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The price of struggle and rapid change


How an idea travelled from Wits to the US South

A short film produced by Witsie historian Dr Karin Shapiro traces the influence of a group of Wits-trained doctors on public health in the USA.

Dr Shapiro (BA 1980, BA Hons 1981) is Associate Professor of the Practice in the Department of African and African American Studies at Duke University in the US. Her film about Duke epidemiologist Sherman James shows how his thinking on the relationship between social stresses and health was shaped by doctors who left South Africa between the late 1950s and early 1970s and worked at the University of North Carolina and Duke University.  

The video begins: “In 1973, social psychologist Sherman James arrived in Chapel Hill to take up his first academic position as an epidemiologist at the University of North Carolina’s School of Public Health. There he encountered a remarkable group of South African doctors, researchers and educators – pioneers in social medicine and community health.”

These doctors deeply influenced James’ understanding of health and how vulnerability to disease is a function of the social conditions in which people live.

The group included a number of Wits-trained doctors:

  • John Cassel (BSc 1942, MBBCh 1946) (1921-1976)
  • Harry Phillips (MBBCh 1967) (1943-2015)
  • Sidney Kark (MBBCh 1937, MMed 1954, DSc Med honoris causa 1982) (1911- 1998)
  • Emily Kark (MBBCh 1938) (1913-2006)
  • Beryl Abrams Slome (BDS 1948) (1924-2009)
  • And UCT’s Cecil Slome (1921-1981)

“As a social epidemiologist,” says Professor James in Shapiro’s video, “I’m interested in the contribution of social, psychological, cultural and economic factors to the health of populations and to disparities in health among various subgroups within a given population.”

He says that when Dr Cassel spoke about how epidemiology brings together social justice and science, he realised the field was what he’d been looking for. The South African doctors’ way of thinking about their patients’ whole lives was not common in medical schools at the time, he says.

The human struggle against “the machine”

Prof James explains how he came to his “John Henryism” hypothesis about the impact of social stresses on health.

John Henry was a legendary figure in the American South: a freed slave and railroad worker who, according to the story, pitted himself against a steeldriving machine in a contest of strength and endurance and won – before dropping dead of exhaustion.

The legend captures the struggle against the constant threat of things changing so quickly that a person cannot keep up.

The John Henryism hypothesis is that “repetitive high-effort coping with difficult social and economic stressors is a major contributor to racial and socioeconomic disparities in hypertension and related cardiovascular diseases.” 

The folk legend, however, carries the message that effort and sacrifice makes things easier for the next generation. “Don’t give up on your dreams.”

Read more about the legacy of John Cassel:

Read more about the history of the UNC Department of Epidemiology:

Wits School of Public Health: