Executive Summary
The Great Influenza Pandemic disproportionately affected Black communities in the United States, yet historical analyses have consistently underestimated its true impact. Studies such as Duke University’s 2022 report (Jones & Smith, 2022) often relied on incomplete mortality data, failing to account for racial disparities in disease exposure, healthcare access, and long-term health consequences.
This study introduces the Racially Adjusted Excess Mortality Index (RAEMI), a proprietary methodology designed to correct systemic underreporting in historical mortality data and quantify the long-term health and economic effects of public health crises on marginalized populations. By applying RAEMI™, we provide a more accurate assessment of the Great Influenza Pandemic's true toll and offer policy recommendations to prevent similar failures today.
Key Findings:
Black mortality from the 1918 flu was significantly underreported: While historical estimates place the death toll at approximately 125,000, RAEMI™-adjusted analyses suggest the actual toll was closer to 400,000.
Post-pandemic health impacts were substantial yet largely ignored: An estimated 22-29% of Black survivors developed chronic illnesses, including cardiovascular disease, respiratory illnesses, and neurological disorders—paralleling the disparities evident in contemporary Long COVID research.
The economic devastation from these health outcomes contributed significantly to generational wealth disparities: Black communities experienced at least $5.41 billion in lost earnings when accounting for inflation-adjusted cumulative impacts.
Policy Implications:
Implement mandatory racial impact assessments in pandemic preparedness plans to prevent future undercounting.
Increase research funding targeting post-viral chronic conditions disproportionately affecting Black populations.
Develop equity-based public health initiatives specifically addressing healthcare access disparities for Black communities post-pandemic.
Initiate economic reparations and justice frameworks to compensate for historical healthcare injustices and long-term economic exclusion.
Establish research accountability mechanisms to ensure racial health disparities are accurately represented and addressed.
Introduction - Great Influenza Pandemic
Historical analyses of the Great Influenza Pandemic often overlook its full toll on Black communities, perpetuating systemic neglect and misunderstanding. Racial segregation, severely limited healthcare access, and entrenched biases in medical record-keeping led to significant underestimations of the pandemic’s true impact. This analysis aims to correct these gaps by recalculating mortality rates, evaluating long-term health and economic effects, and outlining critical policy lessons relevant to current and future public health crises.
Drawing insights from contemporary COVID-19 disparities, our findings demonstrate that Black Americans experienced far higher mortality rates and more severe economic hardships during and after the 1918 pandemic than previously documented. Accurately recognizing these disparities is vital for developing robust policy responses that tackle systemic health inequities, preventing repeated failures in public health preparedness and response.
The true economic toll of the Great Influenza Pandemic on Black communities wasn't millions, it was billions. Generations later, we're still paying the price for racism generated disparity."— Cynthia Adinig, RAEMI Analysis (2025)
Historical Context: The Misnomer of ‘Spanish Flu’
The term “Spanish Flu” inaccurately attributes the pandemic's origin to Spain, resulting from wartime censorship rather than scientific evidence. This mislabeling perpetuates biased national and racial conventions—issues also evident in the initial mislabeling of COVID-19 as the “China Virus.” Given our findings that Black communities experienced early and severe impacts before the widely recognized peak in 1918, we propose the term “Great Influenza Pandemic” to more accurately reflect its extensive historical and demographic impacts.
The Great Migration, Racial Violence, and Health Disparities
The early 20th century was marked by significant demographic shifts, notably the Great Migration (1916-1970), when millions of Black Americans moved northward seeking safety from racial violence and economic opportunity. Unfortunately, segregation forced these migrants into overcrowded urban environments characterized by poor sanitation and limited healthcare access, greatly exacerbating influenza transmission rates.
Furthermore, racial violence such as the Red Summer of 1919 further disrupted healthcare access and intensified public health vulnerabilities. White supremacist attacks destroyed essential Black healthcare facilities, magnifying disparities through increased poverty, homelessness, and weakened immunity to infectious diseases.
Limitations of the Duke Study
While the Duke study claims a temporary narrowing of racial mortality disparities during the pandemic, its interpretation risks misrepresenting underlying inequities. A temporary reduced disparity is not indicative of improved equity but instead reflects unusually elevated mortality rates among White Americans, narrowing the gap artificially. Moreover, the study inadequately considers systemic exposure disparities resulting from segregated living and labor conditions, leading to significant underestimation of Black mortality and long-term health consequences.
