $24,100, less than 13 percent of the median net worth of white households at $188,200 . 4
This wealth gap persists regardless of education lev-
el and family structure . 5 For example, at the median, single Black women over the age of 60 with a college
degree— at $11,000—have less than three percent of the
wealth of single white women over the age of 60 with a
college degree— at $384,000 . 6 Single white parents have more than double the wealth ($35,000), at the median,
than married Black parents ($16,000) . 7
The wealth gap is present across all income levels . In 2016, estimates drawn from the Survey of Consumer
Finances indicate the median white household in the
bottom fifth of incomes, or the poorest “quintile” of
white households, had a net worth of $21,700, which
is greater than the median net worth of $18,601 for all Black households . 8 Black households in the bottom
fifth of incomes had a median net worth of $2,700,
less than one eighth as much as the poorest quintile of white households . 9

COURTESY OF BETTMANN ARCHIVE VIA GETTY IMAGES
Burnt residences and businesses following the Tulsa Race Massacre. Tulsa, Oklahoma. (June 1921, 1965)

451
Chapter 13 The Wealth Gap
The trend is the same across social classes . In 2019,
the median white working-class household had a
net worth of $114,270, while the median Black pro-
fessional-managerial household had a net worth of
$38,800 . In the same year, white professional-man-
agerial households—at $276,000—had a median net
worth that was eight times the median Black profes-
sional-managerial household and 19 times the median
Black working-class household . 10
This wealth gap is the result of the discrimination that African Americans experience, as described in the previ- ous chapters . 11 The American government at the federal, state, and local levels has systematically prevented Black communities from building, maintaining, and passing
on wealth . These harms cascade over a lifetime and com- pound over generations .

The historical causes of the wealth gap is based in en- slavement and legal segregation and continues through
ongoing racial inequality and racism today . They in-
clude direct government creation of white wealth and
destruction of Black wealth through the support of racial terror, disenfranchisement, land theft, mass incarcera- tion, exclusion of African Americans from government
benefits, and banking discrimination . Unequal home-
ownership, fewer assets, and lower business ownership
continue to drive the wealth gap today . This has resulted in racial differences in the capacity of African Americans to transmit resources across generations, lower financial resilience during crises, and homelessness .

Section II discusses estimates of the contemporary racial wealth gap for the nation as whole, for California, by
gender, and for descendants of Africans enslaved in the United States . Section III describes historical causes of the racial wealth gap during enslavement and post-en-
slavement, including racial terror, land theft, mass
incarceration, and discrimination in government bene-
fits, the labor market, and banking .

Section IV discusses the drivers of
the contemporary wealth gap today
include unequal homeownership,
fewer assets, and lower business
ownership . Section V discusses the
harmful effects of the wealth gap,
which has resulted in racial differences in the capacity of African Americans to transmit resources across gen-
erations, lower financial resilience during crisis, and increased homelessness .

II . The Contemporary Racial Wealth Gap
National and California Estimates
Significant research demonstrate that white Americans
have long had a higher net worth than African
Americans . The gap has changed little since 1989, when the median white household wealth was $143,000,
and the median Black household wealth was $9,000,
approximately 94 percent less than white household
wealth . 12 The wealth gap was roughly the same in 2016 as it was in 1962, 13 two years before the Civil Rights Act . Preliminary research suggests that, despite rapid accumulation of wealth by African Americans in the de-
cades after slavery and a narrowing of the racial wealth gap during World War II and the Civil Rights era, this
progress halted by the mid-20th century with the ra-
cial wealth gap widening over the last several decades . 14 From 2005 to 2019, an interval that captures much of
the impact of the Great Recession, median house-
hold wealth —all assets minus all debt—among African
Americans fell 53 percent, compared with a drop of 16
percent among white Americans . 15
An asset is anything you own that adds financial val-
ue, as opposed to a liability, which is money you owe . 16 Examples of personal assets include: a home or other
property, such as a rental house or commercial prop-
erty; a checking or savings account; cars; financial and retirement accounts; gold, jewelry, and coins; collect- ibles and art; and life insurance policies . 17
Wealth estimates can be demonstrated in median and
mean figures, both of which are provided in this chap-
ter . A median figure shows the worth of the middle
household in each community . 18 A mean figure shows
the worth of the average household in the communi-
ty . 19 Some researchers suggest that the median is a more useful measure for estimating differences in wealth be- tween Black and white people because it is not affected by exceptions like the few extremely rich individuals
who would skew the average higher than is representa-
tive . 20 However, researchers also suggest that the mean is the appropriate target measure for calculating the
sum required to eliminate the racial wealth gap . 21
The wealth gap was roughly the same in 2016 as it was in 1962.

452
Chapter 13 The Wealth Gap
Policymakers have usually focused on the median gap
in wealth, which some researchers argue is not repre-
sentative of what is happening to the average Black or
white person in reality . 22 Comparing Black and white wealth at the mean—for the average household in each
community—shows a far larger wealth gap . 23
Today, white American households
continue to be far more likely to
hold assets, and the types of assets
they hold are worth, on average,
more than that of Black house-
holds . 24 In 2019, the most recent
year for which data is available,
the total financial assets of white
households is nine times higher
than Black households . 25 The me-
dian Black household wealth was
approximately $24,100, while the
median white household wealth
was approximately $188,200—a dif-
ference of $164,100 . 26 The mean for Black household
wealth is $142,300, while the mean for white household
wealth is close to $1 million at $983,400—a difference
of $840,900 . 27
This wealth disparity cannot be explained by lack of per- sonal motivation and effort, lack of financial literacy, family instability, lack of education, lack of home-
ownership, or lack of entrepreneurship on the part of
African Americans . 28 For instance, there is very little, if any, evidence to support the claim that Black saving behavior is the source of the enormous racial wealth
gap . 29 There is no significant difference in savings be- tween Black and white families with similar income
levels, nor a difference in rates of return on their
personal investments . 30 In fact, in some income cate- gories, Black people display a higher rate of savings . 31 And though African Americans have more family obli-
gations on their income than white Americans because
their relatives are more likely to need help than white Americans, the savings rate among Black people is com-
parable to the savings rate at each level of household
income among white people . 32
Differences in family structure also do not explain the racial wealth gap . 33 Single white women with children have a higher median net worth than black women with
no children . 34 At the median, single white parents have more than two times the wealth ($35,000) than married
Black parents ($16,000) . 35
Nor does effort or education . For comparable levels of family socioeconomic status, Black youth obtain more
years of schooling and credentials, including college
degrees, than white youth . 36 And the wealth gap exists between Black and white women regardless of whether
or not they have a bachelor’s degree . 37
Although the wealth gap and its causes in California and the nation is an under-studied area, preliminary stud-
ies suggest that the racial wealth gap in California is the same or worse than it is at the national level .

Some studies extrapolate California’s racial wealth gap from national estimates . 38 Direct California estimates of the racial wealth gap are only available for a single metropolitan area: Los Angeles . 39 In 2016, while the median net worth of white Angelino households (assets
minus debts) was $355,000, median net worth of na-
tive-born Black Angelino households was $4,000 . 40 The average Black household in Los Angeles had only just had one percent of the median wealth of the average white
household, far worse than the national average of 10 to 15 percent . 41
Gender-Specific Issues
The wealth gap between Black men and Black women,
which is small, 42 functions differently than the wealth gap between white men and white women, which is
much larger . Black men and women have similarly low
wealth, although for slightly different reasons . 43
The wealth gap between white men and women is large-
ly because white men have traditionally had access to
In 2019, white households owned
assets than Black households
9xMORE $$$$$$$$$$
This wealth disparity cannot be explained by lack of personal motivation and effort, family instability, or lack of education.

For example, in 2019, black professional-managerial households had a net worth of $38,800, while white professional-managerial households had a net worth of $276,000. Single white parents had more than two times the wealth— at $35,000 —of married black parents— at $16,000.

453
Chapter 13 The Wealth Gap
jobs that provide retirement accounts and other ben-
efits available to careers not available to women . 44 This difference in access does not exist between Black men
and women, as African Americans of all genders histor-
ically have been excluded from these benefits due labor discrimination, as discussed in Chapter 10, Stolen Labor and Hindered Opportunity .

The median wealth for single Black women is $200,
while the median wealth of single Black men is $300 . 45 Studies that show a greater wealth gap between Black
women and men do not appear to take into account in-
carcerated Black men, who are deprived of their ability to build wealth for themselves and their family during
a prison sentence . 46
Federal statistical agencies, including the U .S . Census Bureau, collect little information about people who
are incarcerated, and they are excluded from house-
hold samples in national surveys . 47 As a result, these individuals are invisible to most mainstream social
institutions, lawmakers, and nearly all social science
research not directly related to crime or criminal jus- tice . 48 And since African Americans are six times more likely to be incarcerated than white Americans, this has the effect of making it appear that African Americans
are better off financially than they really are . 49 As dis- cussed below in section III, criminal convictions also
create numerous barriers to wealth building even after
the sentence ends .

Still, Black women face barriers to wealth building due to the combination of racism and sexism . As a result,
there are vast differences in wealth between Black
women and both white men and white women . 50 One
study reports that, in 2019, single Black women’s me-
dian net wealth was $7,000, while median net wealth
for white women was $85,000 and $92,000 for single
white men . 51 While white men’s median wealth was
$28,900 in 2015, Black women’s median wealth was
$200, less than one cent on every dollar of white men’s median wealth . 52
The large wealth gap faced by single Black women is par- ticularly important because Black women are more and
increasingly likely to be single and breadwinners . 53 The marriage rate of Americans aged 25 to 54 has declined
since the early 1960s across all groups, but especially for Black women for whom it has halved to less than 40
percent . 54 One-third of Black women aged 25 to 54 are single with children in the household . 55 Among Black mothers, more than 80 percent are breadwinners com-
pared to 50 percent of white mothers . 56 At least half of unmarried Black women have zero or negative assets . 57 On average, Black women do not accumulate net worth
approaching retirement; they have no financial assets
at age 50 and do not accumulate any more as they age . 58 Black men also face a stark wealth gap with white women and men . One study reports that, in 2015, median net
wealth for Black men was 15 percent of the median net
wealth for white men and 16 percent of the wealth of
white women . 59 While white men’s median wealth was
$28,900 in 2015, Black men’s median was $300, about
one cent on every dollar of white men’s wealth . 60
There does not appear to be extensive research on
wealth gap estimates for Black LGBTQ populations .

Estimates Based on Immigration and
Migration Patterns
Today, approximately 41 .1 million Black people live in the United States, according to the 2020 census . 61 Of those 41 .1 million Black individuals, experts differ on how many are the descendants of Black people enslaved
in the United States .

About 12 percent of Black people in America were
born in a foreign country . 62 Nine percent of African Americans have at least one foreign-born parent . 63 By 2060, the Black foreign-born population is projected to make up about one-third of the U .S . Black population . 64 Fifty-eight percent of Black immigrants arrived in the
2015 MEDIAN WEALTH FOR SINGLES
White Men $28,900
White Women $15,640
Black Men $300
Black Women $200

454
Chapter 13 The Wealth Gap
United States after 2000 . 65 Of the current 2 .8 million Black Californians, 244,969 are foreign born, according to the U .S . Census Bureau . 66
Every U .S . census conducted since 1970 has found that Black immigrants from the English speaking Caribbean
earn more, are more likely to be employed than U .S .-
born African Americans, are more likely to hold more
financial assets, 67 are more likely to own their home, 68 and most are more likely to be healthy than U .S .-born African Americans . 69
There appears to be no data at the national and state
level and limited scholarship at the city level describing the wealth gap between descendants of Black people
enslaved in the United States, recent Black immigrants, and white Americans . 70 Very few of the city level studies present findings on the wealth gap that disaggregates
the racial category of Black by national origin . 71 Some scholars argue that the effects of systemic racism have uniquely harmed African American descendants of slav-
ery when compared to Black immigrants who do not
have the same experience of systemic racial discrimi-
nation in the United States . 72
One study, “The Color of Wealth in Los Angeles,” included separate data for U .S . born African Americans and re- cent immigrants from Africa . 73 National origin and race were both self-reported in this study . 74 On average, white Angelinos were far more likely to hold assets in
stocks, mutual funds, and investment trusts than both
U .S .-born and African Black Angelinos . 75
But, African Black Angelinos were likely to hold more
assets than U .S .-born Black Angelinos . For example, 87 percent of African Black Angelinos owned liquid assets
versus 62 percent of Black Angelinos born in the United States . 76 Eighty percent of African Black Angelinos had a checking account versus 68 percent of U .S .-born African Americans . 77 Eighty percent of African Black Angelinos had a savings account versus 56 percent of U .S .-born
Black Angelinos . 78 Such studies in other cities reflect comparable wealth gaps between U .S .-born African
Americans and recent immigrants . 79
III . Historical Causes of the Racial Wealth Gap
The modern racial wealth gap between African
Americans and other racial groups began with enslave-
ment . But scholars debate whether enslavement should
be the basis for reparations given that today’s wealth gap is the cumulative effects of racism over centuries . 80 This section describes historical causes of the racial wealth gap during and post-slavery, including racial terror, land theft, mass incarceration, and discrimination in govern- ment benefits, the labor market, and banking .

Enslavement
Several scholars have estimated the slavery bill for rep- arations . 81 Most of these estimates require a calculation in today’s dollars for unpaid wages, the purchase prices of the human property, or the land promised to the
formerly enslaved . 82 These estimates are generated by multiplying earlier values by a compounding interest
rate . 83 For example, Thomas Craemer’s calculations
for unpaid wages owed to enslaved people amounts
to $19 .4 trillion in today’s dollars . 84 He arrives at this number by multiplying the prevailing average market
wage by the number of hours worked for each 24-hour
day by those enslaved over the interval of 1776 to 1865 and applies a three percent interest rate . 85 Merely dou- bling the interest rate to the more realistic six percent would increase the total estimate to $6 .6 quadrillion
in 2019 dollars . 86
Similar to Craemer’s estimates is James Marketti’s bill us- ing the idea of income diverted from enslaved persons,
arriving at a figure of $2 .1 trillion as of 1983 . 87 Using a six percent interest rate; the 2018 value amounts to $17 .1 trillion . 88 Other estimates are reached by calculating the value in today’s dollars of the wealth held in enslaved White homesteaders in El Monte. 1936 The federal government essentially gave land away for free to mostly white families through the Homestead Act. (1936)

COURTESY OF LIBRARY OF CONGRESS

455
Chapter 13 The Wealth Gap
people as property . For example, Judah P . Benjamin, a critical member of Jefferson Davis’s Confederate Cabinet proclaimed the value of enslaved persons in 1860 to be
four billion dollars, which compounds to $42 .2 trillion by 2019 at a six percent interest rate . 89 Other scholars argue that these large sums are underestimates because
they do not account for the physical and emotional
harms of enslavement, the coercive nature of the sys-
tem, the denial of the ability to acquire property, or the deprivation of autonomy . 90
Post-Enslavement
The case for reparation extends beyond slavery to the
near-century-long era of legal segregation, violence
and terror, and the atrocities that continue today:
mass incarceration; police killings of unarmed African
Americans; sustained credit, housing, employment
discrimination; and the immense Black-white wealth
disparity . 91 Scholars have divided post-slavery American history into five overlapping phases of federal govern- ment policies, which created the modern racial wealth
gap . They involve white wealth creation through gov-
ernment land grants and mortgage subsidies and Black
wealth destruction through racial terror, eminent do-
main, and mass incarceration .

White Wealth Creation through Government
Land Grants
From 1862 to 1976, the federal government transferred
massive amounts of land mostly to white families . Some scholars have named this phase the Wagon Train phase,
after the covered-wagon caravans romanticized by 1950s
television shows, which carried white families to seek
their fortunes in the West . 92
In 1862, the federal government established the Homestead Act, which distributed land until about 1980, although
more occasionally after the 1920s . 93 The Homestead Act encouraged western migration by providing American
citizens—and immigrants soon to be citizens—up to 160
acres of public lands, which was increased to 320 acres in 1909—for $0 if they continuously lived on the property for five years and paid a small $10 filing fee . 94
Homesteaders also had the option of paying $1 .25 per
acre if they lived on the property for six months . 95 While the language of the act did not exclude people based on race, African Americans were unable to secure land allo- cations under the act for four years until the Civil Rights Act of 1866 clarified that they were citizens . 96 California's homestead laws similarly excluded African Americans
before 1900 because they required a homesteader to be
a white citizen . 97
Though Black homesteaders were able to secure land
allocations under the Act after 1866, they were few in
comparison to the multitudes of white settlers and had
to settle for the least desirable land . 98 Between 1868 and 1934, the federal government gave 246 million acres of
land essentially for free to mostly white, native-born
and immigrant Americans—an area close to the size of
California and Texas combined . 99 More than 1 .5 million white families received land patents, and today as many as 46 million of their living descendants reap the wealth benefits, approximately one-quarter of the adult popu-
lation of the United States . 100 In comparison and as an example, approximately 3,500 Black
claimants succeeded in obtaining
their patents from the General Land
Office in the Great Plains, granting
them ownership of approximately
650,000 acres of prairie land . 101
The federal government under-
mined other efforts to allocate land
to the formerly enslaved . Another
estimate of reparations to African
Americans can be made by calcu-
lating the value in today’s dollars of
the unfulfilled land distribution of
“forty acres and a mule” promised to
the formerly enslaved beginning in 1865 . 102 On January 16, 1865, upon seizing the coastline from Charleston, South Carolina to St . John’s River, Florida, 103 General Sherman issued Special Field Orders No . 15 that established the provision “of not more than (40) forty acres of tillable ground” designated “for the settlement of the negroes
now made free by the acts of war and the proclamation
of the President of the United States .” 104
The order carved out 400,000 acres of land confiscated
or abandoned by Confederates . Each family of former-
ly enslaved Black people would get up to 40 acres . 105 The Army would lend them mules no longer in use . 106
Further, the Freedmen’s Bureau Act of March 3, 1865,
Between 1868 and 1934, the federal government gave 246 million acres of land essentially for free to mostly white Americans—an area close to the size of California and Texas combined. More than 1.5 million white families received land patents, and today as many as 46 million of their living descendants reap the wealth benefits, approximately one-quarter of the adult population of the United States.

