Methodological approaches to structural change: epidemiology and the case for reparations

Scholars, activists, and policymakers have long called for reparations-a process of repair and restitution for harm and injustices done-to descendants of enslaved Africans in the United States as a structural intervention to address historic and ongoing injustices. However, there has been very limited epidemiologic work examining reparations. We explore some of the epidemiologic benefits and challenges of using causal inference frameworks to model reparations as an example of a large-scale, structural intervention that pushes the limits of what is considered "well-defined" and may violate key identification assumptions. Finally, we weigh these methodological limitations with the utility of assessing public health implications of reparations policies and conclude by discussing implications for future epidemiologic research. This article is part of a Special Collection on Methods in Social Epidemiology.