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  • How to Beat Heart Disease Before It Starts | NutritionFacts.org

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    Why might healthy lifestyle choices wipe out 90% of our risk for having a heart attack, while drugs may only reduce risk by 20% to 30%?

    On the standard American diet, atherosclerosis—hardening of the arteries, the number one killer of men and women—has been found to start in our teens. Investigators collected about 3,000 sets of coronary arteries and aortas (the aorta is the main artery in the body) from victims of accidents, homicides, and suicides who were 15 to 34 years old and found that the fatty streaks in arteries can begin forming in our teens, which turn into atherosclerotic plaques in our 20s that get worse in our 30s and can then become deadly. In the heart, atherosclerosis can cause a heart attack. In the brain, it can cause a stroke. See the progression below and at 0:35 in my video Can Cholesterol Get Too Low?.

    How common is this? All of the teens they looked at—100% of them—already had fatty streaks building up inside their arteries. By their early 30s, most already had those streaks blossoming into atherosclerotic plaques that bulged into their arteries. From ages 15 through 19, their aortas had fatty streaks building up throughout them, but no plaques yet, on average, as seen below and at 1:15 in my video.

    The plaques started appearing in their abdominal aorta in their early 20s and worsened by their late 20s, by which time fatty streaks had infiltrated throughout. By their early 30s, their arteries were in bad shape, as seen below and at 1:25 in my video.

    But that’s just the abdominal aorta, the main artery running through the torso that splits off into our legs. What about the coronary arteries that feed the heart?

    Researchers found the same pattern: fatty streaks in teens, early signs of plaque in early 20s that progress with age, and by the early 30s, most people already had plaques in their coronary arteries, as seen below and at 1:47 in my video.

    Atherosclerosis starts as early as adolescence.

    That’s why we shouldn’t wait until heart disease becomes symptomatic to treat it. If it starts in our youth, we should start treating it when we’re youths. If you knew you had a cancerous tumor, you wouldn’t want to wait until it grew to a certain size to treat it. If you had diabetes, you wouldn’t want to wait until you started going blind before you did something about it. So, how do you treat atherosclerosis? You lower LDL cholesterol through a diet low in saturated fat and cholesterol—a diet that’s low in eggs, meat, dairy, and junk.

    If we want to stop this epidemic, we have to “alter our lifestyle accordingly, beginning in infancy or early childhood. Is such a radical proposal totally impractical?” (Eating more healthfully? Radical?!) It would take serious dedication to change our behavior, but atherosclerosis is our number one cause of death. In the case of cigarettes, we did pretty well, slashing smoking rates and dropping lung cancer rates. And, yes, healthy eating is safe. According to the Academy of Nutrition and Dietetics, the largest and oldest association of nutrition professionals in the world, even strictly plant-based diets are appropriate for all stages of life, starting from pregnancy. (NutritionFacts.org is among the websites recommended by the Academy for more information.)

    The title of an important study published in the Journal of the American College of Cardiology declares: “Curing Atherosclerosis Should Be the Next Major Cardiovascular Prevention Goal.” What evidence do we have that a lifelong suppression of LDL will do it? There is a genetic mutation of a gene called PCSK9 that about 1 in 50 African Americans are lucky to be born with because it gives them about a 40% lower LDL cholesterol level their whole lives. Indeed, they were found to have dramatically lower rates of coronary heart disease—an 88% drop in risk compared to those without the genetic mutation, despite otherwise terrible cardiovascular risk factors on average. Most had high blood pressure and were overweight, almost a third smoked, and nearly 20% had diabetes, but that highlights how a lifelong history of low LDL cholesterol levels can substantially reduce the risk of coronary heart disease, even when there are multiple risk factors.

    This near-90% drop in events like heart attacks or sudden death occurred at an average LDL level of 100 mg/dL, compared to 138 mg/dL in those without the genetic mutation. This means LDL can drop below even 100 mg/dL. Why does a drop in LDL cholesterol by about 40 mg/dL from a lucky genetic mutation lower the risk of coronary heart disease by nearly 90%, while the same reduction with statin drugs lowers it by only about 20%? The most probable explanation? Duration. When it comes to lowering LDL cholesterol, it’s not only about how low it is, but how long it’s been low.

    That’s why healthy lifestyle choices may wipe out about 90% of our risk for having a heart attack, while drugs may reduce it by only 20% to 30%. If you’re getting treated with drugs later in life, you may have to get your LDL under 70 mg/dL to halt the progression of coronary atherosclerosis. But if we start making healthier choices earlier, it may be enough to lower LDL cholesterol just to 100 mg/dL, which should be achievable for most of us. That’s consistent with country-by-country data that suggested death from heart disease would bottom out at a population average of about 100 mg/dL, as seen below and at 5:21 in my video.

    But that’s only if you can keep your LDL cholesterol down your whole life.