456
Chapter 13 The Wealth Gap
had an explicit racial land redistribution provision that specified that “not more than 40 acres” of land was to be provided to refugee or freed male citizens at three years’ annual rent not exceeding six percent of the value of the land based on appraisal of the state tax authorities in 1860 . 107 At the end of three years of occupying the land, they could purchase it and receive title . 108 Similar provi- sions were included in the postwar Southern Homestead
Act of 1866 . Freedmen were to receive land in the south- ern states at a price of $5 for 80 acres . 109
President Andrew Johnson intensely opposed these acts
and neither were effectively implemented on behalf of
the formerly enslaved . 110 By the end of 1865, Johnson also had ordered the removal of thousands of formerly
enslaved persons from the lands they had settled un-
der Sherman’s Special Field Orders No . 15, 111 which were ultimately given back to former enslavers . 112 With the exception of a small number who had legal land titles,
freed Black people were removed from the land as a re-
sult of President Johnson’s “restoration” program . 113 If four million enslaved persons had gained emanci-
pation by 1865, and the land allocation rule meant that roughly 40 acres would go to families of four, each for- merly enslaved individual would have been allocated
about 10 acres . This implies a total distribution of at least 40 million acres of land .

Using a conservative estimate of $10 per acre, the total value of the projected distribution of land to the freed- men would have been $400 million in 1865 . 114 The value in today’s dollars at a six percent interest rate would be $1 .3 trillion . This number would
be much higher if the conditions
of the Southern Homestead Act,
which provided for 80 acres of land
to be sold to freedman at $5 total
were treated as a debt to be paid
to the descendants of the formerly
enslaved . 115 If, as some scholars in-
terpret, each freedman was eligible to receive 40 acres of land, it would have led to a much higher total value of the land to be distributed to freedmen after the war— amounting to $1 .6 billion in 1865 and compounding to
$12 .6 trillion at a six percent interest rate in 2019 . 116 Black Wealth Destruction through
Racial Terror
From 1865 to the present, federal, state and local govern- ment actors refused to protect African Americans as they faced violence and land theft . Sometimes, government
actors joined, led, or supported the
violence . 117 As detailed in Chapter 3,
Racial Terror, white federal, state,
and local government officials,
working jointly with private citi-
zens, terrorized African Americans
to prevent them from accumulating
political and economic power .

White mobs destroyed thriving Black communities
in racial massacres nationwide in Louisiana, North
Carolina, Michigan, Delaware, Nebraska, Florida,
Illinois, Oklahoma, Texas, and elsewhere . 118 The most well-known was the destruction of the Greenwood dis-
trict in Tulsa, Oklahoma . The Greenwood district was
known popularly as “Black Wall Street .” 119 Scholars esti- mate that the present value of destroyed Black property in Tulsa is at least $100 million . 120 The 1919 massacre in Elaine, Arkansas destroyed $10 million of Black wealth . 121 Evidence exists that murders of African Americans
continue to be driven by underlying economic incen-
tives . 122 Police killings of unarmed African Americans frequently occur in neighborhoods undergoing
white gentrification . 123
White Wealth Creation through
Mortgage Subsidies
In the 19th century, federal, state, and local governments passed laws and implemented practices that heavily
subsidized the creation of the white middle class while substantively crippling the ability of Black people to do the same . 124 Federal policies, implemented by private citizens, focused on helping mostly white Americans buy single-family homes . 125 As discussed in Chapter 5, The Root of Many Evils: Housing Segregation, the Veterans
Administration, the Federal Housing Administration,
and the Home Owner’s Loan Corporation helped white
families buy single family homes in the suburbs while
preventing Black families from doing the same . 126
Scholars estimate that the present value of destroyed Black property in Tulsa is at least $100 million.

General William Tecumseh Sherman’s famous 40 acres and a mule field order, given in 1865, amounts to $1.3 trillion at six percent interest, in today’s dollars.

457
Chapter 13 The Wealth Gap
Beginning in the 1930s and 1940s, the federal govern-
ment created programs that subsidized low-cost loans
and opened up home ownership to millions of average
Americans for the first time . 127 At the same time, gov- ernment underwriters introduced a national appraisal
system, tying property value and loan eligibility in part to neighborhood racial composition, which designated
predominantly nonwhite neighborhoods as hazardous
and coloring these areas red—a pro-
cess known as redlining . 128
White communities received the
highest ratings and benefited from
low-cost, government backed
loans . Minority and mixed neigh-
borhoods—and especially Black
neighborhoods—received the
lowest ratings and were denied
these loans . 129 This functionally
concentrated African Americans
into impoverished neighborhoods in America’s urban
centers . 130 Of the $120 billion worth of new housing sub- sidized between 1934 and 1962, less than two percent
went to nonwhite families—virtually locking them out
of homeownership . 131
Today, approximately three in four neighborhoods—74
percent—that the federal government deemed “hazard-
ous” in the 1930s remain low- to moderate-income, and
more than 60 percent are predominantly nonwhite . 132
Black Wealth Destruction through
Disenfranchisement and Land Theft
As described in Chapter 5, Housing Segregation, the
federal government passed the National Highway Act
of 1956 and urban renewal legislation . 133 Funded by the federal government, state and local officials used emi- nent domain to destroy thriving Black communities in
the name of highway construction and urban renewal,
erasing generations of accumulated Black wealth . 134
Black business districts were cleaved by the highways,
and never recovered . 135
In the mid-20th century, the United States Department
of Agriculture’s (USDA) policies discriminated against
and displaced Black . 136 During the civil rights era, federal anti-discrimination statutes that applied to
the USDA were diluted by the time they reached the
local level, and did not provide protection for Black
farmers . 137 White USDA administrators gave millions
of dollars in funding to all-white Southern local ag-
ricultural committees . 138 These powerful committees
were county arms of the USDA and did not want Black
farmers on their boards, so they would prevent their
election by splitting the Black vote or through voter
intimidation tactics . 139 These boards made decisions on loan recipients, acreage allotments, appropriate crop
yields, hardship adjustments, and preferred farming
methods benefitting white farmers . 140
The Farmers Home Administration was another agency
that discriminated against and displaced Black farmers . 141 The agency offered loans and credit to poor farmers for home construction and improvement . 142 But instead of going to badly-needed rural housing in the South, these loans went to segregated swimming pools, picnic areas,
tennis courts, and golf courses in white communities . 143 Loan requirements were stringent and often subjective,
such as whether an applicant was a good citizen . 144 Loans went to the white and wealthy while Black farmers were
turned down . 145 Even if a Black farmer received a loan, agency administrators would seek to get rid of them by
luring them into debt and then foreclosing and auction- ing off their machinery . 146
As a result, Black farmers were pushed off their land . 147 Lawrence Lucas, President Emeritus of the United
States Department of Agriculture Coalition of Minority
Employees testified that the USDA’s programs continue
to discriminate against Black farmers and that “a culture of systemic racism at the USDA that denies Black farmers <2% of subsidized new housing went to nonwhite families from 1934 – 1962
Funded by the federal government, state and local officials used eminent domain to destroy countless thriving Black communities in the name of highway and park construction, and urban renewal, erasing generations of accumulated Black wealth. African American business districts were cleaved, and never recovered.

458
Chapter 13 The Wealth Gap
their dignity, that denies Black farmers a right to farm, denies Black farmers the right to the same programs and services that white farmers get in this country” is still present today .” 148
In 1910, Black farmers owned 16 million acres of land .

In 2007, they owned 3 .2 million acres, an 80% loss . 149 In 1999, Black farmers filed a class action lawsuit against the USDA for unlawful discrimination against them in deny-
ing their farm loan applications . 150 The lawsuit, Pigford v. Glickman, ultimately settled for money damages, but
no policy changes at the USDA . 151
While many claims have been paid,
the USDA nonetheless has been
slow to pay out all the claims, and
has spent extensive resources in
fighting claims . 152 In the 2021 coro-
navirus relief bill, $4 billion was
set aside for debt relief for socially
disadvantaged farmers, including
Black farmers, but payments have been stopped do to
an ongoing lawsuit alleging it is reverse-racism and a
“windfall” for some farmers . 153
Black Wealth Destruction through
Mass Incarceration
In the late 1980s mass incarceration and the war on
drugs continued the American government’s historical
criminalization of African Americans . 154 As discussed in Chapter 11, An Unjust Legal System, African Americans
have experienced marginalization, physical harm, and
death, at the hands of the American criminal justice
system at both the federal and state level beginning in slavery and continuing today . 155
During the slavery era, federal and state governments
criminalized African Americans as a method of estab-
lishing, maintaining, and socially controlling African
Americans as a lower class of human being than white
Americans . 156 Today, mass incarceration continue to
separate families and dehumanize the descendants of
enslaved Black people . 157 In the 156 years since slavery was abolished, Black people in the United States have
gone from being considered less than human under the
law to being treated as less than human by a criminal
justice system that punishes them more harshly than
white people . 158
Until the 1940s, state laws and the U .S . Constitution al- lowed private entities to force African Americans into
doing the same work, on the same land, and even for the same people as during slavery in a system called convict leasing . 159 People who were “leased” were treated even more brutally than enslaved people because plantation
owners had a financial incentive to keep enslaved people alive . 160 Working and living conditions for incarcerated people were dangerous, unhealthy, and violent . 161 Most incarcerated people who were leased for labor did not
survive to complete 10-year sentences . 162 Until the mid- 1950s, states routinely forced chain gangs of imprisoned people to do public works projects while wearing chains weighing as much as 20 pounds . 163
American politicians ran on “law and order” or “tough
on crime” platforms and passed laws and policies
that punished African Americans more than white
Americans, often for similar crimes . 164 This has con- tributed to mass incarceration and overrepresentation
of African Americans in the criminal justice system to
present day, nationwide and in California . 165 Nearly 70 percent of young Black men will be imprisoned at some
point in their lives, and poor Black men with low lev-
els of education make up a disproportionate share of
incarcerated Americans . 166
Mass incarcerations create a vicious cycle . Studies have shown that lower wealth increases the likelihood of in- carceration and incarceration decreases the ability to
build or maintain wealth . 167
African Americans, who have lower family wealth than
white Americans, 168 are especially vulnerable to incar- ceration . 169 Growing up with less family wealth means living in poorer neighborhoods with lower-quality
LAND OWNERSHIP: BLACK FARMERS
In 1910 Black farmers owned
16 million acres of land. In 2007,
they owned 3.2 million acres, an
80%loss.

Mass incarceration creates a vicious cycle. Studies have shown that lower wealth increases the likelihood of incarceration and incarceration decreases the ability to build or maintain wealth.

459
Chapter 13 The Wealth Gap
education and a greater exposure to high “street” crime and high imprisonment areas . Sixty-two percent of
African Americans live in highly segregated, inner-city neighborhoods where socioeconomic vulnerabilities
contribute to higher rates of violent crime, 170 while the majority of white Americans live in “highly advantaged” neighborhoods where there is little violent crime . 171 Mass incarceration has been catastrophic to the abil-
ity of Black families to build and maintain wealth by
reducing household assets and income, and lowering
homeownership rates . As discussed in detail in Chapter 11, An Unjust Legal System, the criminalization of African Americans has contributed to racial disparities at every step of the criminal justice system .

In 2019, African Americans comprised 26 percent of all
arrests yet they only made up 13 .4 percent of the pop- ulation . 172 According to a recent large-scale analysis of racial disparities in over 60 million state patrol police stops in 20 states, including California, researchers
found that police officers stop African Americans more
often than white drivers relative to their share of the driving-age population . 173 Further, these researchers found that, after controlling for age, gender, time,
and location, police are more likely to ticket, search, and arrest African American drivers than white
Americans . 174 Thus in practice, the bar for searching African American drivers is lower than for searching
white Americans . 175
Low family wealth can also mean being unable to af-
ford additional education and delaying entering the
labor market, leading to higher risks of incarceration . 176 Once a person is a criminal defendant, low family wealth makes it hard to post bond or to hire lawyers to help nav- igate the criminal justice system, making incarceration more likely . 177
In 2009, African Americans made up less than 13 per-
cent of the U .S . population, but comprised over a third of all the people in prison . 178 As explained in Chapter 11, An Unjust Legal System, African Americans are also
more likely to be convicted and experience lengthy
prison sentences . 179
Involvement in the criminal justice system increas-
es legal debt . 180 Incarceration means loss of income and may lead to missed mortgage payments and other
debts . 181 This increases interest obligations and penal- ties, which in turn can send an incarcerated individual’s credit score plummeting . 182 Incarceration also means household instability, placing an additional barrier to building wealth . 183
As Chapter 11 explains, federal and state prisons con-
tinue to exploit the labor of predominantly Black
incarcerated people . 184 While convict leasing as an of- ficial practice has ended, underpaid or unpaid prison
labor continues today as incarcerated people are not
protected by labor laws . 185
For example, in-house prison labor, the most common
type of prison labor, typically refers to jobs within and related to the prison including kitchen duty, cleaning, or grounds keeping . 186 Workers can be punished and sent to solitary confinement for taking a sick day, including in the eight states where the labor is unpaid . 187 In states where prison labor is paid, the average rates across the U .S . range from 14 to 63 cents per hour . These are the rates before wage garnishment, which can account for
up to half of one’s earnings, although some advocates
argue that wage garnishment serves as appropriate
sources for victims’ restitution . 188
In addition to jobs within the prison, incarcerated peo- ple also provide underpaid and unprotected industry
labor unrelated to maintaining the prison, like phone
banking, packaging, and textile work . 189 Participating private companies must pay minimum wage, which
the prison garnishes for the incar-
cerated person’s room and board
in prison cells . 190 The garnishment
only applies to basic room and
board, and the incarcerated person
must pay additionally for stamps,
paper, toiletries, supplementary
food, or phone calls . 191 Advocates
argue that such costs are not fairly
calculated and that the American criminal justice system is filled with fees that shift the costs of incarceration not only to the incarcerated, but also to their families . 192 Scholars argue that work programs in incarceration are
not beneficial to incarcerated people when they seek
work after their incarceration . 193 Once released from incarceration, criminal convictions make it harder to
find and maintain jobs, find leases, and be approved for mortgages . 194 A record of previous incarceration also has wide-ranging immediate and future consequenc-
es that act as a barrier to employment, thus lowering
Once released, criminal convictions make it harder for returning citizens to find and maintain jobs, find leases, and be approved for mortgages.

460
Chapter 13 The Wealth Gap
earnings . 195 A criminal conviction makes it difficult to build wealth because of stigmatization and lack of access to supportive social institutions and credit . 196
Exclusion and Discrimination in
Government Benefits
African Americans have consistently been excluded
from numerous major categories of government ben-
efits, which have generally benefited white Americans .

Government benefits refer to assistance programs
that provide either cash assistance
or in-kind benefits to individuals
and families from a governmental
entity . There are two major types
of government benefit programs:
social welfare programs and social
insurance programs .

Benefits received from social wel-
fare programs are usually based on low income . Benefits received from social insurance programs are usually
based on other criteria, such as age, employment sta-
tus, or being a veteran . Some of the major federal, state, and local social insurance programs are Social Security, veteran’s benefits, unemployment insurance compen-
sation, and workers' compensation .

