The Continuing Puzzle of Hypertension Among African Americans: Developmental Origins and the Mid-century Socioeconomic Transformation

Abstract

African Americans have an excessive prevalence of hypertension relative to whites, particularly in the South. We seek to understand this puzzle by applying the developmental origins hypothesis to the rapid socioeconomic improvement that occurred after World War II. The long experience of pre-World War II poverty prepared African Americans born around the 1950s for survival in a lean world of poor nutrition and hard work, but created vulnerabilities for chronic diseases when conditions improved later in life. We analyze individual-level evidence from the CDC’s Behavioral Risk Factor Surveillance System with household income data, finding results consistent with the developmental origins hypothesis, that accelerated income growth from poverty strongly indicates an increased prevalence of hypertension. This strongly suggests that the collection of individual-level, intergenerational data is necessary to further evaluate this puzzle.

Appendix: Murray Reflections by Richard Steckel

John Murray entered my graduate economic history class in 1989 and we soon became friends. We had a common educational ancestor in Oberlin College and like me, he came late to the field of economic history as an older student. It was greatly rewarding to see him flourish under the freedom economic history offered for research topics. Virtually, every subfield of economics has a history, and soon he was exploring interdisciplinary topics as well, writing a term paper on the Shakers, which later turned into a dissertation on the relationship of their living standards to their rise and decline in the century after 1780. John had an important qualification for a good economic historian, a nose for data and delight in discovering useful evidence in the archives. In fact, he and his wife, the epidemiologist Lynn Wellage, spent part of their honeymoon at the restored Pleasant Hill Shaker site. His intellectual curiosity propelled him into research on many topics from anthropometric history, literacy, fertility, the origins of American health insurance, and the Charleston Orphan House. Beyond his substantial research output, John was truly a good citizen, winning teaching awards, serving on editorial boards, helping as referee and book review editor, being trustee of the Cliometric Society, and performing various tasks for the Social Science History Association. As his dissertation advisor, I sometimes wondered if I pushed him too hard as a graduate student, urging him to gather more evidence, conduct additional analyses, and rewrite his work. One day, frustrated with the lack of light at the end of the tunnel, he came into my office and said he had enough. I told him to finish writing and he would be ready to graduate in a few weeks. Several years later, he thanked me for pressing him so hard because it expedited publishing and tenure.

John Murray was one of the good guys in the economic history profession. Friendly, gregarious, approachable, and eager to offer comments and suggestions on research in progress, he had many friends and admirers. I am proud to be among them.