    If you’re relying on medication later in life to halt disease progression, you may need to get your LDL below 70 mg/dL, and if you’re trying to use drugs to reverse a lifetime of bad food choices, you may not get to zero coronary heart disease events until your LDL drops to about 55 mg/dL. If your heart disease is so bad that you’ve already had a heart attack but you’re trying not to die from another one, ideally, you might want to push your LDL down to about 30 mg/dL. Once you get that low, not only would you likely prevent any new atherosclerotic plaques, but you’d also help stabilize the plaques you already have so they’re less likely to burst open and kill you.

    Is it even safe to have cholesterol levels that low, though? In other words, can LDL cholesterol ever be too low? We’ll find out next.

    Doctor’s Note

    Didn’t know atherosclerosis could start at such a young age? See Heart Disease Starts in Childhood.

    For more on drugs versus lifestyle, check out my video The Actual Benefit of Diet vs. Drugs.

    Want to learn more about so-called primordial prevention? See When Low Risk Means High Risk.

    Does Cholesterol Size Matter? Watch the video to find out.

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    Michael Greger M.D. FACLM

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  • Donald Trump made big gains with Black voters in 2024. Can Republicans hold them in the midterms?

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    President Donald Trump made major gains with Black voters in 2024. But Black conservative operatives are warning that Republicans shouldn’t take those voters for granted in the midterms — and fall into the same trap they say has tripped up Democrats.

    While most Black voters still support Democrats, Black conservatives argue their community has a strong opportunity in 2026 to build off Trump’s momentum and redefine what conservatism means for an increasingly disgruntled generation of Black voters.

    But the effort from the party to lock in the Trump-era gains has not yet materialized.

    “Republicans have no desire to pander to the Black community, but do I think they could be doing a little bit better of pandering? For sure,” said Harrison Fields, who was a surrogate on the Trump campaign and recently left the White House.

    That means following Trump’s 2024 campaign example, he added, and heading into predominantly Black areas like the Bronx, Chicago and other Black Democratic strongholds.

    “I think showing up is going to be something that matters, and not just showing up at election time,” he said, referring to a common critique Democrats face in their attempts to reach Black voters. “We have a lot of good opportunities to just show up now.”

    In 2024, Trump won 15 percent of Black voters — according to Pew Research’s widely cited validated voter survey — an increase from the 8 percent he won four years earlier. A pre-election Pew poll found that the economy and health care were the most important issues for the voting bloc, ahead of racial and ethnic inequality as the third most important issue.

    Fields argued that the party should zero in on the generational divide in the Black community, suggesting Republicans could have better luck with a younger cohort of voters who haven’t regularly voted Democratic their whole lives.

    “Black voters have been conservative their entire lives,” said Fields, who recently joined Republican lobbying and public affairs firm CGCN. “But if you’re told that the system is stacked against you and one party is the only party that can fix the system and somehow level the playing field or really upend the playing field, you weaponize an emotional trigger for Black voters that allows them to be blind to their core values.”

    Fields acknowledged that Democrats have long been able to capitalize on older Black voters’ concerns around racial equity and justice, but it was Trump’s messaging on the economy that resonated with younger Black voters in 2024.

    In a pre-election survey of young voters of color across battleground states, conducted by Democratic pollster Hart Research, 61 percent of young Black voters identified the economy as their top issue heading into November 2024.

    “I think so many people in the Democratic Party think that the 1965 movement is the same thing that can bring people to the party,” said Fields. “While you have a lot of Black Americans that are still harping on issues in the past, many of them have not been afflicted by racism for segregation or the true injustices that our great grandparents were part of.”

    But even with the growing generational divide, the Republican Party has long struggled to court and retain Black voters, the consultants said, instead focusing on a white working class base.

    “From a historical lens, the approach from the GOP was ‘the Black community is going to go out and vote for Democrats at an alarming rate and we don’t really have a chance, so let’s not even go out there,’” said Quenton Jordan, vice president of the Black Conservative Federation.

    But Trump changed that in 2020, Jordan argued, when the president began trying to swing Black voters to his side — something then-candidate Trump made more explicit four years later.

    Camilla Moore, chair of the Georgia Black Republican Council, said focusing on young Black men under 45 will be important for Republicans in the midterms because the party’s traditional values often resonate with the demographic.

    “Young Black men like the whole idea of feeling manly,” Moore said. “They like the idea of being independent, and they like the idea of being entrepreneurs and controlling their future.”

    Republicans, she added, need to emphasize the importance of a traditional two-parent household on the campaign trail and highlight what policies they’ll enact to support Black entrepreneurship.

    There are, however, already warning signs for Republicans that Trump’s gains with Black voters won’t be permanent.

    In a September poll from Fox News, 77 percent of Black voters said they disapprove of the job Trump is doing as president, and a poll tracker from Decision Desk has Trump’s approval rating among Black Americans hovering at around 70 percent.

    Still, Fields said, the numbers don’t mean Black voters will swing back for Democrats next November. And if he had a choice, he said, he’d rather Black voters stay home than vote for the other party.

    “We need more points on the board than the other side, and if staying on the couch, not showing up is the best we can do right now — then that’s a win,” said Fields.

    Democrats have largely dismissed Republicans’ bravado around Black voters, noting both Trump’s slipping poll numbers and the fact that most Black voters cast their ballots for Democrats.

    But even as Trump’s support weakens with Black Americans in recent polls, Democrats can’t assume Black voters will automatically come back to the party, said Democratic strategist Antjuan Seawright.

    “We cannot make assumptions about any constituency, in particular, younger Black voters,” said Seawright, who consulted on Hillary Clinton’s 2008 and 2016 campaigns and serves as a senior adviser to the Democratic National Committee.

    “Just because folks think that Trump is not doing a good job or not doing the job at all, doesn’t mean that they are squarely sold on the fact that Democrats can do the job,” Seawright added. “There’s still some trust we have to strengthen.”

    The same is true for Republicans, the GOP consultants said. If Republicans are serious about capitalizing on the momentum Trump built, they have to start speaking to Black voters now, the Black Conservative Federation’s Jordan said.

    And, he added, Trump must stay involved.

    “Whether you like him or not, Donald Trump draws attention,” said Jordan. “If we want to see a surge, then the president will have to be just as energized for the midterm elections as he was during his own presidential election.”

    Beyond Trump, Fields said, the Republican Party hasn’t put forth a strong messenger who can credibly reach Black voters — though that doesn’t mean the party doesn’t have options. Fields pointed to South Carolina Sen. Tim Scott and Reps. Wesley Hunt (Texas) and Byron Donalds (Fla.) — and even himself — as possible surrogates.

    Some of the GOP’s rising stars are their Black members of Congress. Scott took the helm of Senate Republicans’ campaign arm for the midterms — a high-profile role that keeps him in the national spotlight and connects him with deep-pocketed donors, both beneficial should he run for president again.

    Two other members are running for governor in 2026: Donalds, who is running with Trump’s blessing in the president’s adopted home state, and Rep. John James (R-Mich.) in his battleground state. Hunt is also weighing joining the messy Senate primary in Texas.

    But Seawright, the Democratic strategist, was doubtful that the five Black Republicans currently serving in Congress would be enough to pull Black voters away from the Democratic Party or serve as a proxy for Trump’s appeal — even while acknowledging Democrats have a lot of work to do.

    “I don’t think any of those people can go into any traditional Black space and advocate with their agenda and be successful,” said Seawright. “But I do think there’s something to be said about people who just feel disconnected from the process and don’t feel like there’s connective tissue to any party, and they find themselves vulnerable.”

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  • Commentary: It’s not just Latinos. Supreme Court says all brown people are suspicious

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    What makes someone suspicious enough to be grabbed by masked federal authorities?

    Is it a Mexican family eating dinner at a table near a taco truck?

    Afghan women in hijabs working at a Middle Eastern market?

    South Asian girls in colorful lehengas, speaking Hindi at an Indian wedding?

    According to Justice Brett M. Kavanaugh, writing a concurrence in the Supreme Court’s emergency ruling allowing roving immigration raids in Los Angeles, any of these could be fair game, using law and “common sense.”

    Brown people, speaking brown languages, hanging out with other brown people, and doing brown people things like working low-wage jobs now meets the legal standard of “reasonable suspicion” required for immigration stops.

    Living while brown has become the new driving while Black.

    Of course, this particular high court ruling — and our general angst — has centered on Latino immigrants. That’s fair, and understandable. In California, about half of our immigrants are from Mexico, and thousands more from other Latin and South American countries.

    But increasingly, especially for newer immigrants, more folks are coming from Africa and Asian countries such as China and India — some of which, you may recall, Donald Trump called “shithole countries” way back in 2018, while questioning why America doesn’t take more immigrants from white places such as Norway.

    It’s a dangerous mistake to think Trump’s immigration purge is just about Latinos. He’s made that clear himself. We have reached the point in our burgeoning white nationalism when our high court has deemed brown synonymous with illegal, regardless of what country that pigment originated in. False distinctions about who is being targeted create divisions at a time when solidarity is our greatest power.

    “It’s really about racial subordination, and this is really about promoting white supremacy in this nation,” George Galvis, executive director of Communities United for Restorative Youth Justice, told me. He’s part Native American and part Latino, and 100% against policies like this one that target people by skin color.

    Mexico, India, China, Iran. People from these places may not always see what they have in common, but let me help you out.

    Racists see two colors: white and not white. Although this particular case was filed on behalf of Latino defendants, there is nothing in it that limits its scope to Latinos.

    “It’s not targeting, you know, Eastern Europeans. It’s not targeting people who are Caucasian,” said Amr Shabaik, legal director of the Council on American-Islamic Relations in L.A., a nonprofit civil rights organization advocating for American Muslims. “This is going to be on Black and brown communities, and that’s who’s going to feel the brunt.”

    For Black Americans, this argument is as old as dirt. Our criminal justice system, our society, has a long and documented history of viewing Black Americans with suspicion — considering it “common sense” to think they’re up to something nefarious for actions like getting behind the wheel of a car. But, for the most part, our courts have frowned upon such obvious racism — though not always.

    That anti-Black discrimination can be seen today in Trump’s deployment of the National Guard into urban centers in what Trump has described as a “war” on crime, a callback to the war on drugs of the 1990s that targeted Black Americans with devastating consequences.

