Dr. Ala Stanford of the Black Doctors COVID-19 Consortium lampooned the Kenney administration for failing the Black community in its response to the novel coronavirus pandemic on Thursday at Salem Baptist Church in Abington Township (Philadelphia Tribune Photo by Michael D’Onofrio).
By Akilah Johnson and Nina Martin, Pro Publica
The Rev. Dr. Kejuane Artez Bates was a big man with big responsibilities. The arrival of the novel coronavirus in Vidalia, Louisiana, was another burden on a body already breaking under the load. Bates was in his 10th year with the Vidalia Police Department, assigned as a resource officer to the upper elementary school. But with classrooms indefinitely closed, he was back on patrol duty and, like most people in those early days of the pandemic, unprotected by a mask. On Friday, March 20, he was coughing and his nose was bleeding. The next day, he couldn’t get out of bed.
Bates was only 36, too young to be at risk for COVID-19, or so the conventional wisdom went. He attributed his malaise to allergies and pushed forward with his second full-time job, as head pastor of Forest Aid Baptist Church, working on his Sunday sermon between naps. Online church was a new concept to his parishioners, and during the next morning’s service, he had to keep reminding them to mute their phones. As he preached about Daniel in the lion’s den — we will be tested, but if we continue to have faith, we will come through — he grimaced from the effort. That night he was burning up with fever. Five days later he was on a ventilator; five days after that, he died.
While COVID-19 has killed 1 out of every 800 African Americans, a toll that overwhelms the imagination, even more stunning is the deadly efficiency with which it has targeted young Black men like Bates. One study using data through July found that Black people ages 35 to 44 were dying at nine times the rate of white people the same age, though the gap slightly narrowed later in the year.
And in an analysis for ProPublica this summer using the only reliable data at the time accounting for age, race and gender, from Michigan and Georgia, Harvard researcher Tamara Rushovich found that the disparity was greatest in Black men. It was a phenomenon Enrique Neblett Jr. noticed when he kept seeing online memorials for men his age. “I’ll be 45 this year,” said the University of Michigan professor, who studies racism and health. “I wasn’t seeing 60- and 70-year-old men. We absolutely need to be asking what is going on here?”
To help illuminate this gap in knowledge and gain a deeper understanding of why America has lost so many young Black men to COVID-19, ProPublica spent months gathering their stories, starting with hundreds of news articles, obituaries and medical examiners’ reports, then interviewing the relatives and friends of nearly two dozen men, along with researchers who specialize in Black men’s health. Our efforts led us to a little-known body of research that takes its name from one of the most enduring symbols of Black American resilience.
As the legend goes, John Henry was a steel-driving man who defeated a steam-powered drill and died with a hammer in his hand. The folktale celebrates one man’s victory against seemingly insurmountable odds. But it holds another, harsher truth: His determination and strength are also what killed him.
The John Henry of contemporary social theory is a man striving to get ahead in an unequal society. The effort of confronting that machine, day in and day out, compounded over a lifetime, leads to stress so corrosive that it physically changes bodies, causing Black men to age quicker, become sicker and die younger than nearly any other U.S. demographic group. COVID-19 is a new gear in an old machine.
In interviews about the young men who died from the virus, a portrait emerged of a modern John Henry: hard-working, ambitious, optimistic and persistent, trying to lift others along with themselves.
They were the very people communities would have turned to first to help recover from the pandemic: entrepreneurs who were also employers; confidants like coaches, pastors and barbers; family men forced into a sandwich generation younger than their white counterparts, because their parents got sick earlier and they had to care for them while raising kids of their own.
They were ordinary men. Time and again, it was their fight that was remarkable.
Bates, the only child of a single mother who supported him as a teacher’s aide, made it to Alcorn State University on football and choir scholarships. When his mother got sick with breast cancer, he had to drop out; after she died, he was almost destitute.
Over the years, he built himself into multiple men at once, each a pillar to many others: the pastor whose flock depended on his counsel; the mentor known to school kids as Uncle Officer Bates; the assistant football coach and band director; the adoring father to 5-year-old Madison — his “heartbeat,” he called her. Recently he and his wife, Chelsea, a second grade teacher, had launched One Love Travel, organizing excursion packages and cruises as part of their long-term plan to build generational wealth.