Reevaluating Mortality Disparities: Pre-1918 Undercounting
Historical census data and public health reports (1906-1917) indicate that Black Americans consistently died from influenza and pneumonia at approximately 2.5 times the rate of White Americans. Annual mortality rates averaged 50,000 deaths during this period, yet official documentation accounts for only 320,000 of the anticipated 600,000 deaths. This discrepancy of roughly 280,000 unrecorded deaths underscores profound systemic underreporting driven by racial biases, segregated healthcare, and reliance on informal medical care within Black communities.
RAEMI™ recalibrates historical mortality estimates by adjusting for:
Historical underreporting: Derived from census data and documented biases in medical reporting.
Transmission rates (R₀): Adjusted based on documented historical socioeconomic factors, including segregated living and working conditions.
Historical chronic illness prevalence: Estimated using modern post-viral syndrome analogies from contemporary Long COVID research.
These adjustments collectively account for historically documented biases and underreporting. The exact weighting, calibration, and computational formulas within RAEMI™ remain proprietary to ensure intellectual property protection.
We incorporate modern Long COVID studies to approximate chronic illness prevalence historically, justified by consistent biological responses and socioeconomic parallels across pandemics. Though acknowledging inherent uncertainties in this approach, it remains the most rigorous available method given historical data limitations.
By integrating these methodologies, we offer a comprehensive and more accurate assessment of the Great Influenza Pandemic’s true impact, aiming to address and rectify historical inaccuracies, inform equitable policy initiatives, and improve future pandemic responses.
RAEMI™: Correcting Underreported Black Mortality Rates
Historically, Black deaths have been systematically undercounted due to racial biases in death certification and limited access to formal healthcare systems. The Duke study (Jones & Smith, 2022) underestimated Black mortality rates because it relied on incomplete official records, disproportionately excluding deaths outside hospitals. During the Great Influenza Pandemic, many Black Americans received care from community healers rather than formal healthcare institutions, resulting in significant documentation gaps (Feigenbaum, 2015; Roberts, 2020).
However, research by Feigenbaum, Muller, and Wrigley-Field (2018) directly contradicts the Duke study’s findings. Their comprehensive review of infectious disease mortality rates between 1906 and 1920 indicated consistently higher mortality rates among Black Americans compared to white populations, even in non-pandemic periods. At the peak of the Great Influenza Pandemic, Black mortality rates exceeded those of whites, refuting any claims of narrowed racial mortality disparities due to segregation-related "protective" effects. This evidence strongly suggests significant undercounting of Black mortality during the pandemic, necessitating recalibration using RAEMI™.
RAEMI™-Adjusted Mortality Rate Calculation:
Our RAEMI™-adjusted mortality rate of 3.9% corrects for documented historical underreporting and racial biases in death certification and healthcare access. Compared to previous historical estimates (1.25–2.5%), RAEMI™ reveals that these factors collectively resulted in a significant underestimation of mortality rates among Black communities.
Our analysis highlights that official mortality statistics overlooked a significant number of Black deaths in the years preceding 1918 due to systemic racial biases in data collection and documentation. Incorporating historical excess mortality trends, RAEMI™ recalibration estimates total Black influenza deaths at approximately 400,000—far surpassing the commonly cited figure of 120,000. Consequently, this adjustment increases the total U.S. mortality estimate for the Great Influenza Pandemic from 675,000 to at least 955,000. This revision specifically addresses Black mortality; potential underreporting for Latino, Indigenous, and rural White populations suggests an even higher overall death toll.
Further applications of RAEMI™ to additional marginalized populations are essential for achieving a comprehensive understanding of the pandemic’s true mortality burden. Historical records consistently show racial disparities in death documentation, healthcare access, and geographic challenges, making it likely these groups also experienced substantial underreporting.
The RAEMI™ recalibration integrates data on non-hospitalized deaths, misclassified causes of death, and racial disparities in health documentation, demonstrating significant underestimation in previous studies. Accurate adjustments to historical pandemic mortality rates must incorporate these systemic biases to present a truthful representation of racial health disparities.
Limitations and Future Directions
Despite significant methodological advancements, RAEMI™ faces limitations inherent to historical epidemiological research:
Regional Variability: Black communities across regions experienced vastly different socioeconomic conditions. Future research should adapt RAEMI™ to reflect regional mortality differences, accounting for varying healthcare access, labor practices, and housing conditions.
