With the June 2025 vote to exclude undocumented adults from the state-run health care program, a reported 85% prenatal no-show rate at the peak of Operation Metro Surge, and the local safety net hospital in serious threat of closure, the status of health care in Hennepin County is dire. These structural and policy failings have reinforced the perception of health care as a zero-sum game where one’s gain is directly tied to another’s loss.
What if deficit-based care were not the status quo in Minnesota? What if health care repaired harms inflicted from the legacies of exclusionary policy and medical racism? What if health care started with joy instead of pain? What if healing started with Black joy instead of Black pain? What would health care in Minnesota look like if we approached policy and clinical decisions this way?
These are questions that the Healthcare Reparations Cooperative has been exploring in political education workshops and, more recently, at a Community Assembly for the Reparations Project. Through facilitation and arts-based practices, the cooperative works to address the crisis of the imagination that the status quo of health care must remain as is, and instead encourages us to dream into the reality that another world is possible and that health care can be fundamentally different.
Scarred past drives the Minnesota Paradox
The status quo of health care in Minnesota is built on extracted land (Henry Mower Rice donated stolen land to establish the first hospital in Minnesota, Sisters of St. Joseph Hospital, in 1853) and sustained by the extracted labor of an underresourced workforce. Despite the liberal exterior, Minnesota’s health care landscape is one with sordid foundations, including historically deep roots in the eugenics movement and more recent dealings with nonconsensual experimentation. This scarred past is not unique to Hennepin County or Minnesota, but drives the Minnesota Paradox that set the stage for a status quo where the state is best in class for white Minnesotans, yet ranks among the worst for Black Minnesotans.
The drivers of inequitable health outcomes and lasting implications were highlighted during the COVID-19 pandemic and echoed the longstanding truth that Black and brown people are disinvested and deprioritized in systems of health care and care more broadly. The consequences limit life chances and lower life expectancies.
Yet even with this long-standing knowledge, the solutions remain reactive and lack reparative priorities, in turn maintaining the status of the status quo.
If Black joy were a core driver of health care, what material conditions (labor, infrastructures, technologies) would need to shift?
Basset and Galea make it clear, “There has not been a single year since the founding of the United States when Black people in this country have not been sicker and died younger than White people. A growing consensus highlights a structural basis for these preventable disparities — structural racism — clarifying the need for a structural solution.” Racism is still a public health crisis, and we need to treat it as such in our solutions. To be clear, actualizing Black joy in health means going beyond disparity mitigation, moving us toward the redistribution of resources and the equitable and collective access to them.
Actualizing Black joy in health through reparative solutions means more than a check. It means catalyzing momentum to flip the paradox despite the current political attacks.
A vision of actualized Black joy in health
If Black joy were an essential component of health care, from the interpersonal to the structural, we would shift from managing a disease to building a sustainable infrastructure that promotes health, wellness and abundance. The individuals and communities dynamically situated at the intersections of Blackness, Indigeneity, queerness, transness, immigration status and disability, those who are most impacted by health care harms, would be prioritized. Public health would focus on public healing as a form of disability justice that acknowledged temporary ability.
Actualized Black joy in health would mean that statistical inference is not based on a white referent, so that one’s existence is not based on “despite of” and “compared to” statements. Actualized Black joy in health would mean health care systems and health-knowledge-producing institutions acknowledged, reckoned with, were accountable to, and redressed the legacies of medical racism and human rights violations in health.
Actualized Black joy in health would mean care was an expansive term that integrated justice in a way that the social determinants of health were not a distinct priority area to be addressed, but a universally understood human reality — health cannot be separated from a community’s social and physical environment. Actualized Black joy in health would mean the elimination of medical debt and the uncoupling of health from racial capitalism. Actualized Black joy in health would mean everything would have to be fundamentally different, and that would be beautiful.
But, But, But!
Yes, there are a million buts that could be thrown into all of this, and those arguments are what have maintained operations as usual. Arguments of “but, this is how it has always been done”; “but, there is a crisis”; “but, we don’t have enough votes”; “but, how will it actually happen”; “but, those people don’t deserve it”; “but, we don’t have the money”; “but, that will take away from me” but, but, but!
Yes, dreaming is hard. But the power of building together and dreaming into something different is so worth the struggle.
Olúfẹmi Táíwò names this common worry, “The ambitions of the worldmaking project recommended by the constructive view may make reparations appear beyond daunting. How can we possibly succeed at a task as immense and contested as building the just world?”
He goes on to say, “The unjust world order we have is the outcome of five centuries of human action — it would be an incredible achievement to undo this evil in half that time.” But he calls us to embrace an ancestral approach to worldmaking, making the moment bigger and intergenerational, saying that “It often takes everything a generation has just to win the struggle immediately in front of them. But if they pass on the right things — and if we in the generations that follow pick up what they left for us — that can be enough.”
Call to Action
One political education participant described the following:
“In that space, there is no worry about impending debt from seeking medical care. There are affirmations, the wait times are reasonable, and there are people wishing health and wellness onto everyone waiting to receive care. Family can stop by and be sure that their loved ones matter to the care-providing team. The market does not dictate hospital logistics. No one is banking on these folks to die in order to collect any payouts from insurance companies. The waiting room feels like an extension of home, and relationship-centered care is the norm. The care providers are Black. The nurses are Black. They look like neighbors from the community who are just a little bit extra trained on how to keep people healthy.”
The next time you are in a care space — be that a pharmacy, clinic, hospital, or dentist — imagine the care starting from a place of joy instead of pain. Imagine the expansive possibilities repair offers for strengthening relationships, not unlike the hard work of mending a relationship with that longtime friend. Imagine the structural changes beyond the clinical setting that pave the way for joy to be the new status quo. As you imagine, think of what it would look like, feel like, sound like, smell like and taste like. Let yourself dream into the reality that another world is possible and health care can be fundamentally different.
