There has not been a single year since the founding of the United States when Black peo-ple in this country have not been sicker and died younger than White people. A growing consen-sus highlights a structural basis for these preventable disparities — structural racism — clarifying the need for a structural solu-tion. Black reparations are one such solution and, we believe, a long-overdue approach to persis-tent Black–White health dispari-ties in the United States.