This Juneteenth, we must invest in our future as well as remember our past 

In Boston, the city where I trained to become a family doctor, the median net worth in 2015 for a White family was $247,500. And for a Black family? $8.  

This racial wealth gap isn’t isolated to one city, but rather a glaring national fact that has grown worse in recent decades. The Juneteenth holiday reminds us that this gap stems from a long history of exploitation and broken promises — ones that live on in the present.  

I witnessed the consequences of this racial wealth gap almost daily in my Dorchester health center, where I cared for many Black families. One elderly woman’s family couldn’t afford to fix a broken fridge that stored her insulin; her diabetes worsened and her kidneys began to fail. A woman in her eighth month of pregnancy came to see me not knowing where she and her eight-year-old daughter would sleep that night. My patients suffered from the psychic and physical toll of not having economic security.  

Alongside income, one often overlooked dimension of economic security is the impact of wealth. With wealth comes a store of capital that provides people with the resources they need for health in different stages of life, whether caring for an aging parent or owning a home for a growing family. 

Baby bonds can help achieve this.   

Baby bonds are publicly invested child trust accounts established at birth that are progressively seeded such that children from with fewer resources households receive the largest endowments. Once the child reaches adulthood, baby bonds can be used for wealth-building activities like higher education, homeownership or entrepreneurship. As described by economist Darrick Hamilton, baby bonds offer the “birthright of capital,” and in the process can help redress the racial wealth gap in a country whose unjust history has prevented its Black and minority citizens from full economic participation.  

A version of this policy is already being implemented. The state of Connecticut is investing $3,200 for every baby born in the state’s Medicaid program, and this seed capital is anticipated to grow to $10,000-$20,000, depending on when the young person makes their claim. An estimated 15,000 babies are already enrolled in the program.  

And momentum is building elsewhere — the Massachusetts state legislature is just the latest of at least 10 states seriously considering their own policy. On a national level, Rep. Ayanna Pressley (D-Mass.) and Sen. Cory Booker (D-N.J.) introduced legislation in 2023 to adopt baby bonds countrywide.  

The research backs this promise. One study found that a baby bonds program implemented in the 1990s could have reduced the median racial wealth gap between Black and White young adults by more than ten-fold. With more assets, families can exercise greater freedom in controlling access to health-enabling resources — from housing to medical care — while also being protected from the negative psychological and physical consequences of financial hardship. There’s also population-wide health evidence: a recent modeling analysis found that a national baby bonds program would improve life expectancy by a full year. 

Some worry that baby bonds will be too expensive. Yet a national program would be a relative bargain, at less than 10 percent of annual Social Security spending. And without long-term investments, governments end up paying much more for the damaging consequences of diminished opportunity for people and communities. By one estimate, child poverty alone costs the U.S. $1 trillion each year. 

To be sure, baby bonds aren’t a panacea. We need policies that tackle the immediate cost of living challenges that harm families as well, from the housing crisis to the lack of affordable child care to higher education and medical debt. But policymakers can think of baby bonds as an affordable down payment in creating a healthier future as they tackle the critical economic issues that threaten people in the near term.  

In effect, I’m advocating for an approach that I take in my clinic — investing the time and resources to prevent strokes and heart attacks that might otherwise happen decades from now, while treating the heartburn or cold that my patient is concerned with today. We must do both.  

Physicians, health workers and the public health field can activate critical coalitions for baby bonds. Local health departments can partner with potential allies, like elected officials or even their region’s Federal Reserve, to assess the impact of racial wealth gap in their area and mobilize support, as New York City has done. Public bodies like the National Institutes of Health could fund novel research that can guide the design and evaluation of wealth interventions and their impacts on health, with baby bonds as a prime example. And, perhaps most importantly: as states and municipalities consider baby bonds, physicians and health workers can rally behind such legislation, helping illustrate how wealth inequities impact the health of patients we care for and the communities in which we work. 

Alongside celebrating a history of newfound freedom, the memory of Juneteenth should redouble our efforts to establish a new baseline of racial and economic justice in our time — the kind that investing in baby bonds might just nurture for the health of all my future patients.

Victor Roy is an incoming assistant professor of family medicine and community health at the University of Pennsylvania; a Paul and Daisy Soros Fellow; and a Public Voices Fellow of The OpEd Project. A family physician and sociologist, he directs the Health and Political Economy Project based at the New School’s Institute on Race, Power and Political Economy.