He carried the stress of his efforts in his blood vessels, in his kidneys, in the extra pounds that accumulated with each passing year; he had diabetes and hypertension and at 6-foot-6, he was more than 100 pounds overweight. His official cause of death, on April 1, was COVID-19-related pneumonia and acute respiratory distress syndrome.
But Chelsea knows that the virus, no matter how powerful, didn’t kill her husband on its own. It was the years of working nonstop, taking care of other people more than himself, that wore his body down. And when the virus attacked, he couldn’t fight back.
In the summer of 1978, the social epidemiologist Sherman James, then a 34-year-old researcher at the University of North Carolina at Chapel Hill, met the man who would shape his life’s work. At 70, John Martin was a retired farmer who suffered from debilitating osteoarthritis and hypertension. He had peptic ulcers so severe that doctors had to remove 40% of his stomach. Recounting his story in his backyard rocking chair, his cane resting on his lap, the old man had no doubt why his health was so bad: “I worked too hard.”
Born in 1907, Martin grew up in a family of sharecroppers who were only paid half of what their labor in the tobacco fields earned. Throughout the South at the time, most Black farmers lived at the economic mercy of landowners who were employers, landlords and vendors all at once. Martin watched as the system ruthlessly exploited his father; after one particularly harsh winter spent hungry, Martin vowed he would be different. Borrowing $3,725 in 1941, he purchased 75 acres. He had 40 years to settle the mortgage but accomplished the near-impossible: He paid it off in five. “That’s the reason my legs [are] all out of whack today,” he told James.
James listened, spellbound, until Martin’s wife called out, “John Henry, it’s time for lunch.” At that moment, something clicked.
Holy cow, James remembers thinking. “It was just like the ancestors were speaking to me.” The power of Martin’s story wasn’t simply that it echoed the legend of John Henry; it also echoed the life experiences of most of the working-class African American men James knew.
Five years out of graduate school, James was among a small group of researchers focusing on one of the most enduring public health problems in the United States: why health outcomes for Black men are so poor.
Black men live shorter lives than all other Americans — 71.5 years versus 76.1 years for white men — and have for generations. Black men’s life expectancy didn’t reach 65, the eligibility age for Medicare, until 1995, 30 years after the federal health program for the elderly became law; white men were living into their mid-60s by 1950.
The shorter lifespans reflect a broader disparity: Black people have much higher rates of hypertension, obesity, diabetes and strokes than white people do, and they develop those chronic conditions up to 10 years earlier. The gap persisted this year when the Brookings Institution examined COVID-19 deaths by race; in each age category, Black people were dying at roughly the same rate as white people more than a decade older.
For generations, public health experts mostly ignored the disparities. When they did pay attention, they invariably blamed the victims — their “unhealthy” behaviors and diets, their genes, the under-resourced neighborhoods they “chose” to live in and the low-paying jobs they “chose” to work.
Their chronic illnesses were seen as failures of personal responsibility. Their shorter life expectancy was written off to addiction and the myth of “black-on-black” violence. Many of those arguments were legacies of the slave and Jim Crow eras, when the white medical and science establishment promoted the idea of innate Black inferiority and criminality to rationalize systems built on servitude and segregation.
Pondering the lessons of John Henry Martin, James began to see what many of his colleagues had been missing. It wasn’t just living in poverty that wore down Black men’s bodies, he hypothesized, but the struggle to break out of poverty. It wasn’t just inequality that made them sick, but the effort to be equal in a system that was fundamentally unjust. “It’s this striving to make something of themselves … to live their lives with dignity and purpose and to be successful against extraordinary circumstances,” James said. “They’re trying to make a way out of no way. It’s the Black American story.”
America has changed profoundly since Martin’s day. Yet the machinery of racial inequality continues to be omnipresent. It’s in the hospitals where Black newborns have significantly lower mortality if they’re cared for by Black doctors rather than white ones.
In the redlined neighborhoods where poverty and pollution are concentrated — but not affordable housing or grocery stores or reliable internet. It’s in the crumbling, exploitative economies that force parents to risk their lives working long hours for low pay without sick leave. In mass incarceration and voter suppression.