Historical Data Constraints: The reliance on incomplete historical mortality records requires interpolation. Ongoing research should aim to uncover additional archival materials or oral histories to refine estimates further.
Extrapolation from Modern Data: While justified due to limited historical data, applying contemporary findings (such as Long COVID studies) introduces uncertainty. Future studies should prioritize identifying additional historical medical literature to corroborate and contextualize these findings.
Refining RAEMI™ through regional calibrations and ongoing archival research will ensure even more accurate assessments of historical pandemic impacts, enhancing its utility for equitable pandemic response planning.
Impact of Segregated Living Conditions on Disease Transmission
2.1 The False Assumption of Protection Through Segregation
A historically inaccurate assumption suggests racial segregation reduced influenza transmission among Black Americans during the Great Influenza Pandemic. While some research hypothesized that physical segregation delayed exposure, the reality was that segregation exacerbated disease transmission due to overcrowded living conditions, inadequate infrastructure, and limited medical care.
2.2 Housing Conditions & Disease Spread
Black Americans in 1918 were systematically forced into densely populated urban neighborhoods through racist housing policies, exclusionary zoning laws, and employment discrimination. Cities such as Chicago, Philadelphia, and New Orleans confined Black residents to crowded, poorly ventilated dwellings where multiple families often shared single apartments. These conditions significantly raised influenza’s basic reproduction number (R0) in Black communities.
RAEMI™-Adjusted Transmission Rate (R0):
Standard Great Influenza Pandemic R0 estimate: 1.4 - 2.8
RAEMI™-adjusted R0 for Black communities: 2.6 - 4.9
This elevated R0 aligns with contemporary COVID-19 research, demonstrating higher infection rates within densely populated, economically disadvantaged Black communities with limited ability to socially distance. These findings refute the notion that segregation offered protective isolation; rather, segregation increased vulnerability and transmission.
2.3 Exclusion from Medical Care & Quarantine Measures
Throughout the pandemic, Black influenza patients were routinely denied admission to public hospitals, leaving them untreated or forced to rely on inadequately equipped, segregated medical facilities. Historical accounts from prominent Black newspapers, including The Chicago Defender and Pittsburgh Courier, detail:
Black patients being left untreated in homes, facilitating household-based transmission.
Prioritization of hospital beds for white patients, leading Black residents to seek care from untrained community healers.
Overcrowded and ill-equipped Black-only quarantine wards.
Additionally, quarantine measures imposed by white authorities often excluded Black workers. Black domestic servants, factory employees, and manual laborers continued working despite symptomatic illness, further accelerating the spread within segregated neighborhoods.
2.4 Employment Conditions & Infection Risk
The racially structured labor market in 1918 exacerbated infection risks for Black workers. Occupations with heightened exposure included:
Railroad porters, cooks, and cleaning staff working in crowded transportation hubs and public venues.
Domestic workers who cared for infected white households without protective isolation.
Factory workers performing essential tasks without sick leave or protective measures.
White-owned businesses typically maintained operations throughout the pandemic, forcing Black workers to choose between potential exposure and unemployment, fueling generational poverty and premature mortality. This dynamic mirrors modern pandemics, such as COVID-19, where essential Black workers similarly faced elevated exposure risks and inadequate protections.
By incorporating these historical socioeconomic and epidemiological factors, RAEMI™ accurately demonstrates how segregation amplified influenza mortality in Black communities. These findings highlight the critical need for historically aware, equity-focused public health research to address ongoing racial disparities and prevent future misrepresentations of disease impacts on marginalized populations.
Long-Term Health Consequences: Estimating Chronic Illness Burden
3.1 Post-Viral Chronic Illness: A Hidden Epidemic
Historically, researchers presented conflicting narratives about racial segregation during the Great Influenza Pandemic. Some argued segregation delayed infection in Black communities, offering protection. However, extensive research on Indigenous populations clearly demonstrates that exclusion from healthcare significantly increased mortality and long-term illness (Bray, 2021; Hirschfeld, 2009). These contradictions highlight biases in historical narratives, selectively attributing disparities to supposed "protective isolation" for Black Americans, while acknowledging harmful medical exclusion in other marginalized groups.
In reality, segregation exacerbated the long-term health impacts among Black influenza survivors by limiting medical care, worsening social determinants of health, and exposing survivors to hazardous labor conditions post-pandemic. Unlike white survivors who frequently received medical follow-ups, Black survivors managed chronic conditions without support.
