The physiological wear and tear that results from that kind of long-term struggle will manifest itself in high blood pressure and so on. And because African Americans are overrepresented in low-wage jobs, in physically demanding jobs, in jobs that offer inadequate levels of economic security. And so the wear and tear that results from that, I think, contributes really quite importantly to the epidemic of cardiometabolic diseases in the African American population.
Wells: I’m curious: Did that finding surprise you?
James: Well, it didn’t surprise me. I think it surprised a lot of other people. I think it surprised non–African Americans. The John Henryism hypothesis went up against a very powerful counter-narrative, which was that the problem is really genetic and diet.
Hamblin: To that point, you’ve since subsequently shown that this effect plays out in other populations as well, in other countries that there are effects of disenfranchisement or domination. That would undermine any idea that it had to do with a particular group’s genes.
James: That’s correct. There are two published studies on European populations. So this is not something that is unique to African Americans. I think it really taps into the human condition. Any population that is immersed in very, very trying economic circumstances and members therein struggle against those circumstances try to overcome them—that’s the group in that society that’s going to be on a faster trajectory to develop these cardiovascular diseases.
Hamblin: It sounds like it also is dependent on exactly how rigged the machine is. If you could get together and just vote, that’s going to have a different effect than if it seems like the same protests have to happen decade after decade, and there is disenfranchisement and voter suppression and gerrymandering and all these things that make the machine that much harder to beat.
James: I think that’s exactly right, Jim. If there is a silver lining in this terrible situation that all of us are going through now, it is that I think white Americans increasingly see the necessity of changing the system, of making the political and economic machinery of the country less deadly to people of color, and particularly African Americans. And for me, that’s something of a shift, which is not to say that you didn’t have a similar kind of alliance across racial lines occurring in the 1960s. As a matter of fact, I doubt very seriously if the changes in social policies that resulted from the civil-rights movement of the 1960s, that those structural changes that took place would have taken place without this cross-racial alliance. And particularly the involvement of young whites along with young blacks. I think the same thing is true now.
Wells: So I’m going to ask you about solutions, but I want to be clear that I’m not asking you for, like, false hope. I’m just curious, from an epidemiological perspective, are there case studies or examples where you’ve seen where these metrics of high blood pressure and cardiovascular disease actually move in response to social changes or certain types of interventions. Like, what actually works? Are there examples of places where you feel those health metrics respond positively?