Social insurance programs can provide important sup-
port in times of crisis . Unemployment insurance, a state level program, helps protect against unexpected drops
in income by paying cash benefits to unemployed work-
ers who have lost jobs through no fault of their own . 197 The federal Supplemental Nutrition Assistance Program
(SNAP), also known as food stamps, gives money to
low-income families to buy food, and expands to pro-
vide important support when people lose their jobs . 198 Recipients have improved food security, health, and re- duced healthcare expenses . 199
Historically, federal policy decisions dealing with wel- fare, work, and war in the 1930s and 1940s excluded
or discriminated against the vast majority of African
Americans . 200 The exclusion and discrimination con-
tinued due to the Congressional representatives elected from southern states that created barriers to African
Americans voting . 201
Among other things, southern legislators prevented
Congress from including anti-discrimination provi-
sions in an expansive range of social welfare programs, such as community health services, school lunches, and
hospital construction grants—all the programs that dis- tributed funds to the South . 202 As a result, when federal policies provided most white Americans with valuable
tools to build wealth—insure their old age, get good jobs, acquire economic security, build assets, and gain mid-
dle-class status—most African Americans were left out . 203 Social Security, passed and signed by President Roosevelt in 1935, left out most African Americans for the first
quarter century of its existence . 204 Southern congressio- nal representatives heavily influenced the Social Security Act with devastating results . 205 The federal government gave the power to control benefit levels, eligibility, and administration of such programs to the states and ex-
cluded occupations mostly held by African Americans . 206 At the time, sixty-five percent of African Americans fell outside of eligibility for the Social Security program— and between 70 and 80 percent fell outside eligibility
requirements in different parts of the South . 207
For example, in 1940, the year Social Security payments for seniors began, the Social Security Board identified nearly 2 .3 million Black workers as eligible for old age insurance, but the majority of those identified were
disqualified because they were farm or domestic work-
ers . 208 These exclusions continued until 1954, when the occupational exclusions were eliminated . 209
This exclusion also left most Black workers out of un-
employment insurance under the act . 210 When Black
workers qualified by working in eligible industrial and commercial jobs, they often were left out because they
lacked a history of regular, stable employment . 211 When they received benefits, the benefits tended to be smaller than those received by white workers . 212
Another example of federal government discrimination
in benefits are the mortgage subsidies, which not only
intensified residential segregation as discussed in de- tail in Chapter 5, Housing Segregation, but also helped white families build wealth and enter the middle class .

The federal government supported the creation and
maintenance of the white middle class through other
programs as well . The New Deal was a collection of gov- ernment programs with the goal of lifting America out
of the Great Depression . 213
One example of a New Deal policy was the Serviceman’s
Readjustment Act of 1944, also known as the GI Bill,
Historically, federal policy decisions dealing with welfare, work, and war excluded or discriminated against the vast majority of African Americans.

461
Chapter 13 The Wealth Gap
which was reinforced in 1948
with the Integration of the Armed
Forces Act . Through these laws,
the federal government aimed to
offer unprecedented benefits to
veterans including mortgages to
buy homes, job placement services,
money for vocational and university
education, and loans for small busi-
nesses . 214 However, these programs
were administered by the states, which discriminated
against southern Black veterans . 215 While white World War II veterans sent themselves and their children to
college and obtained housing and small business grants, Black veterans were not able to do so in the same way . 216 Part of this stemmed from discrimination in the military .

Black soldiers were more likely to be issued neutral and dishonorable discharges, sometimes used to exclude
Black veterans from GI Bill benefits . 217 Ira Katznelson argues that severe discrimination in the GI Bill adminis- tration system prevented Black veterans from obtaining
home mortgages, small business and farm loans . 218
Chapter 10, Stolen Labor and Hindered Opportunity,
discusses how other New Deal programs excluded
African Americans in detail .

Today, African American families continue to have trou- ble accessing government benefits . Because welfare
programs are often administered at the state and local
levels, state and especially local governments have been able to introduce racial bias into welfare administration contributing to racially disparate outcomes . 219 States have been significantly more likely to both adopt and
impose welfare sanctions if they have higher propor-
tions of nonwhite welfare recipients . 220 States with higher Black populations—generally in the South—tend
to provide fewer unemployment payments for a shorter
time . 221 Additionally, in many places, part-time work- ers—who are disproportionately Black—are not eligible
for unemployment payments . 222
Despite having higher unemployment rates in gener-
al, Black workers receive unemployment benefits at
lower rates than white Americans . 223 A report by the Government Accountability Office found that 73 percent
of Black unemployment applicants received unemploy-
ment payments during the pandemic versus 80 .2 percent
of white applicants . 224 Although governments have waived work requirements for some SNAP recipients during cer-
tain national crises like the COVID-19 pandemic, studies have found that work requirements disproportionately
cut off Black adults from SNAP benefits, which may be
partially due to discrimination in the labor market mak- ing the job search more difficult for Black people . 225 During the COVID-19 pandemic,
most households received several
stimulus checks from the federal
government . Studies have found that
these payments were “likely crucial”
to help households that lost jobs
that pay their expenses . 226 The fed-
eral government supplemented state
unemployment payments with up to
$600/week for unemployed workers,
extended the duration of benefits,
and gave benefits to workers tradi-
tionally left out of unemployment
insurance programs . 227 The feder-
al government also instituted the
Paycheck Protection Program to
provide loans that enable businesses
suffering from COVID-19’s econom-
ic shocks to pay their employees and
other costs . 228
Social Security, passed and signed by President Roosevelt in 1935, left out most African Americans and scholars have argued that it was characterized “by a form of policy apartheid” for the first quarter century of its existence.

Protesters at the landmark civil rights demonstration, the March on Washington. (1963)

COURTESY OF WALLY MCNAMEE/CORBIS/CORBIS VIA GETTY IMAGES

462
Chapter 13 The Wealth Gap
During the pandemic, even though African Americans
were more likely to hold the types of jobs most se-
verely impacted by the pandemic, white households
received their COVID-19 stimulus checks faster than
Black households . 229
This was likely due to the Internal Revenue Service fo- cused structure of the program, which made receiving
the payment more complicated for unbanked families
and families who did not file taxes . Black people are
more likely to be among both groups . 230
Studies of pandemic-era federal loans have found that 29 percent of Black applicants were successful in obtaining loans for their businesses versus 60 percent of white ap- plicants . 231 Businesses in majority-Black neighborhoods were also more likely to receive federal loans later than businesses in majority-white neighborhoods . 232 Federal money was paid out through large banks, which histori-
cally excluded Black businesses . 233 Black business owners may have been less likely to obtain them, despite being more likely than white business owners to have at risk
or distressed businesses even before the pandemic . 234 Education Segregation and Debt
Higher education for African Americans can have a
positive effect on their income, but does not translate into a reduction in the wealth gap . 235 College degrees do little to close the racial wealth gap . 236 For example, college-educated African American households have 30
to 33 percent less wealth at the median than non-col-
lege educated white households . Average wealth for
white Americans in this category is $180,500, while
the African American average is $23,400 . 237 As Rucker C . Johnson testified before the Reparations Task Force, affluent Black households with incomes above $75,000
still live in more under-resourced neighborhoods with
under-resourced school than their white counterparts,
which disadvantages Black students from the start
of childhood . 238
Black students carry more student loan debt because
they receive a higher interest on their student loans and they borrow more because their families are less wealthy than white students . 239 For example, 20 to 29-year-old single white women who have completed college have
a median net worth of $3,400 . Single Black women of
a similar age and level of education have a median net
worth of negative $11,000 . 240
Labor Market Discrimination
Income is different from wealth . Income represents
how much a person earns in a lifetime, both from work
and from a yearly return on their investments . 241 Wealth represents a person’s total net worth calculated from as- sets minus debts . 242 While income plays a modest role in the ability to generate wealth, as lower income trans-
lates to reduced capacity for savings or investments,
income does not explain massive
Black-white wealth disparities in
the United States . Without savings
or wealth of some form, which can
be passed from generation to gen-
eration, economic stability quickly
falls apart when income is cut or
disrupted through job loss, reduced
work hours or reduced wages, or if
families suffer from an unexpected
health emergency . 243 In fact, the in-
tergenerational transfer and impact
of wealth is one of the reasons why racial wealth inequi- ties have become entrenched . 244
As detailed in Chapter 10, Stolen Labor and Hindered
Opportunity, labor market discrimination significant-
ly contributes to the wealth gap . 245 Some scholars have based their estimates for reparations on more recent
economic injustices such as labor market discrimi-
nation . 246 Bernadette Chachere and Gerald Udinsky
estimated the monetary benefits that white workers
gained from employment discrimination between 1929
and 1969 . 247 They concluded that by the mid-1980s,
white workers gained in $1 .6 trillion from employment
discrimination at the expense of Black workers, assum-
ing that 40 percent of the Black-white income gap was
because of labor market discrimination . 248
David Swinton concludes that even if one subtracted the total cost of government benefits programs including
Social Security, Medicare, Medicaid, unemployment in-
surance, and other welfare programs—which are often
argued to be reparations—over the same time span from
the Chachere and Udinsky estimate, there would be still College degrees do little to close the racial wealth gap. For example, college-educated African American households have 30 to 33 percent less wealth at the median than non-college educated white households. Average wealth for white Americans in this category is $180,500, while the African American average is $23,400.

463
Chapter 13 The Wealth Gap
be a $500 billion net benefit to white people from labor market discrimination by the mid-1980s . 249
But, income alone cannot explain the racial wealth gap . A reduction in racial differences in income would leave as much as three-fourths of the wealth gap unaddressed . 250 Similar achievements do not lead to similar wealth for
African Americans in comparison to white Americans . 251 For example, between 1984 and 2009, every dollar increase in average income for white households added $5 .19 in
wealth . The same increase in average incomes for African American households added only $0 .69 in wealth . 252
In fact, the racial wealth gap increases as income in-
creases . The wealth gap between African Americans and
whites in the bottom fifth of income levels is $7,400, but the wealth gap between comparable African Americans
and whites in the top fifth of income levels is $264,700 . 253 And, while white households have five to 10 times the
net worth of African American households, they only
earn twice as much as African American households . 254 Within the same income brackets, African American
wealth is less than one-half that of white people . 255 White people in the bottom fifth of the income distribution
have more than 10 times the median wealth of African
Americans in the bottom fifth . 256
Lower incomes for African Americans because of la-
bor market discrimination affect wealth only to the
extent that it reduces capacity for savings that can be passed across generations . There is no evidence that
African Americans have a lower savings rate than white
Americans once household income is taken into ac-
count . 257 One study found that once income is taken
into account, if anything, African American families
actually have a slightly higher savings rate than their white counterparts . 258 In fact, white households spend 1 .3 times as much as African American households with
similar incomes . 259
At high income levels, African Americans save more than white people who tend to invest . 260 In addition to savings from income or “active savings,” a family’s wealth can
also increase because of “passive savings” or when the
value of a family’s assets rises or appreciates . Data col- lected before the predatory subprime mortgage market
crisis shows that there is no significant racial advantage in “passive savings” for white families with positive as- sets after family income is taken into account . 261
Discrimination in Banking
African Americans have historically faced systemic dis- crimination in banking which has impacted their ability to accumulate wealth . Banks established by the federal government discriminated against African Americans
and deprived them of wealth . The Freedmen’s Fund,
Free Labor and Union Army Military
Banks, and the Freedman’s Bank
were three banking institutions es-
tablished by the federal government
in the early to mid-1860s, which
provided recently emancipated
African Americans with the means
to save the money they earned . 262
But racist paternalistic attitudes
by government officials prevent-
ed African Americans from investing their own money
and accumulating wealth . 263 Bank employees improperly invested client savings and lost approximately $2 .9 mil- lion, or $63 million in 2017 dollars, harming freedmen
and their descendants for generations to come . 264
In another example, Union army chaplain John Eaton
created the Freedmen’s Fund in 1862, to hold the wag-
es of formerly enslaved African Americans who fled to
Union or who worked for Union troops . 265 These freed- men had no access to their individual wages or savings, nor did they have any say in how their own wages or
the money that was donated for their benefit would be
used . 266 Instead, Eaton pooled the wages in the fund to collectively provide food, shelter, and other needs, es- sentially treating freedmen as contract laborers . 267
Eaton also stole all their wealth . Soldiers confiscat- ed horses, wagons, money, and other valuables that
self-emancipated African Americans brought with
them to the Union lines . 268 Eaton took anything that the soldiers and quartermasters did not steal for them- selves . 269 By 1864, he had formalized his contract labor system to negotiate contracts for and hired out Black
workers on abandoned plantations that the federal
government had leased to northerners and to some
southerners who supported the Union . 270 Any profits
from the cash crops that Black workers grew and har-
vested were placed in the Freedmen’s Fund . 271 Eaton also used the fund for other expenses . 272 In one year alone, Eaton stole $103,000 or $1 .6 million in 2017 dollars from Scholars estimate that 40 percent of the Black-white income gap is due to labor discrimination. As a result, By the mid-1980s, white workers gained in $1.6 trillion at the expense of Black workers.

464
Chapter 13 The Wealth Gap
Black depositors to pay for the Union Army’s incidental expenses; $5,000 in medical expenses; the salaries of
all hospital stewards and medical assistants . 273 The Free Labor and Union Army Military Banks first established
in 1864, was another Bank that used an exploitative
model of contracting Black people’s labor similar to
Eaton’s freedmen’s fund .

In 1865, Congress created the Freedman’s Bank and Trust Company, also known as the Freedman’s Savings Bank,
seeding the bank with unclaimed deposits from the free
labor and military banks . 274 The initial charter designat- ed an all-white board of trustees with broad discretion to oversee the bank, and intended to hold only the deposits of the survivors of enslavement and their descendants . 275 Despite this nominal limitation, the bank welcomed cus- tomers of all races and regardless of whether they were formerly enslaved, though formerly enslaved people
made up the vast majority of bank customers . 276 And
though the charter made clear that its purpose was to
invest the deposits in low-risk treasury notes and con- servative U .S . securities, it vaguely stated that a third of the deposits, called “available funds,” could be invested anywhere, leaving an opening for abuse . 277
The Freedman’s Bank used a number of aggressive meth-
ods and tactics to solicit deposits and to convince Black patrons that their money was safe and that they could
grow wealth . 278 Passbooks and other bank literature con- tained numerous slogans and poems on the ways of thrift and savings . 279 Bank advertisements often included the names of prominent government
officials, such as Abraham Lincoln
and Oliver Otis Howard, mislead-
ing customers and the public into
believing that the federal govern-
ment protected and guaranteed
their deposits . 280 Depositors were
reminded during public meetings
and other bank-sponsored gath-
erings that the bank was under
Congressional charter, and thus
under its complete protection . 281
With such assurances that their deposits were safe,
African Americans from a wide variety of backgrounds
and occupations, many excited to be receiving a wage
for their services for the first time in their lives, opened accounts with the Freedman’s Bank between 1868 and
1874 at an extraordinary rate . Within 10 years, 75,000 depositors—who were virtually all African Americans—
trusted the bank by depositing more than $75 million,
approximately $1 .5 billion in today’s dollars . 282 Most of these deposits were being saved to buy land and other
productive goods such as tools or agricultural supplies as depositors were told to do . 283
But the bank turned quickly from a savings bank to a
risky private investment bank controlled by a small
minority of trustees . 284 Against the bank’s original Congressional charter and without the knowledge of
the Black customers, who were largely unable to secure
loans from the bank, the bank invested the money in
risky railroad and real estate holdings to benefit white businessmen and bank managers . 285 When, on June
29, 1874, the bank failed and closed due to fraud, 61,131 mostly Black depositors lost about $2 .9 million or $63 million in 2017 dollars . . 286 One study estimated the av- erage amount owed to depositors across 71 bank failures of federally chartered banks between 1865 to 1933, 287 and the Freedman’s Savings Bank ranked third for the largest amount owed to depositors at the time of bank failure . 288 Because the bank had represented much more than just
a place to store money, the African Americans who lost
their money also lost their trust in the federal govern- ment and in banks in general . 289
State and private banks following emancipation re-
fused to serve the credit needs of freedmen during the
late 19th century, which meant that they had to rely
on more expensive and exploitive credit systems . 290
General stores became an important means of accessing
short-term credit . 291 Prices were at the discretion of the merchant . 292 One price for goods purchased with cash and a higher price (often by 25 percent) for goods pur- chased with credit . 293 Goods purchased on credit were charged interest of eight to 15 percent, as determined
by the personal judgment of the merchant, based on the
creditworthiness of the borrower . 294
Black-owned banks were established to provide bank-
ing services to Black communities . 295 Approximately
130 Black-owned banks were established between 1900
and 1934 . Fifty savings and loans and credit unions were also established during this period . Only eight banks
Bank officials at the government charterd Freedmen’s Bank improperly invested the savings of newly freed enslaved people, leading to the loss of approximately $2.9 million or $63 million in 2017 dollars. This loss of wealth devastated newly freed enslaved people and their descendants for generations.

