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LETTER |
The authors are with the James P. Wilmot Cancer Center, University of Rochester, Rochester, NY.
Correspondence: Requests for reprints should be sent to Jennifer J. Griggs, MD, MPH, University of Rochester, 601 Elmwood Ave, Box 704, Rochester NY 14642 (e-mail: jennifer_griggs{at}urmc.rochester.edu).
In their report in the May issue of the Journal, Bonham and colleagues1 describe John Henryism, a "behavioral predisposition to directly confront barriers to upward social mobility," as a protective factor for African Americans’ health.2 The authors draw on the work of Sherman A. James to propose that this type of "active coping" will lessen the effects of racially based stressors, thus improving health outcomes.2 They make the valid point that personal characteristics may modify the relationship between social circumstances and physical health.3
The authors neglect, however, to acknowledge that the relationship between John Henryism and favorable health outcomes cannot be assumed to be unidirectional. They go so far as to refer to "the positive health effects of John Henryism" and conclude that "John Henryism is beneficial for health." Is it not equally likely that those who have good health are more motivated, determined, and active? Why do we assume that African Americans who exhibit the values that our society prizes—a strong work ethic and a desire to succeed—bring about their own good health? The not-so-subtle message is that African Americans who are less healthy have somehow failed to overcome barriers to achieve good health. It is ironic that James, on whose work the authors depend heavily, has decried the perpetuation of this "moral economy" explanation for racial disparities in health.4
We fear that the ease with which the authors jump to this conclusion of unilateral causality is symptomatic of the underlying biases of our society. By concluding that John Henryism "causes" better health outcomes, we place the burden of health on the individual. According to this argument, those who are troubled by poorer health can be assumed to lack the admirable qualities described by John Henryism. This is tantamount to blaming the victim and places the responsibility for health outcomes squarely in the hands of the individual rather than the health care system at large.5 If we take the authors’ conclusions at face value, we limit the responsibility of providers, the health care system, and our society as a whole in caring for African American patients by making the patients responsible for their own well-being.
References
1. Bonham VL, Sellers SL, Neighbors HW. John Henryism and self-reported physical health among high–socioeconomic status African American men. Am J Public Health. 2004;94:737–738.
2. James SA, LaCroix AZ, Kleinbaum DG, Strogatz DS. John Henryism and blood pressure differences among black men, II: the role of occupational stressors. J Behav Med. 1984;7:259–275.[ISI][Medline]
3. James SA, Strogatz DS, Wing SB, Ramsey DL. Socioeconomic status, John Henryism, and hypertension in blacks and whites. Am J Epidemiol. 1987;126:664–673.
4. James SA. Confronting the moral economy of US racial/ethnic health disparities. Am J Public Health. 2003;93:189.
5. van Ryn M, Fu SS. Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health? Am J Public Health. 2003;93:248–255.
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