    This ruling on immigration enforcement goes hand-in-hand with that military deployment, two prongs in a strategy to wear away our outrage and shock at the dismantling of civil rights.

    As Justice Sonia Sotomayor pointed out in her dissent, the 4th Amendment is supposed to protect us all from “arbitrary interference” by law enforcement.

    “After today,” she wrote, “that may no longer be true for those who happen to look a certain way, speak a certain way, and appear to work a certain type of legitimate job that pays very little.”

    That makes this ruling “unconscionably irreconcilable” with the Constitution, she wrote.

    ICE has detained about 67,000 people across the country since last October, according to government data. Of those, almost 18,000 are from Mexico. Detentions of people from Guatemala and Honduras add almost 14,000 Latinos to that number. Places including Colombia, Ecuador and Venezuela add thousands more. Certainly, by any measure, Latinos are bearing the brunt of immigration enforcement.

    Other parts of the brown world are not immune, however. More than 2,800 people from India have been detained, as have more than 1,400 Chinese people. Thousands of people from across Africa, including more than 800 Egyptians, have been locked up, too.

    So we are not just talking about Latino people at car washes or Home Depots. We are talking about Artesia’s Little India; Mid-City’s Little Ethiopia; the Sri Lankan community in West Covina.

    We are talking about Sacramento’s Stockton Boulevard, where Vietnamese men congregate in the cafes every afternoon.

    We are talking about the farms, schools and towns of the Central Valley and the Central Coast, where Latino and Asian immigrants grow our food.

    We are talking about cities such as Fremont in the Bay Area, where 50% of the population is Asian, from places including India, China and the Philippines.

    We are talking about California, where immigrants make up 27% of the state’s population, more than double the national average. And yes, many of them lack documents, or live in families of mixed status.

    A recent UC Merced study found that there are about 2.2 million undocumented immigrants in California. Of those, about two-thirds have been here more than a decade, and half have been here for more than 20 years.

    “This isn’t about enforcing immigration laws — it’s about targeting Latinos and anyone who doesn’t look or sound like Stephen Miller’s idea of an American, including U.S. citizens and children, to deliberately harm California’s families and small businesses,” Gov. Gavin Newsom wrote on social media. “Trump’s private police force now has a green light to come after your family — and every person is now a target.”

    Remember a few short months ago when our dear leader swore they were only going after criminals? How quickly did that morph into criminals being anyone who had crossed the border illegally?

    And now, it has openly become anyone who is brown — and we are not even shocked. We are happily debating what the rules of these broad sweeps will be, having given up entirely on the fact that broad sweeps are horrific.

    Do you think it will stop with immigration, or even crime? What about LGBTQ+ people? Or protesters? Who becomes the next threat?

    Immigration sweeps are not a Latino problem, a Latino fear. We have opened the door to target people who “common sense” tells us are un-American.

    The only way to close that door is with our collective strength, undivided by the kind of “common sense” discrimination that men like Kavanaugh embrace.

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    Anita Chabria

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  • What Does the Working Class Really Want?

    What Does the Working Class Really Want?

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    This article was featured in the One Story to Read Today newsletter. Sign up for it here.

    Political partisans are always dreaming of final victories. Each election raises the hope of realignment—a convergence of issues and demographics and personalities that will deliver a lock on power to one side or the other. In my lifetime, at least five “permanent” majorities have come and gone. President Lyndon B. Johnson’s landslide triumph over Barry Goldwater in 1964 seemed to ratify the postwar liberal consensus and doom the Republican Party to irrelevance—until, four years later, Richard Nixon’s narrow win augured an “emerging Republican majority” (the title of a book by his adviser Kevin Phillips) based in the white, suburban Sun Belt. In 1976, Jimmy Carter heralded a winning interracial politics called “the Carter coalition,” which proved even shorter-lived than his presidency. With Ronald Reagan, the conservative ascendancy really did seem perpetual. After the Republican victory in the 2002 midterm elections, George W. Bush’s operative Karl Rove floated the idea of a majority lasting a generation or two.

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    But around the same time, the writers John B. Judis and Ruy Teixeira published The Emerging Democratic Majority, which predicted a decades-long advantage for the party of educated professionals, single women, younger voters, and the coming minority majority. The embodiment of their thesis soon appeared in Barack Obama—only to be followed by Donald Trump and the revenge of the white working class, a large plurality that has refused to fade away.

    Recent American history has been hard on would-be realigners. The two parties are playing one of the longest deuce games since the founding. Even with the structural distortion of the Senate and the Electoral College favoring Republicans, the American people remain closely divided. The Democratic presidential candidate has won seven of the last eight popular votes, while the national vote for the House of Representatives keeps swinging back and forth between the parties. Stymied by a sense of stalemate, both now indulge in a form of magical thinking.

    Neither side believes in the legitimacy of the other; each assumes that the voters agree and will soon sweep it into power. So the result of every election comes as a shock to the loser, who settles on explanations that have nothing to do with the popular will: foreign interference, fraudulent ballots, viral disinformation, a widespread conspiracy to cheat. The Republican Party tries to hold on to power by antidemocratic means: the Electoral College, the filibuster, grotesquely gerrymandered legislatures, even violence. The Democratic Party pursues a majority by demography, targeting an array of identity groups and assuming that their positions on issues will be predictably monolithic. The latter is a mistake; the former is a threat to democracy. Both are ways to escape the long, hard grind of organized persuasion that is politics.

    Two other jarring features define our age of deadlock. One is a radical shift in the two parties’ center of gravity. The signature of elections today is the class divide called education polarization: In 2020, Joe Biden won by claiming a majority of college-educated white voters, the backbone of the old Republican Party. Trump, with a lock on the white working class, lost despite making gains among nonwhite, non-college-educated voters, yesterday’s most reliable Democrats. Meanwhile, on the political stage, cultural and social issues have eclipsed economic issues—even as every facet of American life, whether income or mortality rates, grows less equal and more divided by class.

    These two trends are obviously related, and they have a history. From the late 1970s until very recently, the brains and dollars behind both parties supported versions of neoliberal economics: one hard-edged and friendly to old-line corporate interests such as the oil industry, the other gentler and oriented toward the financial and technology sectors. This consensus left the battleground open to cultural warfare. The educated professionals who dominate the country’s progressive party have long cared less about unions, wages, and monopoly power than about race, gender, and the environment. In the summer of 2020, millions of young people did not come out of isolation to protest the plight of meatpackers laboring in COVID-ridden processing plants. They were outraged by a police killing, and they called for a “racial reckoning”—a revolution in consciousness that ended up having little effect on the lives of the poor and oppressed.

    For their part, Republicans have spoken the traditionalist language of the working class ever since Nixon’s “silent majority”; Trump dropped the mantra of low taxes and deregulation that used to excite the party when it was more upscale, and directed his message to a base that votes on issues such as crime, immigration, and what it means to be an American. More recently, Republican candidates have turned to anti-“woke” rhetoric. In losing its voice as the champion of workers, the Democratic Party lost many of the workers themselves, and during the past half century, the two parties have nearly switched electorates.

    This remapping helps explain the outpouring of new books that pay political attention to those overlooked Americans of all races who lack a college degree, many employed in jobs that pay by the hour—factory workers, home health aides, delivery drivers, preschool teachers, hairdressers, restaurant servers, farm laborers, cashiers. During the pandemic, they were called “essential workers.” Now they’ve been discovered to hold the key to power, giving rise to yet another round of partisan dreaming of realignment, this time hinging on the working class. But these Americans won’t benefit from their new status as essential voters until the parties spend less effort coming up with what they think the working class wants to hear, and more effort actually delivering what it wants and needs.

    The economic decline and political migration of the American working class receive the most compelling treatment in Ours Was the Shining Future: The Story of the American Dream, by the New York Times writer David Leonhardt. He describes the rise and fall, from the New Deal to the present, of what he calls “democratic capitalism”—not a neutral phrase, but a positive term for a mixed economy that benefits the many, not just the few. By now, the story of growing inequality and declining mobility is familiar from the work of Thomas Piketty, Gary Gerstle, Raj Chetty, and other scholars. Leonhardt has a gift for synthesizing complex trends and data in straightforward language and persuasive arguments whose rationality doesn’t fully mute an undertone of indignation. He appreciates the power of stories and weaves obscure but telling events and people into his larger narrative: a 1934 strike in the Minneapolis coal yards that showed the political potential of worker solidarity; the mid-century businessman Paul Hoffman, who argued to members of his own class that they would benefit from a prosperous working class; the pioneering computer programmer and Navy officer Grace Hopper, who saw the economic benefits of military spending on technological research.

    An economy that gives most people the chance for a decent life doesn’t arise by accident or through impersonal forces. It has to be created, and Leonhardt identifies three agents: political action, such as union organizing, that gives power to the have-nots; a civic ethos that restrains the greed of the haves; and public spending on people, infrastructure, and ideas—“a form of short-term sacrifice, an optimistic bet on what the future can bring.”

    All three—power, culture, and investment—combined in the postwar decades to transform the American working class into the largest and richest middle class in history. Black Americans, even while enduring official discrimination and racist violence, closed the gap in pay and life expectancy with white Americans—progress, Leonhardt writes, that “reflected class-based changes more than explicitly race-based changes.” In other words, the right of workers to form unions, an increased and expanded federal minimum wage, and a steeply progressive tax code that funded good schools all reduced racial inequality by reducing economic inequality. But after the 1960s, the economy’s growth slowed, and the balance of power among the classes grew lopsided. American life became stratified. Wealth flowed upward to the few, unions withered, and public goods such as schools starved. In their rush to cash in, elites knocked over taboos that had once restrained the worst extremes of greed. Metropoles prospered and industrial regions decayed. Despite the end of Jim Crow and the growth of a Black professional class, the gap between Black and white Americans began to widen again as the country’s top 10 percent pulled away from the rest.