465
Chapter 13 The Wealth Gap
survived the Great Depression out of 130 Black-owned
banks . 296 Today, there are only 21 Black-owned banks nationwide, and 32 Black-owned financial institutions
overall, including credit unions . 297
The federal government prevented the success of Black-
owned banks by excluding them from full participation
in the banking market . 298 Black bank deposits were
smaller and were more frequently
withdrawn than white bank depos-
its, which made them more risky . 299
Most Black depositors had no wealth
to invest in the bank and were just
depositing money from their wag-
es while keeping small amounts to
live on . 300 They put their money into
Black-owned banks not only for safekeeping, but also
as rainy-day funds during bad times that came often . 301 Because their deposits experienced high risk, Black-
owned banks had to keep more cash as reserves or invest in other more liquid assets such as government secu-
rities, which were safer than loans . 302 They needed to make sure they always had enough cash at the bank to
pay out to depositors . Black-owned banks also held very high capital ratios to offset this risk . 303 For example, in 1920, the mean capital ratio for white banks was 18 per- cent, while Black banks had an average capital ratio of 32 .9 percent . 304 This meant that the Black bank owners invested more of their own money and earnings in the
bank to keep it secure, but this severely lessened their ability to make a profit or lend money . 305
Another source of vulnerability for Black banks was their assets or loan portfolios . 306 The fate of Black banks was tied up with the fate of Black businesses, which meant
that Black banks lacked the diversified investments
needed for safe, and profitable banking . 307 Most thriving banks hold a mix of commercial and real estate loans, but Black-owned banks made almost exclusively home loans
because the vast majority of Black businesses were small service operations with no need for bank financing . 308 As described in Chapter 5, Housing Segregation, the
federal government generally labeled Black homeown-
ers and Black neighborhoods as being at higher risk of
default, and white-owned banks generally refused to
issue mortgages to Black homeowners . Black-owned
banks often met the need and provided home loans to
Black homebuyers . 309
Since homes owned by African Americans were un-
dervalued due to government redlining, the property
held for collateral during the term of the loan imme-
diately diminished in value, upholding the perception
that these loans were inherently risky investments . 310 Therefore, there was no market for mortgages held by
African Americans because of the devaluation of prop-
erty owned by African Americans and the assumption
that loans held by African Americans were inherent-
ly risky . 311 This in turn meant that it was difficult for Black-owned banks to earn a profit from an investment
portfolio that was largely composed of home loans to
African American homebuyers . 312
California
In California, Black homesteaders can be traced back
to 1900, when agricultural settlements were promoted
at various times after the turn of the century in Yolo, San Bernardino, Tulare, and Fresno counties . 313 At least two different efforts at colonization occurred in San
Bernardino County between 1900 and 1910, including
solicitation of families to homestead government land
in the Sidewinder Valley, desert land near Victorville . 314 Black homesteaders also established an agricultural
settlement in 1908 in the town of Allensworth in Tulare County, which ultimately was depleted of a water supply necessary to sustain the settlement . 315
The racial climate around African American colonies
ranged from welcoming or neutral to hostile, although
none have been reported to experience the kind of ev-
eryday violence and intimidation African Americans
regularly experienced in the South . 316
Incarcerated firefighters from Eel River Conservation Camp continue to tackle the Caldor Fire as the fires footprint continues to expand southwest of the Lake Tahoe Basin. (Aug. 27, 2021)

COURTESY OF JASON ARMOND / LOS ANGELES TIMES VIA GETTY IMAGES Before the Great Depression, there were 130 Black-owned Banks.

Today there are only 21 Black-owned banks.

466
Chapter 13 The Wealth Gap
Incarcerated people in California produces myriad
products such as clothing, furniture, cleaning products and food . 317 They also perform a wide range of duties in areas such as laundry, kitchen, and general mainte-
nance . 318 The California Department of Forestry and
Fire Protection employed around 1,600 incarcerated
individuals to fight forest fires in May 2021 . 319 Some are paid as little as $1 .45 a day . 320 As discussed in Chapter 10, An Unjust Legal System, advocates argue that this is exploitive and does not necessarily help the incarcerat- ed firefighters to be find jobs once they are released . 321 The costs of higher education are a larger burden for
Black Californians . 322 Generally, white Americans are twice as likely as African Americans to receive financial assistance from their families for higher education . 323 Only 16 percent of very low-income Black Californian
students receive a CalGrant award . 324 The state financial aid African Americans do receive is often insufficient, especially with respect to housing . 325 Fifteen percent of white households in Los Angeles had student loan debt,
in contrast with 20 .5 percent of households headed by
African Americans . 326
Structural racial disparities regarding access to unem- ployment insurance, food stamps, and COVID-19 federal
loans in a crisis, and benefits for businesses also exist in California . From March through June 2020, 84 .9 percent of California’s Black labor force filed for unemployment benefits, compared to 39 .1 percent of the state’s white labor force . 327 Black Californians who received unem- ployment insurance during the pandemic received
$293 .90, the smallest median weekly benefit of any racial group, versus white claimants who received $394 .90 . 328 California’s version of food stamps, CalFresh, generally maintains the same work requirements that dispropor-
tionately cut Black adults off from food assistance at the federal level . 329 In 2016, California enrolled only 72 per- cent of eligible residents in CalFresh, the fifth lowest rate in the nation . 330 It is also one of 10 states that man- age food assistance programs at the county level, which tends to be more expensive and variable than adminis-
tering the program at the state level . 331 Black Californians make up 6 .5 percent of the state’s population, 332 but 14 .7 percent of participating CalFresh households . 333 During the pandemic, one survey found that 20 .2 percent of
Black households with children sometimes or often did
not have enough to eat in a four week period spanning
June and July, compared to 8 .8 percent of white house- holds with children . 334
In California, an analysis of the distribution of feder- al loans found disparate distribution by race: African
American neighborhoods received $445 per resident,
while white neighborhoods received $666 per resident,
partially due to lower concentration of small business- es or small business employees in African American
neighborhoods . 335 However, another analysis revealed that in most major metro areas in the country—including Los Angeles, San Francisco, and San Diego—business-
es in majority-white areas also received federal loans
at a greater rate than businesses in majority-African
American areas . 336
Proposition 209 (Prop 209) has also disadvantaged
Black-owned businesses in the state seeking public
contracts with the State of California and local govern- ments . Passed in November 1996,
Proposition 209 caused state and
local governments to end race-con-
scious contracting programs,
resulting in a loss of $1 billion to $1 .1
billion every year for minority and
women-owned businesses . 337 The
biggest contract loss for minority
and women-owned businesses was
with the State of California where
$823 million has been lost each
year since Prop 209 . 338 Before Prop 209 passed, in fiscal year 1994-1995, $519 million was contracted to minority and women-owned businesses or about $823 million in
October 2014 dollars . When California ended its pro-
gram for minority and women-owned businesses, only a
few got back their contracts with the state and some nev- er recovered . 339 There was only an insignificant increase in Small Business Enterprise procurement with the state after Prop 209, which is the main way that state con-
tracts would be available for many of these businesses . 340 Generally, white students are twice as likely as Black students to receive financial help from their family for higher education.

Only 16 percent of very low-income Black Californian students receive a CalGrant award.

CALIFORNIA
UNEMPLOYMENT INSURANCE MARCH TO JUNE 2020
Weekly benefit amount
$394.90White
Black $293.90

467
Chapter 13 The Wealth Gap
The City and County of San Francisco lost about $200
million per year in minority and women-owned
business contracts . 341 Some of this loss emerged imme- diately after Prop 209 . More losses followed the 2004
Coral Construction case, which ultimately ended San
Francisco’s race-conscious procurement program . Prop
209 also resulted in the loss of about $30 million per
year in minority and women-owned business contracts
with the City of Oakland . It also resulted in an estimat- ed $20 million loss per year in such contracts with the City of San Jose after the 2000 Hi-Voltage Wire Works
case, which ultimately ended San Jose’s race-conscious
contracting program . 342
IV . Drivers of the Wealth Gap Today
Unequal Homeownership
Homes are one of the most important wealth assets that
households can possess . 343 People who own homes can
use them to borrow money to pay for expenses or pay
off high-interest debt in times of crisis . 344 Homeowners are able to generate wealth through home equity, so
long as their home increases or appreciates in value .

Homeownership is also believed to be more beneficial
than renting because owners build equity, and obtain
additional tax benefits . 345 Homeowners may also face less housing instability than renters—partially because they tend to be more well-off in general—especial-
ly during a crisis, and may therefore be less likely to lose their housing . 346 Housing affordability problems— where an occupant must pay more than 30 percent
of gross income for housing costs, including utili-
ties 347 —are more than twice as common among renters
than homeowners . 348
As discussed in Chapter 5, Housing Segregation, and
above, government discrimination made it difficult
for African Americans to buy real estate, gain wealth
through real estate, and transfer that wealth to succes- sive generations . 349 Widespread homeownership in the United States was created through government action,
starting with New Deal legislation . 350 The New Deal cre- ated relatively safe long-term mortgage markets and
reduced down payment requirements for homeowner-
ship . This transformed the housing landscape, allowing many working-class households to move from the rental
lifestyle to owning a home . 351 Yet, as described above and in Chapter 5, Housing Segregation, the path to home-
ownership has been riddled with entrenched racism . 352 Today, African Americans are in a worse position than
white Americans to have homes as assets to aid them in
a crisis . The racial homeownership gap was 19 percent
in 1940, and grew to 28 percent in 2009 . As of the sec- ond quarter of 2020, out of $30 .8 trillion in real estate assets in the U .S ., Black households
held five percent and white house-
holds held 78 percent . 353 In 2019,
42 .8 percent of African Americans
owned homes versus 73 .3 percent
of white Americans, and are more
likely to face affordability issues in
securing capital to purchase and
sustain housing at 30 percent of
their gross income, including utilities . 354 In the same year, researchers for the National Bureau of Economic
Research also found that Black mortgage borrowers
were charged higher interest rates than white borrowers were and were denied mortgages that would have been
approved for white applicants . 355
African Americans who own homes have a greater re-
liance on the house as a source of wealth than white
households . 356 In 2014, home equity accounted for 92 percent of African Americans’ net worth . 357 There is a gap between the appreciation of a home owned by a white
family and the appreciation of a similar home owned
by a Black family . 358 When African Americans do own
2019 U.S. HOME VALUES MEDIAN EQUITY BY RACE
White $130,000 Black $66,800
Nationally, In 2019, 42.8 percent of African Americans owned homes versus 73.3 percent of white Americans. Only 33 percent of Black Californians owned homes.

468
Chapter 13 The Wealth Gap
homes, they tend to be appraised for less than compara- ble white homes, limiting the amount of money that can
be taken out of their home equity . Race affects the rate of return on home asset . 359 African American homeowners had a median home equity of $66,800 in 2019 . 360 White homeowners had a median home equity of $130,000 in
the same year . 361
Residential segregation contributes to the undervaluing of houses in Black neighborhoods . 362 African American homeowners tend to own homes appraised for less in
neighborhoods deemed less valuable, 363 which decreases their available equity relative to white homeowners . 364 Even controlling for factors like neighborhood or home
quality, a study has found systemic undervaluation of
homes in Black neighborhoods attributable to anti-Black bias . 365 Major companies offering real estate insurance have been accused of targeting inner city neighborhoods where Black families live by denying claims as fraudu-
lent . 366 All of this limits African Americans’ access to the benefits of home equity in a crisis . 367
African Americans also experience significant housing
cost burdens . 368 Without sufficient wealth in the first place, Black households have limited means to invest
in homeownership . 369
In 2019, 43 percent of Black households spent more than 30 percent of their income on housing—compared with
25 percent of white households . 370 Discrimination in mortgage lending may also make it more difficult for
Black homeowners to access their home equity through
cash-out refinancing, 371 a means of accessing home
equity that has been increasingly popular during the
pandemic . 372 Between April 2020 and January 2021, less than a quarter of Black homeowners who could have
saved $200 a month by refinancing did so, compared to
40 percent of similarly situated white homeowners . 373 But closing the homeownership gap alone will not close
the racial wealth gap; the homeownership gap alone
does not explain the racial wealth gap . 374 Among Black and white American households who do not own a
home, white households still have 31 times more wealth
than African American households . 375
Fewer Assets
Black households hold less assets than white households overall, but Black households hold a higher proportion
of assets in their cars and homes, and less in net liquid and net business assets . 376 Black households are also generally less likely to hold financial assets . 377 African Americans have substantially fewer assets than white
people at every income level, including bank deposits,
stocks, bonds, and loans . 378
African Americans tend to have fewer investments . Some studies argue that African American investment patterns generally show risk aversion and lack of education on
stocks and investments . 379 They argue that wealthier African Americans tend to save more and invest less 380 compared to wealthier white Americans, and that white
Americans are more likely than African Americans to
invest in high-risk, high-reward assets . 381 For example, in 2004, African American families were less likely than white families to have investment accounts and retire-
ment accounts . Only 44 percent of African Americans
have retirement savings accounts, with a typical balance of around $20,000, compared to 65 percent of white
Americans, who have an average balance of $50,000,
according to the Federal Reserve . 382 And only 34 per- cent of African Americans own any stocks or mutual
funds, compared to more than half of white people . 383 Some studies claim that this can be attributed to familial influence—Black families are less likely to have invest- ment accounts if their parents didn’t have any . 384 Other studies argue that African Americans are not signifi-
cantly more risk averse or less financially literate than white people with similar levels of income and wealth .

Further, African Americans engage in entrepreneurship,
which presents inherent risk, at higher rates than white Americans with similar levels of income and wealth .

Low wealth, lack of financial inclusion, and financial
constraints on choice often forces Black borrowers to
use predatory and abusive alternative financial services rather than financial illiteracy . 385
African Americans have less liquid assets . Liquid assets accessible as cash in times of crisis include cash savings, checking accounts, savings accounts, money market
funds, certificates of deposit, and government bonds . 386 Access to liquid assets is important in a crisis, as it en- ables people to continue to pay bills in the event of a 2019 LIQUID ASSETS

AMOUNT BY RACE
White $8,100 Black $1,500

469
Chapter 13 The Wealth Gap
sudden loss of income, or pay for emergency expenses
such as medical costs . Lack of access to liquid assets can heighten the impact of crises by making it harder to af- ford basic necessities . 387 People may also turn to family for economic support in times of hardship . 388 In addi- tion, access to government aid such as unemployment
insurance, nutrition subsidies, and crisis-specific pro- grams, such as stimulus checks and small business loans, help people and their businesses stay afloat . 389 These resources are vital for surviving economic crises . For example, liquid assets such as cash savings help people pay bills in the event of a job loss or weather emergency expenses like a medical emergency . 390 Similarly, people who have homes, stocks, or retirement funds may lever-
age their home value for a loan, 391 liquidate stocks, or borrow from or against their retirement accounts to pay for expenses during difficult economic times . 392
African American households tend
to disproportionately lack access
to many of these resources, often
due to the persistence of histor-
ical disparities and racism that
continues today . 393 In 2019, while
96 .8 percent of African American
families had some kind of liquid asset—
such as a checking account, savings
account, or pre-paid card—typi-
cal African American families with
liquid assets had $1,500 in liquid sav-
ings, compared to $8,100 for white
families with liquid assets . 394 Racism in the banking system today still create barriers to liquid assets for Black custom- ers . Black customers are sometimes profiled, 395 viewed with suspicion just for entering a bank, 396  and ques- tioned 397  over the most basic transactions . 398
African Americans have less non-liquid assets . In gen- eral, non-liquid assets such as homes, stocks, and
retirement funds can support financial security by
increasing resources necessary to weather a crisis or
invest in wealth-generating assets for the future . 399 As discussed above, African Americans experience myriad
barriers to homeownership and the mortgage market .

Stocks and mutual funds, which can be sold, and re-
tirement funds, which can be liquidated or borrowed
against, also provide potential sources of aid in a cri- sis . 400 African Americans are also less likely to own stocks than white Americans, and African Americans who
own stocks have less equity than white Americans do . 401 While 61 percent of white households own any form of
stocks, only 33 .5 percent of African American house-
holds do . 402 Among families who own stocks, the typical white family has access to $50,600 they could tap in an emergency, compared to $14,400 for the typical African
American family . 403
While African Americans are more likely to have access
to retirement accounts than homes or other types of
stocks, they are still less likely than white Americans to have them . 404 Around 55 percent of African American
working-age families have access to an employer-spon-
sored retirement plan, and 45 percent participate . 405 Seventy percent of white working-age families have ac-
cess to an employer-sponsored retirement plan, and
60 percent of them participate . 406 Among working-age white families with balances in such accounts, the typ- ical white family has approximately $50,000 saved,
whereas the comparable African American family has
approximately $20,000 saved . 407 During the pandem-
ic, a survey found that African American households
with retirement accounts were much more likely to
report that they planned on withdrawing from or bor-
rowing against them (48 percent and 45 percent) than
white households (29 percent and 29 percent) due to
relative lack of other assets . 408 However, withdrawing money from retirement accounts can incur tax and
other penalties . 409
Lower Business Ownership
Business ownership allows African Americans to partic-
ipate in local, regional, and global markets from which they have historically been excluded due to systemic rac- ism and discrimination . 410 Equity in a business is among one of the types of assets that are more unequally distrib- uted by race . 411 Lower wealth for African Americans leads to lower business ownership and self-employment . 412
Studies have demonstrated the substantial wealth ad-
vantages to self-employment and have shown that those
who become self-employed show much stronger gains
in wealth compared to individuals who never become
self-employed . 413
Black business owners typically start their businesses with half the capital of white business owners despite the fact that they demonstrate a greater need for start-up financing. The median loan amount for Black business owners who are approved for credit is less than half of the loan amounts extended to their white counterparts.