In the innumerable hurdles, one piled upon another, that make Black Americans’ climb up the socioeconomic ladder more daunting than ever, their successes more fragile and their setbacks more consequential.
“Everyone thinks about racism as something that is personally mediated, like someone insulting me,” said Linda Sprague Martinez, a professor at Boston University’s School of Social Work who conducts community health research with adolescents and young adults. “But the way in which it’s really pervasive is how it disrupts life chances and opportunity. … These are systems that are designed for you to fail, essentially, and for you to be erased and to be maintained in a certain position in our society.”
Challenging such a relentless machine, through “high-effort coping,” James concluded, requires three categories of personal traits that are major themes of the John Henry legend: tenacity, mental and physical vigor and a commitment to hard work. To measure them, he developed the John Henryism scale, with scores determined by how strongly people identify with 12 statements, including: “Once I make up my mind to do something, I stay with it until the job is completely done,” and, “It’s not always easy, but I usually find a way to do what really needs to be done.”
To score high in John Henryism, you don’t have to be Black or male or economically disadvantaged. But over the years, James and other researchers have found that Black people, especially those who are poor and working-class, do score high and tend to suffer greater cardiovascular risks, perhaps because the innumerable hurdles in their paths require greater effort to overcome. “The stress,” James said, “is going to be far more overwhelming than it has a human right to be.”
Stress is a physiological reaction, hard-wired in the body, that helps protect it against external threats. At the first sign of danger, the brain sounds an alarm, setting off a torrent of neurological and hormonal signals that whoosh into the blood, stimulating the body to fight or give flight. The heart beats faster and breathing quickens; blood vessels dilate, so more oxygen reaches the brain and muscles. The immune system’s inflammatory response is activated to promote quick healing. When the threat passes, hormone levels return to normal, blood glucose ebbs and heart rate and blood pressure go back to baseline. At least, that’s how the human body is designed to work.
But overexposure to cortisol and other stress hormones can cause the gears to malfunction. “Your body’s over-producing, always working hard to bring itself back down to the normal level,” said Roland J. Thorpe Jr., a professor at the Johns Hopkins Bloomberg School of Public Health and founding director of the Program for Research on Men’s Health at the Hopkins Center for Health Disparities Solutions. The constant strain “resets the normal,” he said. As blood pressure remains high and inflammation becomes chronic, the inner linings of blood vessels start to thicken and stiffen, which forces the heart to work harder, which dysregulates other organs until they, too, begin to fail. “Your body starts to wear down,” Thorpe said — a phenomenon known as weathering.
The cumulative effects of stress begin in the womb, when cortisol released into a pregnant woman’s bloodstream crosses the placenta; it is one of the reasons a disproportionate number of Black babies are born too early and too small. Then, exposure to adverse childhood experiences — anything from abuse and neglect to poverty and hunger — continues the toxic stream; too much exposure to cortisol at a critical stage in development can rewire the neurological system’s fight-or-flight response, essentially causing the brain’s stress switch to break. The more stress a youngster endures, the more likely he or she is to have academic, behavioral and health problems from depression to obesity.
Weathering isn’t specific to race, but it is believed to take a particular toll on Black people because of the unique, unrelenting stress caused by racism that wears away the body and the spirit, “just like you have siding on the house, and the rain or the sun beats on it, and eventually it starts to fade,” said Dr. Jerome Adams, the U.S. surgeon general under the Trump administration. Shawnita Sealy-Jefferson, a social epidemiologist at Ohio State University, says the human body isn’t designed to withstand such biological and emotional assaults: “It’s the same thing as if you revved the engine of your car all day, every day. Sooner or later, the car is going to break down.”
The effects of stress can be seen at the cellular level. Researchers have found that in Black people, telomeres — repeated sequences of DNA that protect the ends of chromosomes by forming a cap, much like the plastic tip on a shoelace — become shortened at a faster rate, a sign of premature aging. In a 2018 study examining changes in seven biomarkers in cardiac patients over a 30-year period, researchers found that Black patients weathered at an average of about six years faster than whites. And it was the extraordinarily high rates of hypertension in the Black community that prompted scientists to look at the impact of stress in the first place. By age 55, about 76% of Black men and women develop high blood pressure, versus 54% of white men and 40% of white women, which increases the risk of heart attacks and strokes.