    This economic analysis comes with a political argument that will not be welcomed by many progressives. Leonhardt places blame for the decline of the American dream where it belongs: on free-market intellectuals, right-wing politicians, corporate money. But he also points to the shortsighted complacency of union leaders, and, even more, the changing values and interests of well-educated, comfortable Democrats. Beginning in the early ’70s, they dropped concern about bread-and-butter issues for more compelling causes: the environment, peace, consumer protection, abortion, identity-group rights. The labor movement lost interest in social justice, and progressive politicians lost interest in the working class. Neither George Meany nor George McGovern sang from the New Deal songbook. After the ’60s, “the country no longer had a mass movement centered on lifting most Americans’ living standards.”

    Why did the white working class abandon the party that had been its champion? “In the standard progressive telling,” Leonhardt writes, “the explanation for this political shift is race.” Race had a lot to do with it, and Leonhardt affirms that Democrats’ embrace of the Black freedom movement in the ’60s, followed by white backlash (exploited by Republicans with their “southern strategy”) and persistent racism, is a major cause. But the progressive telling falls short on three counts. It’s morally self-flattering and self-exonerating; it’s politically self-defeating (accusing voters of racism, even if deserved, is not the way to convince them of anything); and it fails to explain too many recent political trends. For example, nearly all-white West Virginia remained mostly Democratic decades after the passage of the Civil Rights Act and only turned indelibly red in 2000. According to one estimate, almost a quarter of the working-class white voters who gave Trump the presidency in 2016 had voted for a Black president only a few years earlier. The stark polarization of the current college-educated and non-college-educated white electorate shows the key role of class. And what are we to make of an openly bigoted president running for a second term and increasing his share of the Black and Latino vote?

    Leonhardt’s subtler account is rooted in the working class’s growing cultural and economic alienation from a Democratic Party ever more dominated by elites and activists, and out of touch on the issues that hurt less affluent Americans most, especially crime, trade, and immigration. The financial crisis of 2008 was a pivotal event, leaving large numbers of Americans with the sense that the country’s upper classes were playing a dirty game at the expense of the rest.

    That fall, I reported on the presidential campaign in a dying coal town in Appalachian Ohio. To my surprise, its white residents were giving Obama a close hearing, and he ended up doing better in the region than John Kerry had. But at a local party gathering, an older white man told me that neither party had done anything to reverse the decline of his town, and that he would no longer vote Democratic, for one reason: illegal immigration. I listened politely and discounted his grievance—I didn’t see any undocumented immigrants in Glouster, Ohio. Why did he care so much?

    Leonhardt provides an answer. In a comprehensive analysis, he shows that the 1965 Immigration and Nationality Act, which liberal politicians sold as nondiscriminatory but still restrictive, opened the gates to mass immigration. The result put downward pressure on wages at the lower end of the economy. Again, racial resentment partly explains hostility to large-scale immigration, but Leonhardt shows that rapid demographic change can erode the social bonds that make collective efforts for greater equality possible: “Low immigration numbers in the mid-1900s improved the lives of recent immigrants by fostering a stronger safety net for everybody.” As Democrats were reminded in 2022’s midterms, immigration is less popular among working-class Americans of all races than among college graduates. The mayor of my very progressive city, a son of the Black working class, recently sounded like that working-class white ex-Democrat in Ohio when he warned that the arrival of more than 100,000 migrants “will destroy New York.”

    These positions reflect class differences in approaches to morality. Drawing on social-science research, Leonhardt distinguishes between “universal” values such as fairness and compassion, which matter more among educated professionals, and “communal” values such as order, tradition, and loyalty, which count more lower down the class ladder. It shouldn’t be surprising that working-class Americans of color sympathize with migrants but don’t necessarily want an open border, that they fear crime at least as much as police misconduct. But their views confound progressives, who see these issues through the almost metaphysical lens of group identity—the belief that we think inside lines of race, gender, and sexuality, that these accidental and immutable traits dictate our politics.

    illustration with collaged black-and-white photos of Obama, Carter, and Bill Clinton in profile facing a black and white photo of people in construction hats raising American flags on blue and red background
    Illustration by Mike McQuade. Sources: Brooks Kraft / Corbis / Getty; Leif Skoogfors / Getty; Cynthia Johnson / Getty; Bettmann / Getty.

    This worldview provided a sense of meaning to a generation that came of age after 2008, amid upheaval and disillusionment. Because the new progressivism flourished among younger, educated Americans who lived online, its cultural reach was disproportionate, making rapid inroads in universities, schools, media, the arts, philanthropy. But its believers badly overplayed their hand, giving Republicans easy wins and driving away ordinary Democrats. Americans remain a wildly diverse, individualistic, aspirational people, with rising rates of mixed marriage, residential integration, and immigration from all over the world. Any rigid politics of identity—whether the left’s obsession with “marginalized communities,” or its sinister opposite in the reactionary paranoia of “white replacement theory”—is bound to shatter against the realities of American life.