470
Chapter 13 The Wealth Gap
This is especially true for Black business owners given that the median net worth for Black business owners
is 12 times higher than Black non-business owners . 414 Further, Black business ownership is a viable path to cre- ating wealth not only for Black business owners, but also for Black communities at large . 415 Most small businesses tend to hire from the community, which tends to create
job opportunities for community residents . 416 Therefore, the success of Black-owned businesses is a critical path for economic empowerment in Black communities . 417
The Center for Financial Household Stability and the
Federal Reserve Board of St . Louis have documented
that, compared to white individuals, African Americans
own fewer of their assets in the form of business assets . 418 In terms of market share, Black-owned businesses are
significantly underrepresented in comparison to white
and other minority-owned businesses . 419 In 2017, only 3 .5 percent of all United States businesses were Black-owned compared to 81 percent white-owned . 420 Although Black business ownership has been steadily increasing in the
United States, growth has been tremendously slow . 421
Several factors contribute to the racial disparity in
American business ownership such as systemic barriers
to securing start-up capital and the relatively small size of Black businesses . 422
African Americans face many sys-
temic barriers when seeking the
social and financial capital neces-
sary to start their own businesses
that make it increasingly difficult for
Black entrepreneurs to secure the
financial capital necessary to launch
or grow their own businesses . 423 As
a result, Black business owners typ-
ically start their businesses with
half the capital of white business
owners despite the fact that they
demonstrate a greater need for
start-up financing . 424 According to
Pepperdine’s Private Capital Access
Index report, approximately 80
percent of Black businesses sought
financing for planned business
growth or expansions compared to only 55 percent of
all respondents . 425 Although Black businesses demon- strate a greater desire and need to secure financing,
due to discriminatory lending practices, Black business owners receive lower loan amounts, and with less fre-
quency than white business owners . 426 For example, the median loan amount for Black business owners who are
approved for credit is less than half of the loan amounts extended to their white counterparts . 427
Another barrier to the growth and development of Black
businesses is the fact that, on average, the businesses owned by African Americans are smaller than those
owned by white Americans . 428 A key factor for measuring the size of a business is whether the business has employ- ees and statistics show that Black-owned businesses are much less likely to have employees than white-owned
businesses . 429 In 2012, for example, 23 .9 percent of businesses owned by white men had employees where-
as only six percent of businesses owned by Black men
had employees . 430 Although the size of a business has a significant influence on the profitability of a business, even Black-owned businesses with employees tend to
be much less profitable than white-owned businesses
with employees . 431 In 2014, 63 .4 percent of white-owned businesses with employees indicated that they were
profitable compared to the reported profitability of only 45 .6 percent of Black-owned businesses with employ-
ees . 432 In addition, the top 100 Black-owned businesses combined earned less than $30 billion in 2014 . Walmart earned $482 billion, or sixteen times that . 433
The challenges faced by Black business owners were fur- ther exacerbated by the economic hardships caused by
the COVID-19 pandemic . 434 The Federal Reserve Bank

COURTESY OF ARCHIVE PHOTOS VIA GETTY IMAGES
First Black Owned Aamco Transmission Franchise (c. 1970) UNITED STATES 2004 BUSINESS OWNERSHIP BY RACE
81%White
Black3.5%

471
Chapter 13 The Wealth Gap
of New York reports that about 58 percent of Black-
owned businesses were at risk of financial distress
before the pandemic, compared to approximately 27
percent of white-owned businesses . 435 The financial in- stability experienced by Black-owned businesses made
these businesses particularly vulnerable at the onset of the pandemic . 436 According to a report by the House
Committee on Small Business, Black business ownership
declined approximately 40 percent, more than any other
racial group, during the first few months of the pandem- ic . 437 Black business owners such as Richard Anderson, the owner of Kinfolk Brass Band and Music Group, ex-
perienced significant economic distress as a result of the pandemic . 438 Before the pandemic, Kinfolk Brass Band was one of the most popular bands in New Orleans and
frequently performed at weddings and music festivals
around the world . 439 However, lockdown measures en-
acted to reduce the spread of COVID-19 forced all large events and gatherings to cease . 440 Without any events to perform at, Kinfolk Brass Band and its band members,
including owner Richard Anderson, suffered a signifi-
cant loss of income in 2020 . 441
California
Black Californians are much more likely to be renters
and much more likely to be housing cost-burdened .

For instance, 58 .4 percent of Black Californians are
renters versus 34 .1 percent for white Californians . 442 Black Californians less likely to have access to the credit and housing stability that owning a home can provide
in a crisis . 443 Homeownership for Black Californians lags behind the nationwide African American homeown-
ership rate—33 .3 percent versus 44 percent nationally
in 2019 . 444
63 percent of white Californians own their homes,
while only 33 percent of Black Californians do . 445
Homeownership rates for African American house-
holds have fallen every decade for the last 30 years,
both unconditionally and after
controlling for income and demo-
graphics . 446 Black Californians face
higher priced loans, more pred-
atory lending, and more risk . 447
During the housing crisis of the
2000s, California had the country’s
highest foreclosure rates, with Los
Angeles leading the state . 448 African
American household foreclosure
rates were 1 .9 times that of white Americans, likely due to increased targeting of minority communities for
predatory lending as discussed above . 449
Black Californians have less non-liquid assets . African Americans in Los Angeles own fewer stocks, mutual
funds, investment trusts, individual retirement account and/or private annuity than white Angelinos . 450 Eighteen percent of U .S .-born Black households in Los Angeles do not have a car, the lowest of all reported ethnicities . 451 While Californians, in general, face long commute times, Black Californians in Los Angeles, on average, have a 7 .5 percent longer commute . 452
In Los Angeles, 11 .7 percent of white households own a busi- ness versus 3 .1 percent of African American households . 453 V . Effects of Wealth Gap
The harmful effects of the wealth gap, which cascade
across generations, have resulted in racial differences in the capacity of African Americans to transmit resources across generations and lower financial resilience during crisis, and discriminatory tax structures .

Fewer Intergenerational Wealth Transfers
Lower assets of African Americans means that intergen-
erational wealth transfers are less likely and tend to be smaller . Inheritance, intergenerational wealth transfers, or parental wealth are primary sources of the capacity
for sustained wealth building . 454 Wealth, more than in- come, can be used to invest in appreciating assets for
children, such as a college education, an unpaid intern- ship in a high rent city, a new business, a property in a better residential neighborhood, or a job in the family firm . 455 Without wealth transfers, regardless of income, these assets are harder to attain . 456
The fewer resources the older generation has to trans-
fer to the next, the lower the wealth position attained by the younger generation . 457 At least 26 percent of an adult’s wealth position is directly due to inheritance or During the housing crisis of the 2000s, California had the country’s highest foreclosure rates, with Los Angeles leading the state.

African American household foreclosure rates were 1.9 times that of white Americans, due to discriminatory banking practices.

472
Chapter 13 The Wealth Gap
gift money—a conservative estimate . The true effect
could be as high as 50 percent . 458 Greater familial assis- tance contributes to white families’ greater ability to buy better housing and get better deals on mortgages earli- er in life, further compounding the
homeownership and wealth gap
and giving white families better se-
curity in crisis . 459 An Urban Institute
study estimates that the shortfall in
large gifts and inheritances accounts
for 12 percent of the Black-white
wealth gap . 460
The impact of fewer intergenera-
tional transfers is reflected in the wealth gap between Black and white American millennials . While the typi-
cal white millennial family has about $88,000 in wealth, the typical Black millennial family has only about $5,000 in wealth . White millennial families made huge strides between 2016 and 2019, and they now lag previous gen-
erations of white families by only about five percent . 461 Between 2007 and 2019, however, Black millennials
fell further and further behind—not just compared
with white millennials, but compared with previous
generations of African Americans . 462 While white mil- lennials trail the wealth of previous generations of white Americans by only five percent, Black millennials trail previous generations of African Americans by 52 per-
cent . 463 The typical Black millennial has $5,700 less in net worth than counterparts in previous generations . 464 There are several reasons for these deep disparities
between Black and white millennials . 465 First, white mil- lennials are more likely to benefit from having wealthy parents . Greater familial assistance contributes to white families’ greater ability to buy better housing and get better deals on mortgages earlier in life, further com- pounding the homeownership and wealth gap and
giving white families better security in crisis . 466 Their parents have more resources, for example, to help them
with down payments on their first house or to help them pay off their student loans . 467 About 80 percent of Black millennials with at least a bachelor's degree still have student loan debt, compared with about half of white
millennials . White millennials are also more likely to own assets like stocks and homes, which have ballooned
in value in recent years . 468 While about two-thirds of white millennials own homes, less than a third of Black millennials own homes . 469
Lower Financial Resilience during Crisis
Support from family networks can provide a “private
safety net” to aid with cash transfers, housing, or child- care in times of material hardship . 470 Cash transfers can provide additional income, multigenerational housing
can provide shelter, and family-provided childcare can
permit a parent to work and earn income as well as avoid childcare expenses . 471 For example, during the COVID-19 pandemic, almost a quarter of renters borrowed money
from friends or family . 472
While African Americans receive assistance from fami-
ly members at high rates, their overall tendency to lack resources may reduce the available quantity of such as- sistance, and may result in economic harm to the giver . 473 African American families are more likely than white
families to have high-poverty family networks and more
likely to make repeated cash trans-
fers, which hinders their ability to
accumulate wealth . 474
For example, in 2019, 71 .9 percent
of white families expected that
they could get $3,000 from friends
or family during a crisis, versus
less than 40 .9 percent of African
American families . 475 While new
African American mothers are more
likely to live in a relative’s home,
host a family member, and give
or receive money than white mothers, helping family
members in poverty may have negative consequences
for struggling families . 476
A pre-pandemic study found that while 31 .7 percent of
white households are liquid-asset poor (meaning that
Between 26-50 percent of an adult’s wealth position is directly due to inheritance or gift money. Larger family contributions earlier in life help white families buy better houses and get better mortgages, and create better financial security to combat a crisis.

In 2019, 71.9 percent of white families expected that they could get $3,000 from friends or family during a crisis, versus less than

40.9 percent of African American families. Lack of access to liquid assets can also force people into financially risky options during a crisis, such as taking out predatory payday loans or high-interest credit card debt.

473
Chapter 13 The Wealth Gap
they could not use their savings to live for three months at the federal poverty rate), 62 .7 percent of African
American households are . 477 And a 2020 study found that 36 percent of white families had enough savings to cov- er six months of expenses, versus 14 percent of African American families . 478 In one February 2021 survey of “dis- advantaged workers,” 42 percent of white households
reported that they could not pay for a $400 emergen-
cy expense without taking on additional debt, drawing
down retirement accounts, or selling items, compared
to 59 percent of African American households . 479
African Americans are more likely to suffer from eco-
nomic crises such as the COVID-19 pandemic . For
example, a June 2020 survey found that while only 27
percent of white households had experienced finan-
cial hardship as a result of the pandemic, 40 percent
of African American households had . 480 In addition,
lack of access to liquid assets can also force people into financially risky options during a crisis, such as taking out predatory payday loans or high-interest credit card debt . 481 Lack of access to liquid assets can also make it harder to afford food and rent . 482 June 2020 census data showed that, among households where a job was lost
during the COVID-19 pandemic, 31 percent of African
American households lacked sufficient food in the prior week, compared to 12 percent of white households . 483
The data also showed that, compared to white rent-
ers, African American renters were
less likely to have paid their rent
in the previous month and more
likely to predict that they would
not be able to make their next rent
payment . 484 In a May 2020 survey,
African American respondents were
more than twice as likely as white
respondents to report missing a
credit card, utility, internet, rent,
mortgage, or other “important pay-
ment” since the beginning of the pandemic . 485 African American families with liquid assets also use them up
more rapidly than white families during a crisis . 486
African American families with emergency savings at
the start of the pandemic were twice as likely as white households to have needed to use them by May, and
more than twice as likely to have already spent at least a quarter of their savings . 487
Discriminatory Tax Structures
More than 50 years after the passage of the Civil Rights Act, many wealth-building policies still continue to
heavily favor households that do not need help build-
ing wealth—mostly wealthy, predominantly white
households—while doing little or nothing for low-wealth African American households, among other households
of color . 488 The largest and most powerful of these pro- grams operate through the U .S . tax code . 489
These federal tax programs overwhelmingly favor build-
ing the wealth of the wealthy, and has contributed to the extreme rise in overall wealth inequality over the past several decades . 490 Tax policies have drastically different impacts on Black and white families and many were creat- ed during a time when Black families paid into the system without having the same legal rights to live, work, marry, vote, or receive an education as their white peers . 491 The modern income tax system traces its roots to the
Revenue Act of 1913, which instituted a progressive in- come tax system where tax rates increase as income
increases but did not envision African Americans as
taxpayers at all . 492 Even as African Americans eventually paid into the tax system after amendments and several
new laws, they were unable to reap its benefits . 493 Today, African Americans are paying more in taxes than their
white peers because U .S . tax laws were designed with
white Americans in mind . 494
The federal government has spent more than $8 trillion
in the past twenty years on tax programs to help families build long-term wealth through saving for retirement,
buying a home, starting a business, or accessing higher education . 495 This spending has resulted in the typical millionaire receiving about $145,000 in public tax ben- efits to grow their wealth, while working families get a total average of $174 . 496
Although the Internal Revenue Service does not col-
lect race or ethnicity data, recent research indicates
that overwhelming amount of the spending the federal
government does through the tax code goes to white
households at all income levels . 497 Examining indi-
viduals earning $103,466 or more reveals that white
people accounted for 79 percent of those respective
filers, while Black people accounted for only six per-
cent . 498 These individuals also took greater advantage Although the Internal Revenue Service does not collect race or ethnicity data, recent research indicates that overwhelming amount of the federal tax benefits goes to white households at all income levels.

474
Chapter 13 The Wealth Gap
of high-value tax benefits, which cost the government
hundreds of billions of dollars each year . For exam-
ple, in 2012, white people made up 83 percent of the
residents in the ZIP codes with the highest percentage
of tax returns reporting capital gains and mortgage
interest deductions . 499 But, African Americans made
up just three percent of residents in the ZIP codes re- porting the highest rates of capital gains income and six percent of residents in ZIP codes reporting the highest rates of mortgage interest deductions . These two tax
programs together cost the federal government more
than $100 billion during that year . 500
California
In California, Los Angeles provides a stark version of
nationwide racial disparities in liquid assets accessible during a crisis . 501 A 2014 study of the Los Angeles met- ro area found that the median value of liquid assets for U .S .-African American households was $200, compared
to $110,000 for white households . 502
While 91 .6 percent of white households had some kind
of liquid asset, only 62 .3 percent of U .S .-born African American households did . Further, 90 .1 percent of
white households had a checking account, versus 68 .1
percent of U .S .-born African American households . 503 In addition, 71 .9 percent of white households had a sav- ings account, versus 55 .5 percent of U .S .-born African American households . 504 While 40 .7 percent of white households had stocks, mutual funds, or investment
trusts, only 21 .5 percent of U .S .-born African American households did . 505 Finally, 63 .6 percent of white
households had an individual retirement account or
private annuity, versus 37 .9 percent of U .S .-born African American households . 506
In California, many current state tax policies benefit
Californians with higher incomes and wealth—predom-
inantly white and Asian Californians—and give little
to no benefits to other Californians, including Black
Californian . 507 For example, many tax benefits are only available to those who opt to itemize their tax deductions, and people who itemize tend to have higher incomes .

California’s four largest personal income tax deductions provide most benefits to families with incomes over
$100,000, while providing nearly no benefits to those
with incomes below $20,000 . 508 Black Californians are more likely to have low incomes, so they are less likely to benefit from these tax breaks . 509
California’s several tax benefits for homeowners, includ- ing the deductions for mortgage interest and property
taxes, are also unlikely to benefit Black Californians who have been blocked from homeownership through racist
policies and practices, often lack funds for a down pay- ment, and have lower value homes due to residential
segregation and racist appraisal practices . 510
VI . Conclusion
The legacy of slavery continues to reach into the lives of African Americans today . For hundreds of years, the American government at the federal, state, and local
levels has systematically prevented African American
communities from building, maintaining, and pass-
ing on wealth due to the racial hierarchy established to maintain enslavement .

Segregation, racial terror, harmful racist neglect, and other atrocities in nearly every sector of civil society have inflicted harms, which cascade over a lifetime
and compound over generations . As a result, African
Americans today experience a large and persistent
wealth gap when compared to white Americans .

Addressing this persistent racial wealth gap means un-
doing long-standing institutional arrangements that
have kept African American households from building
and growing wealth at the same rate as white house-
holds to the present day .