Sustained stress has strong links to obesity, which Black children and adults have at much higher rates than whites. Some of this is physiological: The interplay between cortisol and glucose is complex and insidious, triggering metabolic changes that can lead to diabetes and other chronic diseases. Some of it is psychological and behavioral: Stress is strongly associated with depression and other mental health disorders. “The way that people deal with stress is by strategies that make us feel better,” such as comfort eating, said Thomas LaVeist, dean of Tulane University School of Public Health and Tropical Medicine. Stress and anxiety cause sleeplessness, which itself is correlated with weight gain. The result is often a cascade of health problems — hypertension, cardiovascular disease, metabolic syndrome — that strike early and feed off of each other.
Because Black Americans experience many forms of stress, often at once, researchers have more questions than answers about the specific role John Henryism plays in these outcomes. The study of Black men’s health remains an under-examined frontier, with little in the way of funding or will because “Black men are not viewed as sympathetic,” said LaVeist, and because so few go into the health research professions. He and Thorpe, the Johns Hopkins professor, co-founded the Black Men’s Health Project, the first large-scale national study focused solely on Black men’s needs, with a goal sample size of 5,000. They hope to learn how stressors like segregation and adverse early life experiences impact health outcomes.
If this segregated body of emerging knowledge were to grow and infiltrate the mainstream medical and research communities, James can only imagine how beneficial that would be. Health professionals could build deeper relationships with their patients by better understanding the sources of stress that wreak havoc on their cardiovascular systems. They could test for high blood pressure, diabetes and cholesterol levels more frequently and at younger ages. “Until we can have a society that is more just racially,” James said, “we do need to find these intermediate steps.”
As ProPublica examined the lives lost to COVID-19, themes emerged in the pressure points faced by many young Black men. The wearing down typically begins when they are boys and must become little John Henrys to navigate white spaces or push through the adverse experiences endemic to Black communities. It continues when they grow into men, as most need to navigate the public’s projections of danger with unwavering vigilance. The more they succeed, the more responsibility they feel to lift their families and communities with them, and with that, comes more stress.
As James listened to the stories ProPublica was gathering, he instantly recognized the cycle of striving and succumbing that he has been writing about for 40 years. “They could have done so much more had the struggle not been so intense,” James said. “They were cut down too soon.”
Thomas Fields Jr. was barely a year old when his father first went to prison. The loss altered the trajectory of his life in ways that many children wouldn’t have been able to overcome. His mother, just 17 when he was born, moved with him from the suburbs of Washington, D.C., to Detroit, where her own mother had recently relocated. The city was in freefall: manufacturing jobs were disappearing; crime was surging; middle-class and white flight was stripping away the city’s tax base, eroding vital services and causing schools to fail. Just waiting at the wrong bus stop could get you robbed or shot.
“When you’re a young male living in Detroit, if you live past 18, it’s like you’re 50 years old,” Fields, then 31, said on a Facebook Live chat last year. “I swear that’s how it feels.”
Mitigating childhood adversity requires deep wells of resilience; researchers say one of the best ways to build those reserves is having a nurturing caregiver. In this, young Thomas was exceptionally lucky. His mother worked two jobs and still managed to watch him like a hawk; she told him constantly that she loved him. His grandmothers looked after him after school and during summer breaks. His father, Thomas Sr., did his best to be involved from behind bars, urging him to not make the same mistakes. “I wanted this Thomas Fields to break the mold,” he said.
To do that, Thomas became a little John Henry. He got decent grades, stayed out of trouble and taught himself to cook — healthy food, not the junk so many of his peers ate. After high school, he attended Grambling State University in Louisiana for a couple of years, then joined the U.S. Navy, where he went from being a talented amateur chef to a trained professional. He also became a father. When there were setbacks, he was already planning his next move. It’s a strategy that Black adolescents absorb like the air they breathe and the water they drink, Sprague Martinez said. “The mentality is: ‘Even if this system is not designed to work for me … I’m going to win this game. I haven’t gotten the prize yet? I must not be working hard enough.’”
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