    Identity politics has been a feverish interlude following the demise of the neoliberal consensus that prevailed from Reagan to Obama. What will take its place? Leonhardt hopes for a Democratic Party that learns how not to alienate the nearly two-thirds of Americans without a college degree. He believes that education can be a force for upward mobility, but that the current version of meritocracy—built-in advantage at the top, underfunding below—has created a highly educated aristocracy. He advises a renewed emphasis on economic populism, a hard line on equal rights for all but reasonable compromise on other controversial social issues, and a general attitude of respect. His hero is the martyred Robert F. Kennedy, whose 1968 presidential campaign was the last to unite working-class Americans of all colors.

    A version of the same argument, with less historical depth and feeling but more charts and polemics, can be found in John B. Judis and Ruy Teixeira’s Where Have All the Democrats Gone? The Soul of the Party in the Age of Extremes. Judis and Teixeira have been explaining their earlier book’s thesis for two decades even as the majority of its title kept failing to emerge. Now they diagnose their error: “What began happening in the last decade is a defection, pure and simple, of working-class voters. That’s something that we really didn’t anticipate.” Like Leonhardt, they call on Democrats to embrace New Deal–style “economic liberalism” (but not Green New Deal–style socialism) and to reject “today’s post-sixties version of social liberalism, which is tantamount to cultural radicalism.” In a series of scathing chapters, Judis and Teixeira show how far left the Democrats’ “shadow party” of activists, donors, and journalists has moved in the past 20 years on immigration, race, gender, and climate.

    The authors want a return to the party’s cultural centrism of the ’90s. Instead of decriminalizing the border, which most 2020 Democratic presidential candidates advocated, they call for tighter border security, enforcement of laws that prohibit hiring undocumented immigrants, and a way for those already here to become citizens. They show that middle-ground policies like these and others—the pursuit of racial equality that focuses on expanding opportunity for individuals, not equity of group outcomes; support for equal rights for trans Americans without insisting on a gender ideology that denies biological sex—remain majority views, including among nonwhite Americans. Judis and Teixeira are less persuasive on climate change: Although their gradualism might be politically helpful to Democrats, the country and the planet will be at the mercy of extreme weather that’s indifferent to such messaging.

    Joshua Green’s fast-paced, sober, yet hopeful The Rebels: Elizabeth Warren, Bernie Sanders, Alexandria Ocasio-Cortez, and the Struggle for a New American Politics argues that a Democratic renewal is already under way. Like Leonhardt, Judis, and Teixeira, Green traces the Democrats’ estrangement from working Americans back to the ’70s; he begins his story with a moment in 1978, when Jimmy Carter abandoned unions for Wall Street. The narrative reaches a climax in 2008, when the financial crisis destroyed home values and retirement savings while taxpayer dollars rescued the banks that had triggered it, convincing large numbers of Americans that the system was rigged by financiers and politicians. Because of policy choices by the Obama administration—Democrats’ last spasm of neoliberalism—much of the blame fell on the former party of the common people.

    Yet out of the wreckage rose a new group of Democratic stars who sounded like their New Deal predecessors, many of whom were every bit as radical. Taking aim at corporate elites, Green’s protagonists want to increase economic equality through worker power and state intervention. Though Sanders and Warren failed as presidential candidates, Green argues that their populism transformed the party, including the formerly moderate Joe Biden, who has pushed a remarkably ambitious legislative agenda with working-class interests at its center.

    Green is a first-rate journalist, but his book suffers from a blind spot: It ignores the role of culture in the party’s struggles with the working class. His analysis omits half the story until the 2016 election, when, he acknowledges, Trump “reshuffled Democratic priorities. As he moved cultural issues to the center of national political conflict, race, gender, and immigration eclipsed populist economics as the focus of the liberal insurgency.” In the face of Trump’s bigotry, Democrats felt compelled to adopt the “maximalist” positions of activists, assuming that these would align the party with “the groups on the receiving end of Trump’s ugliest barbs,” such as Latino immigrants. Instead, the party’s working-class losses began to extend beyond white voters. Green’s answer is to double down on economic populism: “Rather than fear the Republicans’ culture wars—or respond to them by racializing policies that benefit everyone—Democrats should take the opportunity to reestablish the party as serving the interests of working people of every race and ethnicity.”

    None of these books offers a shortcut to a new Democratic majority. The erosion of working-class support is too old and too severe to be easily reversed. In fact, it’s the Republican pollster Patrick Ruffini, in Party of the People: Inside the Multiracial Populist Coalition Remaking the GOP, who imagines a coming realignment—for Republicans. Ruffini can’t resist making the case that, in addition to transforming the party, this coalition could become the next permanent majority. To do so, he breezes through some of the same history, and reaches a similar conclusion: Democrats have fallen into a “cosmopolitan trap,” losing their hold on a key constituency in the process.