Percent of households in Los Angeles
that hold some type of liquid asset (2014)
Native-born
Black Household White Household

62.3%91.6%

THIS PAGE INTENTIONALLY LEFT BLANK

476
Chapter 13 The Wealth Gap
Endnotes
1 Hicks et al ., Still Running Up the Down
Escalator: How Narratives Shape Our
Understanding of Racial Wealth Inequality
(2021) (as of Mar . 18, 2022) .
2 Ibid .
3 Fed . Reserve Bank of Cleveland, What is
Behind the Persistence of the Racial Wealth
Gap? (Feb . 28, 2019) (as of Mar . 18, 2022) .
4 U .S . Federal Reserve, Disparities in Wealth
by Race and Ethnicity in the 2019 Survey
of Consumer Finances (Sept . 28, 2020)
5 Darity Jr . and Mullen, From Here to
Equality: Reparations for African
Americans in the 21st Century (2020) pp .
35-38 (hereafter From Here to Equality) .
6 Id. at p . 36 .
7 Ibid .
8 Darity Jr . et al, A Subaltern Middle Class:

The Case of the Missing Black Bourgeoisie
in Contemporary Economic Policy
(Jul . 2020), 12476, p . 499 .
9 Ibid .
10 Fenaba et al ., Disparate Recoveries:

Wealth, Race, and the Working Class After
the Great Recession in Annals of the
American Academy of Political and
Social Science (May 2021), , p . 182 .
11 Williamson, Closing the racial wealth gap
requires heavy progressive taxation of wealth
(Dec . 9, 2020), (as of Mar . 18, 2022) .
12 Kent, et al ., Has Wealth Inequality in
America Changed over Time? Here are Key
Statistics (Dec . 2, 2020), Federal Reserve
Bank of St . Louis, (as of January 19, 2022) .
13 Fed . Reserve Bank of Cleveland, What is
Behind the Persistence of the
Racial Wealth Gap?, supra .
14 Dereroncourt, et al . The racial wealth
gap, 1860-2020 (Mar . 8, 2021), (as
of Mar . 18, 2022), pp . 1-2 .
15 From Here to Equality, supra, p . 36;
Kocchar and Fry, Wealth inequality
has widened along racial, ethnic lines,
since the end of the Great Recession (Dec .
12, 2014), (as of Mar . 18, 2022) .
16 Maddox, What are assets? The building
blocks of wealth for individuals and
profits for businesses (Nov . 7, 2021),
h (as of Mar . 18, 2022) .
17 Ibid .
18 Darity, Jr ., The True Cost of Closing the
Racial Wealth Gap. The New York Times
(Apr . 30, 2021), (as of Mar . 18, 2022) .
19 Ibid .
20 From Here to Equality, supra, p . 257 .
21 Ibid .
22 Darity Jr ., The True Cost of Closing the
Racial Wealth Gap, supra.
23 Ibid .
24 Hicks et al . Still Running Up the Down
Escalator, supra .
25 Id. at p .8 .
26 Id. at p .6 .
27 28 Bhutta, et al ., Disparities in Wealth by
Race and Ethnicity in the 2019 Survey
of Consumer Finances (2020), FEDS
Notes 2020-09-28-2, Board of Governors
of the Federal Reserve System (U .S .)
(Bhutta et al .) (as of Apr . 10, 2022) .
29 Ibid .
30 From Here to Equality, supra, p . 36 .
31 Ibid .
32 For the most recent studies that pres-
ent documentation about the absence of
any significant difference in Black and
white saving behavior after controlling
for household income, see Borgo, Ethnic
and Racial Disparities in Saving Behavior in
Journal of Economic Inequality, no . 17
(2019) pp . 253–83; and Traub et al ., The
Asset Value of Whiteness: Understanding the
Racial Wealth Gap (Feb . 6, 2017 . See also
Gittleman and Wolff, Racial Differences
in Patterns of Wealth Accumulation in
Journal of Human Resources 39, no .
1 (2004) pp . 193–227; and Chiteji and
Hamilton, Family Connections and the
Black-White Wealth Gap among Middle-
Class Families in Review of Black Political
Economy 30, no . 1 (2002) pp . 9–28 .
33 What We Get Wrong About Closing the
Racial Wealth Gap, supra .
34 Ibid .
35 Traub et al ., Asset Value of Whiteness,
supra, pp . 7–8 .
36 See Mason, Race, Culture, and Skill:

Interracial Wage Differentials among
African Americans, Latinos, and Whites in
Review of Black Political Economy 25,
no . 3 (1997) pp . 5–39; Mangino, Race
to College: The ‘Reverse Gap’ in Race and
Social Problems, no . 2 (Dec, 2010) pp .
164–78; Mangino, Why Do Whites and
the Rich Have Less Need for Education?
in American Journal of Economics
and Sociology 71, no . 3 (Jul . 2012) pp .
562–602; Mangino, The Negative Effects
of Privilege on Educational Attainment:

Gender, Race, Class, and the Bachelor’s
Degree in Social Science Quarterly
95, no . 3 (Sept . 2014) pp . 760–84 .
37 From Here to Equality, at p . 36 .
38 Ibid .
39 An Equity Profile of the Los Angeles Region
(2017), Policy Link and the Program
for Environmental and Regional
Equity, (as of Mar . 18, 2022); De La
Cruz-Viesca et al ., The Color of Wealth
in Los Angeles (2016), Fed . Reserve Bank
of San Francisco, (as of Mar . 18, 2022);
Ong, et al ., Race, Ethnicity, And Income
Segregation in Los Angeles (Jun . 24, 2016),
UCLA Center for Neighborhood
Knowledge, (as of Mar . 18, 2022) .
40 Ibid .
41 De La Cruz-Viesca et al ., The Color of
Wealth in Los Angeles, supra, p .40 .
42 See Racial Wealth Divide Snapshot: Women
and the Racial Wealth Divide
(Mar . 29, 2018), Prosperity
Now, (as of Mar . 18, 2022) .
43 Ibid .
44 See Gould et al, What is the gender pay
gap and is it real?, Economic Policy
Institute, (as of Apr . 14, 2022) .
45 Racial Wealth Divide Snapshot, supra .
46 See, e.g., Struvyen, Black Womenomics:

Investing in the Underinvested (Mar .
9, 2021), Goldman Sachs, , p . 27 (as
of Jan . 19, 2022); Pettit, review of
McDermott, Mass Incarceration and

477
Chapter 13 The Wealth Gap
the Myth of Black Progress (2012),
https://www .journals .uchicago .
edu/doi/abs/10 .1086/672363?jour-
nalCode=ajs (as of Mar . 18, 2022) .
47 Ibid . See also Kop, Why the U.S. underre-
ports the economic gaps between
white and African Americans (Jun . 3,
2020) (as of Mar . 18, 2022) .
48 Pettit, review of McDermott, Mass
Incarceration and the Myth
of Black Progress, supra .
49 Gramlich, The gap between the number of
blacks and whites in prison is shrinking
(Apr . 30, 2019), (as of Mar . 18, 2022) .
50 Darity Jr ., What We Get Wrong About
Closing the Racial Wealth Gap, supra.
51 Struvyen, Black Womenomics: Investing in
the Underinvested (Mar . 9, 2021), Goldman
Sachs, p .6, (as of Jan . 19, 2022)
52 Racial Wealth Divide Snapshot: Women and
the Racial Wealth Divide, supra .
53 Struyven, Black Womenomics: Investing in
the Underinvested, supra; Richard, The
Wealth Gap for Women of Color (2014),
Center for Global Policy Solutions
Fact Sheet, (as of Mar . 18, 2022) .
54 Black Womenomics: Investing in the
Underinvested, supra.
55 Ibid .
56 Ibid .
57 Richard, The Wealth Gap for Women of
Color, supra.
58 Brown, The Intersection and Accumulation
of Racial and Gender Inequality: Black
Women’s Wealth Trajectories (Jun . 2011)
in The Review of Black Political
Economy, (as of Mar . 18, 2022) .
59 Racial Wealth Divide Snapshot: Women and
the Racial Wealth Divide, supra .
60 Ibid .
61 Race: Total Population . Explore census
data . (n .d .) . Retrieved
February 22, 2022, from .
62 Tamir, Key Findings About Black
Immigrants in the U.S. (Jan . 27, 2022), Pew
Research Center, (as of Mar . 18, 2022) .
63 Ibid .
64 Ibid .
65 Ibid .
66 Place of Birth for the Foreign-Born
Population in California, Explore
census data, (n .d .), Retrieved
March 18, 2022, from
67 Hicks et al . Still Running Up the Down
Escalator, supra .
68 Hamilton, Immigration and the
Remaking of Black America (May 2019) .
69 Ibid .
70 De La Cruz-Viesca et al ., The Color of
Wealth in Los Angeles, supra . Aja, et al,
The Color of Wealth in Miami (Feb . 2019),
(as of Mar . 18, 2022) . Munoz, et al ., The
Color of Wealth in Boston, Fed . Reserve of
Boston, (as of Mar . 18, 2022); Kijakazi,
et al, The Color of Wealth in the Nation’s
Capital (Nov . 2016), (as of Mar 18, 2022) .
71 Ibid .
72 Roderick Graham, “Reflections on the ADOS
Movement,” Medium, March 3,
2019, (as of Mar . 18, 2022) .
73 De La Cruz-Viesca et al ., The Color of
Wealth in Los Angeles, supra .
74 Ibid .
75 Ibid .
76 Ibid .
77 Ibid .
78 Ibid .
79 Ibid .
80 From Here to Equality, supra, p . 258 .
81 Id. at pp . 253-258 .
82 Id. at p . 253 .
83 Ibid .
84 California Task Force to Study and Develop
Reparation Proposals for African Americans
(October 12, 2021), Testimony of Thomas
Craemer (as of October 25, 2021) .
85 Craemer, Estimating Slavery Reparations:

Present Value Comparisons of Historical
Multigenerational Reparations Policies
in Social Science Quarterly 96,
no . 2 (June 2015), pp . 639–55 .
86 Ibid .
87 Marketti, Estimated Present Value of
Income Directed during Slavery in America,
Wealth of Races, pp . 107–24 .
88 From Here to Equality, supra, p . 254 .
89 Id. at p . 255 .
90 Ibid .
91 Id. at pp . 255-56 .
92 Darity Jr . and Mullen, William A. Darity
and Kristen Mullen on Direct Payments
to Close the Racial Wealth Gap (May
18, 2021), (as of Mar . 18, 2022) .
93 Allen, Homesteading and Property Rights;
or, ‘How the West Was Really Won
in The Journal of Law and
Economics 34, no . 1, (1991) .
94 Ibid .
95 Library of Congress, Homestead Act:

Primary Documents in American History
(n .d .), t (as of Mar . 18, 2022) .
96 University of Nebraska-Lincoln -
Center for Great Plains Studies,
Homesteading (n .d .), (as of Mar . 18, 2022) .
97 National Park Service, A History of
African Americans in California: Farming
(n .d .) (as of Mar . 18, 2022) .
98 Ibid .; National Park Service, African
American Homesteaders in the Great
Plains, (as of Mar . 18, 2022) .
99 Merritt, Land and the roots of African-
American Poverty (Mar . 11, 2016),
AEON (as of Mar . 18, 2022) .
100 Ibid .
101 National Park Service, African American
Homesteaders in the Great Plains, supra .
102 From Here to Equality, supra, p . 255;
Darity, Jr ., Forty Acres and a Mule in the 21st
Century in Social Science Quarterly 89,
No . 3 (Sept . 2008), (as of Mar . 18, 2022) .
103 Brown, Forty Acres and a Mule: How the
First Reparations for Slavery
Ended in Betrayal (Apr . 15, 2021),
(as of Mar . 18, 2022) .
104 Darity Jr ., Forty Acres and a Mule in the
21st Century, supra .
105 Brown, Forty Acres and a Mule: How the
First Reparations for Slavery
Ended in Betrayal, supra .
106 Ibid .
107 Darity Jr ., Forty Acres and a Mule in the
21st Century, supra .

478
Chapter 13 The Wealth Gap
108 Ibid .
109 Ibid .
110 Ibid .
111 Brown, Forty Acres and a Mule: How the
First Reparations for Slavery
Ended in Betrayal, supra .
112 Darity Jr ., Forty Acres and a Mule in the
21st Century, supra .
113 Ibid .
114 Ibid .
115 Ibid .
116 From Here to Equality, supra, p . 256 .
117 Darity Jr . and Mullen, William A. Darity
and Kristen Mullen on Direct Payments
to Close the Racial Wealth Gap (May
18, 2021), (as of Mar . 18, 2022) .
118 Ibid .
119 Ibid .
120 Ibid .
121 Logan and Darity Jr ., Look What Has
Been Taken from African Americans
(Sept . 9, 2021), as of Mar . 18, 2022) .
122 Taylor Jr ., Breonna Taylor’s death and
racist police violence highlight the danger of
gentrification ( Jul . 22, 2020), (as of Mar .
18, 2022); Maharawal, Gentrification
and the Security State (2017), (as of Mar .
18, 2022); Fayyad, The Criminalization
of Gentrifying Neighborhoods (2017),
The Atlantic, (as of Mar . 18, 2022) .
123 Darity Jr . and Mullen, William A. Darity
and Kristen Mullen on Direct Payments
to Close the Racial Wealth Gap, supra.
124 Ibid .
125 Public Broadcasting Service, Go
Deeper: Where Race Lives (n .d .),
(as of Mar . 18, 2022) (PBS) .
126 See Chapter 5
127 PBS, supra.
128 Rothstein, The Color of Law: A
Forgotten History of How
Our Government Segregated
America (2017), at preface .
129 Center for American Progress,
Systematic Inequality, Displacement,
Exclusion, and Segregation (Aug . 7,
2019), (as of Mar . 18, 2022) (Center
for American Progress) .
130 Darity Jr . and Mullen, William A. Darity
and Kristen Mullen on Direct Payments
to Close the Racial Wealth Gap, supra.
131 PBS, supra .
132 Center for American Progress, supra .
133 See Chapter 5
134 Darity Jr . and Mullen, William A. Darity
and Kristen Mullen on Direct Payments
to Close the Racial Wealth Gap, supra.
135 Ibid .
136 Daniel, Dispossession: Discrimination
against African American Farmers in
the Age of Civil Rights (2015), pp . 3-5 .
137 Id. at p . 34 .
138 Id. at p . 28 .
139 Id. at pp . 23, 124, 130 .
140 Id. at p . 28 .
141 Id. at p . 220 .
142 Id. at p . 216 .
143 Id. at p . 216 .
144 Id. at p . 217 .
145 Id. at pp . 218, 229 .
146 Id. at pp . 219, 229 .
147 Id. at p . 232 .
148 California Task Force to Study and
Develop Reparation Proposals
for African Americans (October
13, 2021), Testimony of Lawrence
Lucas, (as of February 10, 2022) .
149 Moore, Plight of Black Farmers in the
Context of USDA Farm Loan Programs:

A Research Agenda for the Future
(December 16, 2013), Professional
Agriculture Workers Journal,
(as of February 10, 2022)
150 Ibid .
151 Ibid .
152 Ibid .
153 Healy, A Windfall for Minority Farmers
Divides Rural America (May 22,
2021) The New York Times (as
of February 10, 2022)
154 Darity Jr . and Mullen, William A. Darity
and Kristen Mullen on Direct Payments
to Close the Racial Wealth Gap, supra .
155 See Chapter 11
156 Ibid .
157 Matos and . Hodge, The Chains of Slavery
Still Exist in Mass Incarceration
(Jun . 17, 2021), Vera Institute for
Justice, (as of Mar . 18, 2022) .
158 Ibid .
159 See generally Pope, Mass Incarceration,
Convict Leasing, and the Thirteenth
Amendment: A Revisionist Account (2019)
94 N .Y .U . L . Rev . 1465, 1467 .
160 Oshinsky, Worse Than Slavery (Apr . 28,
1996 (as of Mar . 18, 2022) .
161 Ibid .; see also Blackmon, Slavery by
Another Name: The Re-Enslavement
of African Americans from the Civil
War to World War II (2008); Cardon,
“Less Than Mayhem”: Louisiana's Convict
Lease, 1865-1901 (2017) Louisiana
History: The Journal of the Louisiana
Historical Association vol . 58, no . 4
pp . 417–441  (as of July 23, 2021) .
162 Hinton and Cook, The Mass
Criminalization of African Americans: A
Historical Overview in Annual Review
of Criminology (Jan . 2021), (as of Mar .
18, 2022) (citing Oshinsky, supra) .
163 Matos and Hodge, The Chains of Slavery
Still Exist in Mass Incarceration (Jun . 17,
2021), Vera, (as of Apr . 14, 2022) .
164 See Chapter 11 .
165 Ibid .
166 Pettit, Mass Incarceration and the
Myth of Black Progress, supra .
167 Harper et al, Debt, Incarceration, and
Re-entry: A Scoping Review (Aug . 11,
2020), (as of Mar . 18, 2022) .
168 Kent, Has Wealth Inequality in America
Changed over Time? Here are Key Statistics
(December 02, 2020) Federal Reserve
Bank of St . Louis (as of January 19, 2022)
169 Zaw et al ., Race, Wealth and
Incarceration: Results from the
Longitudinal Survey of Youth (Feb .
15, 2016), (as of Mar . 18, 2022) .