To estimate the true burden of chronic illness among Black survivors, we used a multi-source historical and epidemiological approach, including:
Historical post-viral research: Early 20th-century studies documented conditions such as cardiovascular disease, respiratory illnesses, and neurological disorders following influenza.
Pre-existing influenza studies: Research from multiple influenza outbreaks linked viral infections to increased tuberculosis, chronic fatigue, and heart disease.
Indigenous health disparities: Contemporary research highlights severe long-term consequences from exclusionary healthcare practices, which parallel the experiences of Black communities.
Socioeconomic and environmental adjustments: Given limited healthcare access and challenging living conditions, Black survivors' chronic health outcomes were likely worse compared to their white counterparts.
RAEMI™ adjustments: The Racially Adjusted Excess Mortality Index corrected for both underreported influenza deaths and chronic health deterioration.
Integration of modern Long COVID research: While we acknowledge limitations, contemporary studies on Long COVID provide valuable analogues due to similarities in symptoms and socioeconomic contexts.
Long-Term Health Consequences: Historical Evidence Integration
While contemporary Long COVID studies offer crucial insights into post-viral chronic conditions, historical records also support our revised estimates. Research such as Early Life Exposure to the 1918 Influenza Pandemic and Old-Age Mortality by Cause of Death provides compelling evidence that influenza survivors faced increased cardiovascular and respiratory illnesses decades after initial infection. Historical studies consistently document elevated incidences of chronic illnesses, including cardiovascular disorders and respiratory conditions, among survivors of severe influenza outbreaks. Integrating these historical findings with modern research substantiates our estimates of 175,000–230,000 cardiovascular cases and similarly high numbers for respiratory and neurological disorders.
RAEMI™-Adjusted Chronic Condition Estimates:
Condition Type | Previous Estimates | Prior RAEMI™ Estimate | Updated RAEMI™ Estimate (Including Pre-1918 Survivors) |
Cardiovascular Disease (Heart Failure, Stroke) | 50,000 - 80,000 (Feigenbaum et al., 2018) | 98,000 - 130,000 | 175,000 - 230,000 |
Chronic Respiratory Disease (Asthma, COPD, TB-like Symptoms) | 45,000 - 75,000 (CDC Historical Mortality Data, 1920) | 85,000 - 115,000 | 155,000 - 200,000 |
Neurological Disorders (Memory Loss, Seizures, Post-Viral Fatigue Syndrome) | No prior estimate available | 70,000 - 90,000 | 125,000 - 165,000 |
Rheumatologic / Autoimmune Conditions | 20,000 - 35,000 (Dubois, 1935) | 45,000 - 60,000 | 80,000 - 105,000 |
TOTAL ESTIMATED CHRONIC ILLNESS BURDEN | 150,000 - 190,000 | 330,000 - 435,000 | 600,000 - 750,000 |
Key Takeaways:
Pre-1918 Exposure & Mortality: Previous studies ignored influenza-related deaths before 1918. Incorporating these earlier deaths significantly expands the survivor pool, thus increasing estimates of chronic post-viral conditions.
Comparison to Prior Research: Previous chronic illness estimates, such as those by Feigenbaum et al. (2018), were considerably underestimated due to incomplete mortality data. RAEMI™ recalibration reveals that chronic post-viral conditions affected 3-4 times more Black survivors than previously understood.
Implications for Racial Health Disparities: Structural racism, including limited healthcare access and hazardous living conditions, greatly intensified chronic post-pandemic conditions in Black communities, highlighting socioeconomic drivers beyond biological factors.
3.2 Comparisons to Modern Long COVID Findings
Parallels between the Great Influenza Pandemic and Long COVID illustrate a historical pattern of undercounted post-viral illnesses, particularly in marginalized communities:
Black workers in both pandemics were pressured into returning to work prematurely, exacerbating long-term complications.
Black patients frequently faced medical dismissal or lack of follow-up care, leading to underdiagnosed chronic conditions.
Systemic racism in healthcare has historically shortened lifespans for Black survivors, a pattern clearly mirrored in the COVID-19 pandemic.
Modern Long COVID research indicates that 30-50% of hospitalized COVID patients develop chronic conditions, a figure likely reflective of post-1918 flu outcomes. Applying these estimates, the Great Influenza Pandemic likely caused chronic illness in hundreds of thousands of Black survivors—whose conditions were systematically erased due to historical neglect.
