A public health framework for reparations and generational healing in Haiti

Amid the dismantling of state structures in Haiti, the first Black republic faces significant health disparities compared to its former colonial power, France. These disparities include lower life expectancy (64.8 vs. 82.3 years) and higher infant and maternal mortality rates. The situation is further exacerbated by widespread mental health issues, severe food insecurity (50% acute vs. 37% moderate), and elevated homicide rates (13.35 vs. 1.35 per 100,000 inhabitants). As calls grow for France to return the independence ransoms extracted from Haiti, there remains limited data on how reparations could impact the country's public health, community well-being, or effective implementation of healing programs. Between Spring and Fall 2023, we conducted 4 focus groups: 1st with Haitian men and women residing in the United States, a 2nd-with men in Haiti, a 3rd with women in Cap-Haïtien and Les Cayes, and a 4th with women in Cité Soleil. We conducted focus groups structured interview protocol, comprised of open-ended questions categorized into 4 thematic sections. These questions provided insights into participants' perceptions on mental health, the daily challenges and barriers to access care, and community-based healing. Participants emphasized need for policies that address the social determinants of health, ensure safety and justice, and promote healthier workplace environments. They also advocated for mental health education aimed at reducing stigma, cultivating trust, and strengthening community support systems; with an emphasis on developing professional training, ethics, and sustainable long-term mental health services accessible for individuals of all ages. Haitian participants underscore the critical need to restore security, address the social determinants of health, and implement community-based mental health initiatives. We propose a biopsychosocial-ecological approach to guide reparations efforts. A targeted investment of $30 billion could yield substantial improvements in healthcare, mental health services, and public safety-contributing to increased life expectancy, reduced mortality rates, and decreased violence.