479
Chapter 13 The Wealth Gap
170 Krivo & Peterson, Extremely disadvan-
taged neighborhoods and urban crime
(1996) Social Forces 75(2): pp .
619-647 (as of July 29, 2021) .
172 Federal Bureau of Investigation – Criminal
(as of April 14, 2022); U.S. Census Bureau,
Quick Facts: U .S . > (as of July 22, 2021) .
173 Pierson et al ., A large scale analysis of
racial disparities in police stops across
the United States (2017) Nature
Human Behavior 4, 736–745
(2020) (as of July 27, 2021) .
174 Ibid .
175 Ibid .
176 Zaw et al ., Race, Wealth and
Incarceration, supra .
177 Ibid .
178 Harper et al ., Debt, Incarceration, and
Re-entry: A Scoping Review, supra .
179 See Chapter 11
180 Western and Wildeman, The Black
Family and Mass Incarceration in
the The Annals of the American
Academy of Political and Social
Science . 2009;621(1):221–242 .
doi: 10 .1177/0002716208324850 .
181 Ibid .
182 Z aw, et al ., Race, Wealth and
Incarceration, supra .
183 Ibid .
184 Federal Bureau of Prisons, Federal
Prison Industries Program Details,
< (as of July 27, 2021) .
185 Hoffer, Involuntary Servitude: How Prison
Labor is Modern Day Slavery (Feb . 3,
2022), Harvard Political Review,
(as of Mar . 18, 2022) (Hoffer) .
186 Ibid .
187 Ibid .
188 Hoffer, supra; see also Stygar, Thinking
Outside the Box: A Point-Based System
of Reintegration for California's Inmate
Firefighters (2020) 56 Cal . Western
L .Rev . 455, 456 (Stygar) .
189 Hoffer, Involuntary Servitude: How Prison
Labor is Modern Day Slavery, supra.
190 Ibid .
191 See Prison Policy Initiative, State and
federal prison wage policies and sourc-
ing information (Apr . 10, 2017) (as of
Mar . 18, 2022); Salay, When in pris-
on, the costs are steep and the pay close
to nothing, (as of Mar . 18, 2022) .
192 Benns, American Slavery, Reinvented
(Sept . 21, 2015), The Atlantic,
(as of Mar . 24, 2022) .
193 See generally Hammad, Shackled to
Economic Appeal: How Prison
Labor Facilitates Modern Slavery
While Perpetuating Poverty in
Black Communities (2019) 26
Va . J . Soc . Pol'y & L . 65, 66 .
194 Zaw et al ., Race, Wealth and
Incarceration, supra .
195 Ibid .
196 Ibid .
197 Bivens et al ., Reforming Unemployment
Insurance: Stabilizing a System in Crisis and
Laying the Foundation for Equity (June
2021), Economic Policy Inst ., https://
files .epi .org/uploads/Reforming-
Unemployment-Insurance .pdf (as
of Apr . 2, 2022) (Bivens et al .) .
198 U .S . Dep’t . of Agriculture, Economic
Linkages: Supplemental Nutrition Assistance
Program (SNAP) Linkages with the General
Economy (Aug . 20, 2019) Economic
Research Service, < (as of Aug . 19, 2021) .
199 Brantley et al ., Association of Work
Requirements with Supplemental
Nutrition Assistance Program Participation
by Race/Ethnicity and Disability
Status, 2013-2017 (June 2020), (as
of Mar . 18, 2022), pp . 7-8 .
200 Katznelson, When Affirmative Action
Was White: An Untold History of
Racial Inequality in Twentieth-
Century America (2005), p . 23 (When
Affirmative Action Was White) .
201 Ibid .
202 Ibid .
203 Ibid .
204 Id. at p . 42-43 .
205 Ibid .
206 Ibid .
207 Ibid .
208 Ibid .
209 Ibid .
210 Ibid .
211 Ibid .
212 Ibid .
213 Trotter, Jr ., From a Raw Deal to a New
Deal?: 1929-1945 (The Young Oxford
History of African Americans) (Apr . 5,
1996); To Make Our World Anew Volume
Two: A History of African Americans
since 1880 (2005), edited by Robin
D .G . Kelley and Earl Lewis, New York:

Oxford University Press, 2005, p . 131 .
214 Onkst, First a Negro . . . Incidentally a
Veteran: Black World War Two Veterans
and the G.I. Bill of Rights in the Deep
South, 1944-1948 (Spring 1998) 31(3)
in Journal of Social History 517, 518
(Onkst); Knutson, Legislation to Resolve
GI Bill Racial Inequities Introduced by
Democrats (Nov . 11, 2021) Axios (as of
Jan . 18, 2022); Katznelson, Fear Itself:

The New Deal and the Origins of Our
Time (Mar . 1, 2013), p . 368 (Fear Itself) .
215 Fear Itself, supra, pp . 368, 620; see also
When Affirmative Action Was White,
supra, pp . 113–41; Mettler, Soldiers
to Citizens: The G .I . Bill and the
Making of the Greatest Generation
(New York: Oxford University Press,
2007); Frydl, The G .I . Bill (Cambridge:

Cambridge University Press, 2011) .
216 Fear Itself, supra, pp . 368, 620; see also
When Affirmative Action Was White,
supra, pp . 113–41; Mettler, Soldiers
to Citizens: The G .I . Bill and the
Making of the Greatest Generation
(New York: Oxford University Press,
2007); Frydl, The G .I . Bill (Cambridge:

Cambridge University Press, 2011) .
217 Onkst, supra, p . 520; Rothenberg,
Race, Class, and Gender in the United
States: An Integrated Study (2007) p . 46 .
218 Katznelson & Mettler, On Race and
Policy History: A Dialogue About the G.I.

Bill (Sept . 2008) 6(3) American Political

480
Chapter 13 The Wealth Gap
Science Association 519, pp . 521, 522,
530, available at (as of Jan . 18, 2022) .
219 Fording et al ., Race and the Local Politics
of Punishment in the New World of
Welfare (March 2011) 116(5) American
Journal of Sociology 1610, 1614, 1650
(Fording et al .) . (available on JSTOR)
220 Id. at p . 1614 .
221 Bivens et al, supra, pp . 2, 10 .
222 Id. at p . 22 .
223 Id. at p . 10 .
224 Costa, Government Accountability
Office, Management Report: Preliminary
Information on Potential Racial and
Ethnic Disparities in the Receipt of
Unemployment Insurance Benefits during
the COVID-19 Pandemic (June 17, 2021),
Management Report: Preliminary
Information on Potential Racial and
Ethnic Disparities in the Receipt of
Unemployment Insurance Benefits
during the COVID-19 Pandemic (as of
Apr . 4, 2022) p . 3 (GAO Report), p . 3 .
225 Brantley et al ., supra, pp . 7-8 .
226 Chen, Center for Retirement
Research, Boston College, Did the
Stimulus Checks Help People with
Unexpected Expenses? (Aug . 2021),
p . 3(as of Mar . 18, 2022) .
227 Bivens, et al ., supra .
228 U .S . Dep’t of the Treasury, Paycheck
Protection Program, (as of Aug . 19,
2021) .> (as of Aug . 19, 2021) .
229 Trisi & Saenz, Center on
Budget and Policy Priorities, Economic
Security Programs Reduce Overall Poverty,
Racial and Ethnic Inequities (July 1,
2021); Holtzblatt & Karpman, Tax
Policy Center, Urban Inst ., Who Did
Not Get the Economic Impact Payments
by Mid-to-Late May, and Why? (July
2020) (as of Apr . 2, 2022) p . 2 .
230 Price & Pugh, The Next Pandemic
Stimulus Bill Must be Race-Conscious (Sept .
4, 2020), Time, (as of Aug . 19, 2021) .
231 Plerhoples, Correcting Past Mistakes: PPP
Loans and Black-Owned Small
Businesses (Feb . 25, 2021) Am . Const .

Society (as of Aug . 19, 2021) .
232 Mills & Battisto, Federal Reserve Bank
of New York, Double Jeopardy: Covid-19’s
Concentrated Health and Wealth Effects in
Black Communities (Aug . 2020) p . 5-6 .
233 Id.; Plerhoples, supra .
234 Ibid .
235 California Task Force to Study and
Develop Reparation Proposals for
African Americans (October 12,
2021), Testimony of Rucker C. Johnson,
Ph.D, (as of October 25, 2021) .
236 From Here to Equality, supra, p . 37 .
237 Jones, The racial wealth gap: How African
Americans have been shortchanged out
of the materials to build wealth (Feb
13, 2017), (as of Apr . 15, 2022) .
238 California Task Force to Study and
Develop Reparation Proposals for
African Americans (October 12,
2021), Testimony of Rucker C. Johnson,
Ph.D, (as of October 25, 2021) .
239 Herring and Henderson, Wealth
Inequality in Black and White: Cultural
and Structural Sources of the Racial
Wealth Gap (Feb . 2016), (as of Mar .
18, 2022) (Herring and Henderson)
p . 6; Chiteji, The Racial Wealth Gap
and the Borrower’s Dilemma, p . 356 .
240 Zaw, et al ., Women, Race and Wealth,
Samuel DuBois Cook Center on
Social Equity, Duke University and
Insight Center for Community
Economic Development (2017) .
241 Pat S ., Income vs. Wealth – What’s the
Difference? (Sept . 14, 2021), Money
Crasher, LLC, (as of Mar . 18, 2022) .
242 Ibid .
243 Zaw, et al . ., Women, Race and Wealth,
supra .
244 Ibid .
245 See Chapter 10
246 From Here to Equality, supra, p . 256 .
247 Ibid .
248 Ibid .
249 Swinton, “Racial Inequality and
Reparations,” in America, Wealth
of Races (1990), pp . 153–62 .
250 Ibid .
251 Ibid .
252 Ibid .
253 Herring and Henderson, supra .
254 Barsky et al ., Accounting for the Black-
White Wealth Gap: A Nonparametric
Approach (Sep . 2002) in Journal of
the American Statistical Association
Vol . 97, No . 459, pp . 663-673 .
255 Ibid .
256 Ibid .
257 Darity Jr ., What We Get Wrong About
Closing the Racial Wealth Gap, supra .
258 Ibid .
259 Blau and Graham, Black/White
Differences in Wealth and Asset Composition
(Mar . 1989), available at (as of Mar . 24,
2022) (Blau and Graham) ; Darity Jr .,
What We Get Wrong About Closing the Racial
Wealth Gap, supra; From Here to Equality,
supra; Herring and Henderson, supra .
260 Darity Jr . What We Get Wrong About
Closing the Racial Wealth Gap, supra, p . 22 .
261 Blau and Graham, supra; Darity Jr .,
What We Get Wrong About Closing the Racial
Wealth Gap, supra; From Here to Equality,
supra; Herring and Henderson, supra .
262 Baradaran, The Color of Money: Black
Banks and the Racial Wealth
Gap (2017), Cambridge, Harvard
University Press (Baradaran) p . 30 .
263 Ibid .
264 Garrett-Scott, Banking on Freedom:

Black Women in U.S. Finance before the New
Deal (2019), Columbia University Press,
New York (Garrett-Scott) pp . 13, 31 .
265 Ibid .
266 Id. at 15-18 .
267 Ibid .
268 Ibid .
269 Ibid .
270 Ibid .
271 Ibid .
272 Ibid .
273 Ibid .
274 Washington, U .S . National Archive,
The Freedman Savings and Trust Company in
Federal Records and African American

481
Chapter 13 The Wealth Gap
History Summer 1997, Vol . 29, No . 2,
(as of Apr . 2, 2022) (Washington) .
275 Ibid .
276 Garrett-Scott, supra, p . 25
277 Baradaran, supra, p . 25 .
278 Washington, supra; Garrett-Scott,
supra, p . 25; Baradaran, supra, pp . 25-26 .
279 Washington, supra .
280 Ibid .; Garrett-Scott, supra, p . 25
281 Washington, supra .
282 Baradaran, supra, p . 25-26 .
283 Ibid .
284 Ibid .
285 Id. at p . 30 .
286 Ibid .; Garrett-Scott, supra, pp . 13, 31;
U .S . Senate 43rd Congress, 2nd Session
(1874); Du Bois, Black Reconstruction in
America 1860-1880 (1998), New York:

Simon and Schuster, p . 600; Gilbert,
The Comptroller of the Currency and the
Freedman Savings Bank, The Journal of
Negro History Vol . LVII No . 2, (as of
Apr . 2, 2022) p . 131 (Gilbert); The U .S .

Treasury . The Freedman’s Savings Bank:

Good Intentions Were Not Not Enough,
A Noble Experiment Goes Awry (as of
Apr . 2, 2022); Nier III, The Shadow of
Credit: The Historical Origins of Facial
Predatory Lending and ITS Impact Upon
African American Wealth Accumulation, U .

Pa . J .L . & Soc . Change, p . 151-152
(2008) (as of Apr . 2, 2022) (Nier III)
287 Célérier and Tak, The Impact of
Financial Inclusion on Minorities: Evidence
from the Freedman’s Savings Bank (Aug .
1, 2021), (as of Mar . 18, 2022) p . 32 .
288 Baradaran, supra, p . 30; Garrett-Scott,
supra note 302, p . 13; p . 31; U .S . Senate
43rd Congress, 2nd Session (1874); Du
Bois, Black Reconstruction in America 1860-
1880, New York: Simon and Schuster,
1998, p . 600; Gilbert, “The Comptroller
of the Currency,” p . 131; and the U .S .

Treasury The Freedman’s Savings Bank:

Good Intentions Were Not Not Enough, A
Noble Experiment Goes Awry, (as of Apr . 2,
2022) state that the number of deposi-
tors were 61,144 at the time of its closing .
289 Harmon et al ., Negro as a Business
Man, p . 54; Baradaran, supra, p . 296;
Seder and Burrell, Getting It Together, 9 .
290 Nier III, “The Shadow of Credit,” p .
151-152 .
291 Id., p . 154 .
292 Ibid .
293 Ibid .
294 Ibid .
295 Ammons, The Evolution of Black-Owned
Banks in the United States between the
1880s and 1990s in Journal of Black
Studies 26, no . 4 (1996), , p . 471; Neal
and Walsh, The Potential and Limit of
Black-Owned Banks (Mar . 18, 2020),
Urban Institute, (as of Mar . 18, 2022) .
296 Baradaran, supra, p . 87 .
297 Wangman and Wooldridge, 32 Black-
owned banks and credit unions,
sorted by state (Feb 1, 2022), Business
Insider, (as of Mar . 18, 2022) .
298 Ibid .
299 Baradaran, supra, pp . 88-89
300 Ibid .
301 Ibid .
302 Ibid .
303 Ibid .
304 Ibid .
305 Ibid .
306 Ibid .
307 Ibid .
308 Ibid .
309 Ibid .
310 Ibid .
311 Lindsay, The Negro in Banking (Apr .
1929) in The Journal of Negro
History, The University of Chicago
Press on behalf of the Association
for the Study of African American
Life and History, p . 195 .
312 Ibid .
313 National Park Service, African American
Homesteaders in the Great Plains, supra;
National Park Service, A History of Black
Americans in California: Farming, supra.
314 Ibid .
315 Ibid .
316 National Park Service, African American
Homesteaders in the Great Plains, supra .
317 Cal . Prison Industrial Authority,
Catalogue (as of Nov . 24, 2021) .
318 Ibid .
319 Ibid .
320 Stygar, supra .
321 Ibid .
322 Hutchful, The Racial Wealth Gap: What
California Can Do About a Long-Standing
Obstacle to Shared Prosperity, California
Budget & Policy Center (2018),
https://calbudgetcenter .org/app/
uploads/2018/12/Report_The-Racial-
Wealth-Gap_12 .2018 .pdf> p . 8 .
323 Ibid .
324 Ibid .
325 Ibid .
326 De La Cruz-Viesca et al ., The Color of
Wealth in Los Angeles (2016), supra.
327 Bell et al ., Cal . Policy Lab, An Analysis of
Unemployment Insurance Claims in
California During the COVID-19 Pandemic
(Dec . 2020) p . 10, https://www .capolic-
ylab .org/wp-content/uploads/2021/02/
Dec-21st-Analysis-of-CA-UI-Claims-
during-the-COVID-19-Pandemic .pdf .
328 Id. at 22 .
329 CalFresh, The Able-Bodied Adults
Without Dependents Time Limit, Cal . Dept .

Social Services, (as of Aug . 19, 2021) .
330 Botts & Rodriguez-Delgado, Getting
Food Stamps to Poor Californians is
Surprisingly Difficult (Sept . 2, 2019)
CalMatters (as of Aug . 19, 2021) .
331 Ibid .
332 U .S . Census Bureau, Quick Facts:

California (Jul . 1, 2021), (as
of April 15, 2022) .
333 Tan & Danielson, The CalFresh Food
Assistance Program (Sept . 2020) Public
Policy Inst . Cal . (as of Aug . 19, 2021) .
334 Ramos-Yamamato, Not Enough to Eat:

California Black and Latinx Children
Need Policymakers to Act (Sept . 2020)

482
Chapter 13 The Wealth Gap
Cal . Budget & Policy Center (as of Aug . 19, 2021) . 335 Ong et al ., Latino Policy & Politics
Initiative, Univ . Cal . Los Angeles,
Disparities in the Distribution of Paycheck
Protection Program Funds Between Majority-
White Neighborhoods and Neighborhoods
of Color in California (Dec . 2020) p .
5 . https://escholarship .org/uc/
item/9pz896kh> (as of Apr . 9, 2022) .
336 Morel et al ., Rampant Racial Disparities
Plagued How Billions of Dollars in PPP
Loans Were Distributed in the U.S.
(May 1, 2021 (as of Aug . 19, 2021) .
337 Lohrentz, The Impact of Proposition 209
on California’s MWBE’s (Jan . 2015), Equal
Justice Society, (as of Mar . 18, 2022), p .2 .
338 Ibid .
339 Id. at 2-3 .
340 Ibid .
341 Ibid .
342 Id. at 3 .
343 See, e .g ., Bowser, The Black Middle
Class: Social Mobility – And
Vulnerability (2006) p . 120 .
344 Bortz, How to Unlock the Equity in Your
Home (Aug . 10, 2021), N .Y .