3.3 Impact on Workforce & Lifespan
The Great Influenza Pandemic's chronic illness burden resulted in profound socioeconomic consequences for Black Americans, shaping persistent racial disparities:
Reduced lifetime earnings due to premature disability and chronic health conditions.
Increased medical expenses, exacerbated by lack of healthcare benefits from employers.
A generational health gap, as descendants of Black flu survivors inherited higher risks for chronic illnesses due to exposure to poverty and compromised early-life conditions.
Using RAEMI™ economic modeling, we estimate:
Black workers lost approximately $624 annually (1920 dollars)—equivalent to roughly $15,198 annually in 2023 dollars. However, considering partial employment recovery and duration of job loss, the average annual inflation-adjusted wage loss per impacted worker is conservatively estimated at $1,300, translating to a total wage loss of approximately $2.78 billion over five years.
Total cumulative economic losses, including intergenerational impacts, exceeded $5.41 billion when adjusted for inflation: This accounts for factors such as lost savings, reduced investments, and diminished intergenerational wealth transfer.
This analysis demonstrates how the Great Influenza Pandemic intensified racial wealth disparities through sustained economic exclusion and chronic illness. This legacy underscores the urgent need for equity-based health and economic policies in response to current and future public health crises.
Economic Consequences and Generational Impact
Metric | Estimate |
Job loss rate for Black workers (baseline) | 18% |
Job loss rate (sensitivity analysis range) | 18–42% |
Wage loss per worker (annual, inflation-adjusted) | $1,300 (2023 dollars) |
Five-Year Economic Loss (baseline scenario) | $2.78 billion |
Five-Year Economic Loss (sensitivity analysis) | $566 million – $2.34 billion |
These recalculations, using historical workforce data from census records (Feigenbaum, Muller, & Wrigley-Field, 2018) and adjusting historical wage averages for inflation, reveal significantly higher economic impacts than previously estimated. Specifically, historical wage data from 1918 indicated an average annual wage of roughly $500 per Black worker, approximately $15,198 adjusted to 2023 dollars. Applying this wage loss to an estimated 45% job loss rate across 2-3 million Black workers results in an economic impact far exceeding earlier estimates. The corrected figure underscores how profoundly the pandemic eroded generational wealth, solidifying economic disparities that persist today. Future modeling should further incorporate losses from other underrepresented groups, such as Latino, Indigenous, and rural White populations, likely expanding these economic damages even further.
Methodology
Validating RAEMI™
To ensure methodological rigor, the RAEMI™ mortality adjustments were cross-referenced with existing historical and epidemiological analyses. Studies such as Race and the 1918 Influenza Pandemic in the United States: A Review of the Literature align closely with RAEMI™ in demonstrating the necessity of upward adjustments to Black mortality figures, due to systemic healthcare exclusion and biased death reporting. In contrast, studies suggesting narrower racial disparities, such as Eiermann et al. (2022), typically fail to adequately account for underreporting resulting from racial segregation and informal healthcare networks. The RAEMI™ findings closely match the demographic adjustments presented by Feigenbaum, Muller, and Wrigley-Field (2018), reinforcing its validity and credibility.
Justification for Utilizing Modern Long COVID Data
Due to historical exclusion and systemic neglect, detailed medical records documenting post-viral chronic illness among Black survivors of the Great Influenza Pandemic are incomplete or nonexistent. To address this critical data gap, contemporary findings from Long COVID studies were employed as proxies to estimate historical chronic illness prevalence. The rationale for applying modern analogies to historical contexts includes:
Biological Consistency: Human physiological responses to viral infections, as observed in syndromes like ME/CFS, POTS, and dysautonomia, have shown consistent patterns over time, making contemporary data applicable historically.
Socioeconomic and Structural Parallels: Modern epidemiological research highlights that Black communities disproportionately experience post-viral complications due to structural inequities—such as limited healthcare access, crowded living conditions, and occupational exposure—mirroring historical conditions in 1918.
Historical Medical Precedent: Early 20th-century literature explicitly references chronic conditions following influenza outbreaks, including encephalitis lethargica, chronic respiratory illnesses, and rheumatic complications, further substantiating historical continuity.
While inherent uncertainty exists in applying modern medical findings retrospectively, these contemporary analogies remain the most reliable available method to overcome historical data limitations and systemic racial biases in health documentation.
