Universal basic income and structural racism in the US South: Differences in health service utilization between older African American men with and without experiences of recent incarceration

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PROJECT SUMMARY/ABSTRACT Structural racism and discrimination (SRD) are complex and drive racial inequities. SRD has sustained racial health disparities in the United States, driven disproportionate incarceration risk among Black men, and systematically restricted minority populations from health, wealth, and prosperity. As a result, diminished income earning ability for generations of Black people has led to economic devastation and poor health. Importantly, older and aging Black men continue to earn less than their White counterparts and the income gap is continuing to widen. Even when accounting for education, research has shown that the rising wage gap is attributable to workforce experience and opportunity, hiring and wage discrimination, and incarceration. Difficulty attaining prevailing wages among older Black men affects family stability, the ability for communities to thrive, and population health. Geography, place, and proximity to capital and markets are underlying drivers of health behavior and healthcare access. As a result, older and aging Black men in particular have demonstrated one of the strongest epidemiologic relationships between low socioeconomic status, residence in communities with endemic poverty, and chronic disease. The proposed Stage 3 efficacy study aims to test a novel intervention that directly reduces the racial income gap by providing a universal basic income (UBI). UBI is intended to promote and protect Black men's health through the influx of capital and subsequent increases in personal agency and social connections. We hypothesize that providing UBI of $500 per month for six months will result in increased healthcare utilization among chronically-ill, older and aging, low-income Black men. Secondarily, we hypothesize that the effect of UBI will depend on whether an individual has a recent history of incarceration, such that no incarceration history combined with UBI will demonstrate the best study outcomes. Empirical research examining UBI among older Black men and its capacity to overturn SRD are lacking in the extant literature. Much of the health disparities research intended to inform health and economic policy originated from limited perspectives of older and aging Black men. Dr. W.E.B. Du Bois said in The Souls of Black Folk that for Black people, “discouragement is an unwritten word”. This study draws on that inspiration as it ultimately seeks to fundamentally overturn the economic oppression and brutality that has defined the Black experience for generations.