Ms. James, a former factory seamstress. From: 28% Of Philadelphia’s Population Live Below The Poverty Line

I tried to pare this article and just post some kernels but the author (@JamesHamblin, MD and senior editor of The Atlantic) pared it down already.

Why Succeeding Against the Odds Can Make You Sick, James Hamblin, New York Times, 27 January 2017
For African-American strivers, hypertension and other health problems may be linked to racism, not race.

If there is any kernel, it’s my title. But here are some pieces anyway:

Gene Brody, a professor at the University of Georgia … and colleagues recently analyzed the socio-economic backgrounds and personalities of the people in the Pittsburgh study and found that those who were “more diligent and tended to strive for success” were more likely than the others to get sick. To Dr. Brody, the implication was that something suffers in the immune systems of people who persevere in the face of adversity.

In 2015, they found that white blood cells among strivers were prematurely aged relative to those of their peers. Ominous correlations have also been found in cardiovascular and metabolic health. In December, Dr. Brody and colleagues published a study in the journal Pediatrics that said that among black adolescents from disadvantaged backgrounds, “unrelenting determination to succeed” predicted an elevated risk of developing diabetes.

The focus on black adolescents is significant. In much of this research, white Americans appeared somehow to be immune to the negative health effects that accompany relentless striving. As Dr. Brody put it when telling me about the Pittsburgh study, “We found this for black persons from disadvantaged backgrounds, but not white persons.”

In the United States, gaps in health and longevity between the wealthy and the poor are some of the greatest in the world … But decades of research show that when resilient people work hard within a system that has not afforded them the same opportunities as others, their physical health deteriorates.

The effect has become known as John Henryism.

Why would white people appear to be immune? … Her conclusion is that because African-Americans encounter more overt and systemic discrimination, “the combination of adversity and high-effort coping is what’s having health consequences.”

Going forward, John Henryism is likely to affect other races, other groups:

Globally, there is no association between skin color and the length of one’s life. This is an American phenomenon. In medical school we are taught that black men are much more likely than other patients to have hypertension, as if this were simple biology.

“There’s very little genetic basis for hypertension,” said Dr. Mujahid. “It’s much more about social context and lifestyle.”

And that social context is now changing in the United States.

“Because African-Americans experience so much more exclusion and degradation — something that working-class whites didn’t experience at the time — that probably created conditions that were ripe for us to only see the effects in blacks,” Dr. James said about his research in the ’80s. “But now white Americans are experiencing a great deal of economic — and, dare I say, psychological — pain because of their dislocation as a result of powerful macroeconomic forces.”

Dr. James expects John Henryism can now be seen across Western democracies, wherever people are inculcated with a Protestant sense of personal responsibility and belief in self-reliance. “When people act on that — really trying to make ends meet going up against very powerful forces of dislocation — their biological systems are going to pay a price,” he said.

“That’s the situation African-Americans have been in since the beginning,” he added. “Now we’re seeing other groups begin to be exposed to these same forces.”

In the spirit of the original John Henry, among those forces is technologically induced unemployment. The mechanization of labor once pushed rural Southern blacks into the factories of the North. Now mechanization is giving way to automation, affecting less-educated white Americans, especially men.

The answer? Work towards ending racism and building the middle class:

The Trump administration could do much more to damage Americans’ health than just repeal the Affordable Care Act and leave people without access to hospitals and medications. “The consequences around the divisiveness, and increased instability and uncertainty for families and children, combined with increased racial tension and overt acts of discrimination,” Dr. Mujahid noted, all stand to heighten the John Henryism effect.

“What we want is for people who overcome so much to achieve the American dream to have the health to enjoy the fruits of their efforts,” said Dr. Brody. “Right now that doesn’t seem to be happening.”

Or maybe people should simply have to overcome less in the first place — to have something close to equal opportunity to succeed. But as the middle class contracts and wealth gaps expand, the promise of equal opportunity seems to be receding.

John Henryism. If I use that term in the future, you’ll know what I mean.

It isn’t just the food we eat, or whether we smoke or drink or use drugs or don’t sleep enough or fail to stay active; it’s how effective our immune system is and how much it’s put upon that contributes to health. This makes ending racism and economic inequality a goal for public health.