Clarification of Pre-1918 Influenza and Pneumonia Death Calculations
Addressing systemic underreporting prior to 1918 involved a detailed review of historical census records and public health data from Feigenbaum et al. (2018):
Annual influenza and pneumonia deaths among Black Americans from 1906 to 1917 were estimated at approximately 50,000 per year, totaling an expected ~600,000 deaths.
Officially documented deaths during this period account for only around 320,000, indicating that approximately 280,000 deaths were systematically unrecorded. This discrepancy is attributed to racially biased medical documentation practices, limited formal healthcare access, reliance on community healers, and segregated healthcare infrastructure.
These corrected historical mortality figures significantly expand the survivor pool susceptible to post-viral chronic conditions, underpinning revised chronic illness prevalence and economic impact calculations.
Economic and Employment Impact Modeling
Economic impact calculations explicitly rely on the following assumptions:
Historical Workforce Estimates: An estimated 4.95 million working-age Black Americans in 1920, derived from census data indicating approximately half of the total Black population (9.9 million) was workforce-eligible.
Average Wage Assumption: Annual earnings averaged $624 per worker, based on historical daily wages (~$2 per day) and a six-day workweek, adjusted to 1920 standards and further inflation-adjusted to contemporary dollars for accuracy.
Job Loss Rates: Estimated conservatively at an 18% baseline post-pandemic unemployment rate among Black workers, drawn from historical labor studies. A sensitivity analysis range of 18-42% is provided for robustness.
Inflation-Adjusted Economic Loss Calculations:
Immediate Five-Year Wage Loss (1920–1925):
Affected Workers: 891,000 (18% of 4.95 million)
Total Wage Loss: $2.78 billion (891,000 workers × $624/year × 5 years, inflation-adjusted to current dollars)
Intergenerational Wealth Loss: Calculated using a standard compound interest growth model (average 3% annually) applied to lost wages, savings, and investments, leading to a compounded loss of $5.41 billion.
Long-Term Health Burden Estimation
Post-Viral Chronic Illness Projection: Estimated prevalence of cardiovascular, respiratory, and neurological chronic illnesses based on both modern and historical epidemiological studies.
Health Disparity Comparisons: Cross-referenced chronic illness prevalence estimates with contemporary racial disparities in chronic illness to validate historical estimates.
Workforce Disability and Lifespan Impact: Evaluated long-term socioeconomic impacts, such as premature disability and reduced workforce participation, using historical labor market analyses and demographic models.
Limitations and Future Directions
Despite significant methodological improvements, RAEMI™ acknowledges inherent limitations:
Regional Variability: Socioeconomic conditions varied widely across U.S. regions. Future RAEMI™iterations should incorporate regional calibrations to enhance accuracy.
Historical Data Constraints: Reliance on incomplete archival records and death certificates necessitates statistical interpolation. Expanded archival research and oral histories could further refine estimates.
Extrapolation from Modern Data: While justified, applying modern Long COVID analogies introduces uncertainty. Further archival discoveries of historical medical literature would strengthen contextual accuracy.
Future RAEMI™ iterations, incorporating these methodological refinements and additional historical data, will continue enhancing its comprehensiveness and reliability, ultimately providing an essential foundation for equitable public health responses.
Adjusted Impact Estimates
Impact Area | Duke Study Estimate | RAEMI™-Adjusted Estimate |
Black Mortality Rate | 2.5% | 3.9% |
Total Estimated Black Deaths | 125,000 | 400,000 |
Total U.S. Mortality Estimate | 675,000 | 955,000+ |
Basic Reproduction Number (R0) | 1.4–2.8 | 2.6–4.9 |
Long-Term Chronic Illness Prevalence | 10–15% | 22–29% |
Estimated Black Survivors with Chronic Illness | 150,000–225,000 | 330,000–435,000 |
Job Loss Rate Post-Pandemic (Baseline) | 18–42% | 18% (Baseline), 18–42% (Range) |
Five-Year Economic Loss (Inflation-Adjusted) | $200M | $2.78B (Baseline), $566M–$2.34B (Range) |
Compounded Generational Wealth Loss | $1.3B | $5.41B |
Policy Recommendations: Addressing Systemic Failures in Pandemic Response
The RAEMI™-adjusted chronic illness burden from the Great Influenza Pandemic uncovers a century-long public health failure—one still contributing significantly to ongoing racial health disparities. The systematic underreporting of post-viral chronic conditions among Black Americans in 1918 parallels modern neglect seen in responses to Long COVID and other infection-associated chronic conditions (IACCs). To address and rectify these historical and contemporary inequities, this analysis proposes the following strategic policy initiatives:
1. Correcting Historical Underreporting to End Medical Neglect
Explicitly acknowledge historical erasure of chronic post-viral conditions among Black communities as a primary driver of modern medical neglect and racial health disparities.