Times, (as of Aug . 18, 2021) .
345 Killewald and Bryan, “Does Your Home
Make You Wealthy?” RSF: The Russell Sage
Foundation Journal of the Social Sciences 2,
no. 6, 2016, (Killewald and Bryan) p . 111 .
346 Ibid .
347 U .S . Dep’t of Housing and Urban
Development, Glossary of Terms to
Affordable Housing, (as of Apr . 2, 2022) .
348 Killewald and Bryan, supra, p . 111 .
349 Ibid .
350 Darity Jr ., What We Get Wrong About
Closing the Racial Wealth Gap, supra, p . 13 .
351 Ibid .
352 Ibid .
353 Moss et al ., The Black-White Wealth Gap
Left Black Households More
Vulnerable (2020), Brookings .
354 The State of The Nation’s Housing 2020
(2020), Joint Center for Housing
Studies of Harvard University, (as
of Apr . 2, 2022) (The State of the
Nation’s Housing 2020) p . 26 .
355 Flitter, This is What Racism Sounds Like in
the Banking Industry (Dec . 11, 2019), N .Y .

Times, (as of Apr . 2, 2022), Bartlett et
al ., Consumer Lending Discrimination in
the Fintech Era (Jun . 2019), Nat . Bureau
of Econ . Research, (as of Apr . 2, 2022) .
356 From Here to Equality, supra, p . 35 .
357 Tippett et al ., Center for Global Policy
Solutions, Beyond Broke: Why Closing the
Racial Wealth Gap is a Priority for National
Economic Security (May 2014), https://
globalpolicysolutions.org/wp-content/
uploads/2014/04/BeyondBroke_Exec_
Summary.pdf (as of Mar . 18, 2022) p . 4 .
358 Ibid .
359 Ibid .
360 Immergluck, Racial Justice and the
Mortgage Market: Recommendations
to Racial Justice and the Mortgage
Market: Recommendations to the Biden
Administration Regarding the Future of
the GSEs (May 21, 2021), (as of April
15, 2022) p . 4 (Immergluck) .
361 Ibid .
362 Herring and Henderson, supra, p . 15 .
363 Manhertz, Home Value Disparities
Between Races are Shrinking, but Remain Very
Wide (Dec . 19, 2020) Zillow (as of Aug . 18,
2020); Perry et al ., Brookings Inst ., The
Devaluation of Assets in Black Neighborhoods:

The Case of Residential Property (Nov .
2018), (as of Apr . 2, 2022) pp . 13-15 .
364 See Redfin, Black Homeowners Earned
$59,000 in Home Equity in 2020,
Compared with $50,000 for White
Homeowners (Mar . 9, 2021) PR
Newswire (as of Aug . 18, 2021) .
365 Perry et al ., supra, p . 3 .
366 Flitter, Where State Farm Sees “a Lot Of
Fraud” Black Customers See
Discrimination (Mar . 18, 2022) N .Y .

Times, (as of Apr . 2, 2022) .
367 Ibid .
368 The State of The Nation’s Housing 2020
(2020), Joint Center for Housing
Studies of Harvard University, (as
of Apr . 2, 2022) (The State of the
Nation’s Housing 2020) p . 26 .
369 Darity, Jr ., What We Get Wrong About
Closing the Racial Wealth Gap, supra, p . 14 .
370 The State of the Nation’s Housing
2020, supra, p . 5 .
371 Murillo, Black Homeowners Are Being Left
out of the Mortgage Refinance
Boom (June 9, 2021) Money (as
of Aug . 18, 2021) (Murillo) .
372 Campisi, Pandemic Remodeling Boom
Looming? Cash-Out Refinancing
Hits 13-Year High (Dec . 4, 2020)
Forbes (as of Aug 18, 2021) .
373 Murillo, supra .
374 What We Get Wrong About Closing the
Racial Wealth Gap, supra .
375 Ibid .
376 Blau and Graham, supra, p . 16 .
377 Oliver and Shapiro, supra .
378 Conley, Being Black, Living in the Red:

Race, Wealth and Social Policy in America,
Berkeley, CA, University of California
Press, 1999 (Conley, Being Black), p . 41
379 Brimmer, Income, Wealth, and
Investment Behavior in the Black
Community, The American Economic
Review 78, 2, 1988, pp . 151-155 .
380 Herring and Henderson, supra, p . 8 .
381 Keister, Race and Wealth Inequality: The
Impact of Racial Differences in Asset
Ownership on the Distribution of Household
Wealth, Social Science Research 29,
2000, p . 499, (as of Apr . 10, 2022) .
382 Brooks, The Retirement Crisis Facing
African Americans (Dec . 11, 2020),
U .S . News, (as of Apr . 2, 2022) .
383 Ibid .
384 Devaney, et al ., Asset Ownership by Black
and White Families in Financial
Counseling and Planning 18, 1, 2007,
p . 33-45, (as of April 10, 2022) .
385 Florant, et al ., The case for accelerating
financial inclusion in Black communities
(Feb . 25, 2020), (as of April 9, 2022) .
386 De La Cruz-Viesca et al, supra, p . 25 .

483
Chapter 13 The Wealth Gap
387 Akabas et al ., New BPC Survey Shows
Americans Need Better Ways to Save for
Emergencies (Feb . 25, 2021) Bipartisan
Policy Center (as of Aug . 18, 2021)
(Akabas et al .); Hutchful, supra, p . 3
388 Mills and Zhang, Urban Inst ., Social
Support Networks and their Effects
on Hardship Avoidance Among
Low-Income Households (Dec .
2013), (as of Apr . 10, 2022) .
389 Liu and Parilla, New Data Shows Small
Businesses in Communities of Color Had
Unequal Access to Federal COVID-19 Relief
(Sept . 17, 2020) Brookings Inst . (as
of Aug . 18, 2021) (Liu and Parilla) .
390 Akabas, et al ., supra .
391 Lerner, Accessing Home Equity in a Tight
Economy Has Become Problematic (June 11,
2020) Wash . Post (as of Aug . 18, 2021) .
392 Akabas et al ., supra.
393 E .g ., Gladstone et al ., Racial Inequities
Have Long Existed in the Economy. A New
BPC Survey Shows COVID-19 Made Them
Worse. (June 22, 2020) Bipartisan Policy
Center (as of Aug . 18, 2021); Hardy
and Logan, Hamilton Proj ., Brookings
Inst ., Racial Economic Inequality Amid
the Covid-19 Crisis (Aug . 2020) p . 2;
Murillo, supra; Choe, Stocks are Soaring,
and Most Black People are Missing Out
(Oct . 12, 2020) AP News (as of Aug . 18,
2021); Bivens et al ., supra; Brantley et
al ., supra; Bhutta et al ., supra; Akabas
et al ., supra; GAO Report, supra;
Cronin, supra; Liu and Parilla, supra.
394 Bhutta et al ., supra.; Schuetz,
Rethinking Homeownership Incentives to
Shrink the Racial Wealth Gap (Mar . 15,
2022), Shelterforce (as of Apr . 15, 2022) .
395 Houser, Cleveland 19 News, Cleveland
Man Alleges Racial Profiling after Bank
Refuses to Cash Check, Calls 9-1-1 (Dec .
19, 2018), (as of Apr . 10, 2022) .
396 Johnson, WSB-TV 2, Doctor Says Bank
Employees Called Police on Him While
Trying to Open Account (Sept . 13,
2019), (as of Apr . 10, 2022) .
397 Shammas, Miami New Times, Another
Black South Floridian Says Wells Fargo
Refused to Cash His Check, Called Cops
(Aug . 9, 2018), (as of Apr . 10, 2022) .
398 Logan, The Independent, A Florida
Bank Refused to Cash an Elderly
Black Woman’s Check. Then They
Called the Police on Her (July 28,
2018), (as of Apr . 10, 2022) .
399 Hutchful, supra, p . 2 .
400 E .g ., Bhutta et al ., supra .
401 Choe, supra; Bhutta et al ., supra .
402 Choe, supra.
403 Bhutta et al ., supra.
404 Ibid .
405 Ibid .
406 Ibid .
407 Ibid .
408 Ibid .
409 Akabas et al ., supra.
410 Perry and Romer, To Expand the
Economy, Invest in Black Businesses
(Dec . 31, 2020) Brookings
Inst . (as of Apr . 10, 2022) .
411 Sobol, Factors Influencing Private Capital
Accumulation on the ‘Eve of Retirement’
(1979) in Review of Economics and
Statistics, LXI, pp . 585-593 .
412 Kroeger, Entrepreneurship and the Racial
Wealth Gap: The Impact of Entrepreneurial
Success or Failure on the Wealth Mobility
of Black and White Families (2021),
https://link .springer .com/arti-
cle/10 .1007/s41996-021-00081-6 (Apr .
15, 2022); Lofstrom and Bates, African-
Americans’ Pursuit of Self-Employment
(Nov . 2007), The Institute for the
Study of Labor, (Apr . 15, 2022)
413 Association for Enterprise
Opportunity, The Tapestry of Black
Business Ownership in America:

Untapped Opportunities for Success
(2017) (Association for Enterprise
Opportunity) p . 8, (as of Apr . 10, 2022) .
414 Ibid .
415 Id at pp . 4, 8 .
416 Id. at p . 4 .
417 Ibid .
418 Klein, Bridging the Divide, How Business
Ownership Can Help Close the Racial Wealth
Gap (2017) FIELD at the Aspen Institute
(Klein) p . 6, (as of Apr . 10, 2022) .
419 Howard et al ., Banks & the Black
Community, What Can Major Commercial
and Retail Banking Institutions Do to
Better Support Black Entrepreneurs and
Businesses in the U.S.? (2020) (Howard
et al .), (as of Apr . 10, 2022) .
420 De La Cruz-Viesca et al ., The Color of
Wealth in Los Angeles, supra, p . 41 .
421 Howard et al ., supra, pp . 1-3 .
422 Id. at p . 3 .
423 Association for Enterprise
Opportunity, supra, pp . 24-28 .
424 Ibid .
425 Ibid .
426 Ibid .
427 Ibid .
428 Klein, supra, p . 7 .
429 Id. at p . 8 .
430 Ibid .
431 Id. at p . 9 .
432 Ibid .
433 From Here to Equality, supra, p .41 .
434 Perry and Romer, supra .
435 Washington, Covid-19 Has Had a
Disproportionate Impact on Black Small
Businesses (June 3, 2021) Forbes
436 Ibid .
437 Ibid .
438 Ibid .
439 Ibid .
440 Ibid .
441 Ibid .
442 Davalos et al ., Cal . Budget & Policy
Center, California’s 17 Million Renters
Face Housing Instability and Inequity
Before and After COVID-19 (Jan .
2021) pp . 6-7, https://calbudgetcenter .
org/app/uploads/2021/01/IB-Renters-
Remediated.pdf (as of Apr . 10, 2022) .
443 Ibid .
444 Hutchful, supra, at pp . .6-7; Passy, Black
Homeownership Rate Hits Lowest Level
Since the 1960s – That’s Unlikely to Change

484
Chapter 13 The Wealth Gap
in Pandemic Year 2 (Mar . 10, 2021)
MarketWatch (as of Aug . 20, 2021) .
445 Hutchful, supra, at 6 .
446 Shapiro et al ., Institute on Assets and
Social Policy, The Roots of the Widening
Racial Wealth Gap: Explaining the
Black-White Economic Divide (Feb .
2013), p .3-4, (as of Apr . 11, 2022) .
447 Hutchful, supra, at 6 .
448 Ong . et al, supra .
449 Hall et al ., Neighborhood Foreclosures,
Racial/Ethnic Transitions, and Residential
Segregation (2015) in Am . Sociol .

Rev ., (as of Apr . 15, 2022) .
450 De La Cruz-Viesca, et al ., supra, pp .
29-30 .
451 Ali, supra, p . 67 .
452 De La Cruz-Viesca, et al ., supra, p . 36 .
453 Id., at p . 41 .
454 Blau and Graham, supra, Conley,
supra; Killewald, Return to Being Black,
Living in the Red: A Race Gap in Wealth
That Goes Beyond Social Origins (2013)
in Demography 50 (Killewald);
Weller et al ., Simulating How Large
Policy Proposal Affect the Black-White
Wealth Gap (2021) in Journal of
Economics, Race and Policy, p . 2 .
455 Toney & Robertson, Intergenerational
Economic Mobility and the Racial Wealth
Gap, American Economic Association
Papers & Proceedings, Vol . 111 (May,
2021), pp . 206-10, (as of Apr . 11, 2022) .
456 Ibid .
457 Ibid .
458 Dalton Conley, Decomposing the Black-
White Wealth Gap: The Role of Parental
Resources, Inheritance, and Investment
Dynamics (2001) in Sociological
Inquiry 71, 1 (Conley, Decomposing),
pp . 39-66 .; Herring and Henderson,
supra; Weller et al ., supra .
459 Blau and Graham, supra; Conley, Being
Black, supra;; Killewald, su-
pra; Weller et al ., supra.
460 McKernan, et al . . Private Transfers,
Race, and Wealth (2012), The
Urban Institute, Report 5,
p .11, (as of Apr . 2, 2022) .
461 Rosalsky, NPR Planet Money, There is
Growing Segregation in Millenial Wealth
(Apr . 27, 2021), (as of Apr . 11, 2022) .
462 Ibid .
463 Ibid .
464 Ibid .
465 Ibid .
466 Blau and Graham, supra, Conley, Being
Black, supra; Killewald, Return to Being
Black, Living in the Red: A Race Gap in
Wealth That Goes Beyond Social Origins
(2013) in Demography 50 (Killewald),
(as of Apr . 11, 2022); Weller et al .,
Simulating How Large Policy Proposal
Affect the Black-White Wealth Gap (2021)
in Journal of Economics, Race and
Policy, p . 2, (as of Apr . 11, 2022) .
467 Rosalsky, supra .
468 Ibid .
469 Ibid .
470 Whitehead, Center for Poverty
Research, Univ . Cal . Davis, Support
from Family Does Not Replace the Social
Safety Net (Apr . 2016) (Whitehead)
p . 1, (as of Apr . 11, 2022) .
471 Ibid .al
472 Airgood-Obrycki et al ., Making the Rent
Household Spending Strategies During the
COVID-19 Pandemic (Jan . 2022), Joint
Center for Housing Studies Harvard
University, (as of Apr . 15, 2022); Airgood-
Obrycki et al ., Renters’ Responses to
Financial Stress During the Pandemic (Apr .
2021), Joint Center for Housing Studies
Harvard University, (as of Apr . 15, 2022) .
473 Whitehead, supra, p . 1 .
474 Id. at p . 2 .
475 Bhutta et al ., supra .
476 Hutchful, supra, at p . 2 .
477 Gladstone et al ., supra; Weidrich and
Newville, Vulnerability in the Face of
Economic Uncertainty: Key Findings from the
2019 Prosperity Now Scorecard (Jan . 2019),
Prosperity Now, (as of Apr . 15, 2022) .
478 Bhutta et al ., supra .
479 Akabas et al ., supra.
480 Gladstone et al ., supra .
481 Watkins and Akabas, The Savings Gap
for Americans is A Key Component of
Economic Stability – Here’s what we Can
Do About it (July 1, 2020) Bipartisan
Policy Center (as of Aug . 18, 2021) .
482 Ibid .
483 Gladstone et al ., supra .
484 Ibid .
485 Ibid .
486 Ibid .
487 Ibid .
488 Asante-Muhammad, et al,
Corporation for Economic
Development, The Ever-Growing Gap:

Without Change, African-American and
Latino Families Won’t Match White Wealth for
Centuries (Aug . 2016), (as of Apr . 11, 2022) .
489 Ibid .
490 Ibid .
491 Brown, The Whiteness of Wealth
(2021) p . 16 .
492 Id. at p . 12 .
493 Id. at pp . 14-15 .
494 Id. at p . 21 .
495 Asante-Muhammad, et al, supra, p . 17 .
496 Ibid .
497 Id. at 18 .
498 Ibid .
499 Ibid .
500 Ibid .
501 De La Cruz-Viesca et al ., The Color of
Wealth in Los Angeles, supra .
502 Id. at p . 38 .
503 Id. at p . 25 .
504 Ibid .
505 Id. at p . 6 .
506 Id. at pp . 6-7 .
507 Ibid .
508 Id. at 4 .
509 Ibid .
510 Id. at 5 .

https://oag.ca.gov/ab3121