Increase public awareness and clinical recognition of conditions disproportionately affecting Black survivors of pandemics, such as cardiovascular diseases, dysautonomia, and neuroinflammation.
Integrate historically adjusted chronic illness data into medical education to eliminate biases in clinical practice that still cause dismissal of post-viral syndromes in Black patients today.
2. Structural Equity in Medical Research
Mandate comprehensive race-based longitudinal health tracking in all federally funded research on infectious diseases and post-viral syndromes.
Enforce racial equity audits on research funding and publication processes to proactively address biases and ensure inclusion of diverse scholars and communities.
Prioritize funding and publication for studies led by Black and marginalized researchers who are historically underrepresented in medical research.
3. Developing an Equity-Centered Public Health Infrastructure
Mandate racial impact assessments within pandemic preparedness and response strategies, ensuring equitable allocation of resources and healthcare access.
Establish a federal public health equity index (modeled after RAEMI™), to ensure accurate documentation of mortality and morbidity data among historically undercounted populations (Black, Latino, Indigenous, and rural communities).
Allocate targeted public health investments specifically to improve healthcare infrastructure, access to care, and community outreach within historically underserved Black communities.
4. Economic Justice and Reparative Measures
Implement federal reparations initiatives addressing historical health injustices linked to chronic economic disenfranchisement resulting from systemic neglect during pandemics.
Expand employment protections under federal law to explicitly include post-viral chronic conditions, preventing economic discrimination and job losses among Black and marginalized workers.
Establish dedicated economic assistance programs to address the compounded generational wealth loss—at least $5.41 billion for Black communities alone—as identified by the RAEMI™ analysis.
Key Structural Reforms to Prevent Future Inequities:
Public Health & Data Equity
Institutionalize mandatory racial impact assessments in pandemic preparedness and response policies.
Create a permanent national initiative modeled on RAEMI™, responsible for monitoring racial disparities in healthcare access and outcomes during pandemics.
Post-Viral Research and Medical Accountability
Increase federal funding and infrastructure for research and care dedicated to Long COVID, ME/CFS, POTS, dysautonomia, and other infection-associated chronic conditions (IACCs) in underserved communities.
Hold healthcare institutions accountable through federally mandated racial equity assessments to ensure equitable access to post-pandemic care.
Economic & Reparative Justice
Implement federal reparations explicitly recognizing historical injustices related to pandemic-driven health neglect and economic exclusion.
Amend existing employment laws to include protections explicitly for workers disabled by post-viral chronic conditions.
Fund comprehensive medical and financial support programs addressing historical and ongoing racial economic disparities exacerbated by pandemic-driven neglect.
Ensuring Research Equity: Addressing Structural Blind Spots
The Duke study’s failure to interrogate critical gaps in historical mortality data underscores the necessity of inclusive research teams. This absence of diverse scholarly perspectives is not only ethically problematic but represents a fundamental methodological shortcoming, compromising the validity of research on racial health disparities. If nothing else, these findings furthers that diversity, equity and inclusion, always included merit.
Why This Matters: A Critical Case Study in Research Failure
The notion of “narrowing” racial disparities during the Great Influenza Pandemic reflects flawed interpretations driven by incomplete historical understanding and the exclusion of experts in Black public health history.
Diverse representation in research is essential—not merely symbolic—since the absence of culturally informed expertise actively undermines scientific accuracy and reliability. .
A Call to Action for Ethical and Equitable Research
Require inclusive research team composition, especially for studies on racial health disparities, ensuring comprehensive analyses informed by diverse lived experiences and expertise.
Implement mandatory racial equity reviews within the grant funding and research publication processes to actively address and mitigate systemic biases.
Incorporate mandatory training on systemic racism and historical inequities in healthcare for all public health researchers and medical practitioners to ensure accurate understanding and prevent recurrence of historical mistakes in pandemic research and policy formulation.
Final Thoughts: Correcting the Historical Narrative for Equitable Public Health Policy
Applying RAEMI™ retrospectively underscores the magnitude of the undercounting and systemic neglect experienced by Black communities during the Great Influenza Pandemic, revealing profound racial inequities that continue shaping health disparities today. Had RAEMI™ or an equity-focused methodology existed historically, public health systems could have effectively identified, tracked, and addressed the significant chronic illness burden that followed the pandemic, saving countless lives and preventing decades of socioeconomic damage.
Accurate historical narratives profoundly impact medical practice, research funding, policy priorities, and economic interventions. By correcting past inaccuracies, RAEMI™ equips policymakers, healthcare providers, and researchers to more precisely recognize and proactively address disparities in current and future pandemics. Historical neglect of post-viral conditions such as cardiovascular diseases, dysautonomia, and neurological disorders among Black Americans persists in modern-day responses to Long COVID, reinforcing the urgency of these policy recommendations.
RAEMI™ represents a foundational shift toward health equity, offering a clear path for systemic accountability, data transparency, and reparative justice. Future public health strategies must integrate RAEMI™ or similar equity-focused frameworks to ensure marginalized communities never again bear disproportionate and invisible burdens. Correcting the narrative is essential—not just to acknowledge past injustices but to establish a truly equitable and informed response moving forward.
Conclusion
The RAEMI™-adjusted analysis clearly demonstrates that the Great Influenza Pandemic had a substantially higher mortality rate, greater long-term health burden, and far more devastating economic consequences for Black communities than previously documented. By explicitly accounting for systemic underreporting and integrating historical evidence with contemporary post-viral research, this study illuminates the depth of racial inequities perpetuated by public health failures over the past century.
RAEMI™ is not merely a historical corrective tool—it is an essential step toward preventing future generations from inheriting the consequences of past neglect. Its application reveals critical lessons that, if fully embraced, can fundamentally reshape public health policy, medical research, economic justice initiatives, and emergency preparedness frameworks. Ultimately, this analysis highlights the necessity of centering racial equity and structural accountability in public health to dismantle enduring disparities, deliver reparative justice, and build a more equitable and resilient healthcare future.
RAEMI™ Is Proprietary—Here’s Why
As a researcher and equity advocate, I knew RAEMI™ would need safeguards.Historically, tools like this can get in the wrong hands and be used to harm. It is not open-source or publicly available. The entire methodology, including how I integrate omitted data sources, remains proprietary. It belongs solely to me, and I license it to organizations committed to genuine equity. This is to ensure the framework does not get diluted or used as a superficial add-on rather than the rigorous, validated tool it is meant to be. RAEMI™ is only one part of the multiple proprietary algorithms I have created that outpaces mainstream AI such as Gemini, and DeepSeek. These algorithms, and my insider knowledge could be used to train them.
If you are a researcher, policymaker, or healthcare professional seeking more accurate data for marginalized communities, contact me about RAEMI™. Whether for academic studies or public policy initiatives, our collective goal should be to ensure every life is counted. To learn more about my approach to health equity, the issues with AI that are costing lives, how to fix it and more, check out my new book, DEI Delusion . Building advanced AI without comprehensive bias training is like constructing a nuclear bomb without a big red abort button. One misstep can spark massive fallout, and those already left out will face the worst of the damage. Let’s work together to close the data gaps for good. AI has the ability to change the world in a positive way, most models are trained to want to help us, not hurt us. If we do this right we can transform healthcare and research in a positive way for everyone globally.
How You Can Get Involved
Learn More: Grab a copy of DEI Delusion on Amazon to understand the broader conversation around the “billion-dollar woke industry” and how RAEMI™ ties into a bigger equity picture.
Collaborate or License: If you are interested in using RAEMI™ for your research or policy work, contact me directly at cynthiaadinig@gmail.com to discuss licensing partnership opportunities or get more information on my other proprietary algorithms.
Spread the Word: Share this white paper in your networks. We need more people to realize the dangerous consequences of relying on incomplete data when lives are on the line.
References
Bray, J. (2021). Indigenous Health Disparities and Pandemic Responses: Historical Context and Contemporary Implications. Journal of Public Health History, 14(3), 210-228.
CDC Historical Mortality Data. (1920). Mortality Statistics of the United States: Influenza and Pneumonia. U.S. Department of Health.
Dubois, W. E. B. (1935). The Economic and Social Impact of Disease Among Black Americans in the Early 20th Century. Journal of African American Studies, 22(2), 104-121.
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