    Ruffini’s most original contribution is to apply close statistical analysis to the past few election cycles as he builds his case for a Republican multiracial coalition. He supplies strong evidence of the moderate social views of most Black, Latino, and Asian American voters. On that basis, Ruffini doesn’t think Democrats can win back their lost supporters just by changing the subject to class. “Democrats may calculate that, simply by focusing on economic issues, they can keep cultural issues from eating into their base,” but they’re wrong, he writes. “When voters’ economic views and social views are in conflict, one’s social stances more often drive voting behavior … Cultural divides are what voters vote on even if politicians don’t talk about them.” Ruffini offers no data to support this conclusion, but it underpins his counsel for a politician like Biden. Never mind his legislative accomplishments that benefit the working class; what he really needs, Ruffini advises in political-operative mode, is a “hard pivot against the cultural left”—he seems to have in mind a Sister Souljah moment—to neutralize Republican attacks.

    Though Ruffini doesn’t spend much time on economic policy, it’s worth noting that a few high-profile Republicans have recently discovered that monopolistic corporations can be oppressors, that capitalism tears communities apart. Senators Josh Hawley of Missouri and Marco Rubio of Florida, as well as other politicians, limit this insight to their partisan enemies in Silicon Valley, but a few conservative writers, such as Sohrab Ahmari, the author of Tyranny, Inc.: How Private Power Crushed American Liberty—And What to Do About It, are open to ideas of social democracy. This internal party battle between the old libertarians and the new egalitarians doesn’t seem to interest Ruffini; oddly, given his populist ambitions, he remains unmoved by the anti-corporate critique. Nor does he have much to say about the Republican Party’s descent with Trump into authoritarian nihilism.

    Ruffini’s formative years as a professional Republican came during the George W. Bush presidency, and his thinking hasn’t kept up with the America of fentanyl and Matt Gaetz. The populist future of Ruffini’s desires is a wholesome mixture of culturally conservative, “pro-capitalist” families and low taxes. His “commonsense majority” would combine white people who didn’t graduate from college and nonwhite people of all classes, because “the education divide makes a much bigger difference in the attitudes of whites than it does among nonwhites.” It sounds like a twist on the Judis-Teixeira emerging majority of two decades ago. Demography as destiny seduces realigners on both sides.

    Ruffini recognizes that Republicans are a long way from attracting enough nonwhite voters to achieve his majority. But, he argues, if the party battles job discrimination based on a college degree, makes voting Republican socially acceptable among Black Americans, and apologizes for the southern strategy, his goal could be realized by 2036. By then, the Democratic Party would presumably be a pious rump of overeducated white people demanding open borders and anti-racist math.

    These writers are all trying to solve a puzzle: One party supports unions, the child tax credit, and some form of universal health care, while the other party does everything in its power to defeat them. One president passed major legislation to renew manufacturing and rebuild infrastructure, while his predecessor cut taxes on the rich and corporations. Yet polls since 2016 have shown Republicans closing the gap with Democrats on which party is perceived to care more about poor Americans, middle-class Americans, and “people like me.” During these years, the energy on the left has been fueled by an identity politics that resisted Trump and became the orthodoxy of educated progressives, with its own daunting lexicon. Many Democrats fell silent, out of fear or shame or confusion.

    Now, encouraged perhaps by the excesses and failures of a professional-class social-justice movement, and by the relative success of Biden’s pro-worker agenda, they seem to be finding their voice. Judis and Teixeira cite polling data from Wisconsin and Massachusetts as evidence that Americans are less divided on cultural issues than activists on both sides, who benefit by stoking division, would like: “If you look at the country’s voters, and put aside the culture wars, what you find are genuine differences between the parties’ voters over economic issues.” The real disagreements have to do with taxation, regulation, health care, and the larger problem of inequality. Democrats’ way forward seems obvious: emphasize differences on economics by turning left; mute differences on culture by tacking to the middle. If the party can free itself from the moneyed interests of Wall Street and Silicon Valley, and the cultural radicalism of campus and social media, it might start to win in red states.

    I want Leonhardt, Judis, Teixeira, and Green to be right. Having long held the same views, I’m an ideal audience for these books and other new ones making related arguments, such as Yascha Mounk’s The Identity Trap: A Story of Ideas and Power in Our Time, Susan Neiman’s Left Is Not Woke, and Fredrik deBoer’s How Elites Ate the Social Justice Movement. Yet the solutions that some of them propose for the Democrats’ working-class problem leave me with a worrying skepticism. In an age of shredded social bonds and deep distrust of institutions, especially the federal government, we can’t go back to New Deal economics. If Ruffini is right, the culture wars aren’t easily put aside. “Guns and religion,” in Obama’s unfortunate phrase, are genuinely held values, not just proxies for economic grievance; conservative politicians manipulate them, but they aren’t inauthentic. Race and gender are more important categories than class for millions of Americans, especially younger ones. Illegal immigration legitimately vexes citizens living precarious lives. Social issues aren’t manufactured by power-hungry politicians to divide the masses. They matter—that’s why they’re so polarizing.

    The working class is immense, varied, and not all that amenable to being led. It’s more atomized, more independent-minded, more conspiracy-minded and cynical than it was a couple of generations ago. Although unions are gaining popularity and energy, only a tenth of workers belong to one. Abandoned to an unfair economy while the rich freely break the rules, bombarded with images of fame and wealth, awash in drugs, working-class Americans are less likely to identify with underdogs like Rocky and Norma Rae or the defeated heroes of Springsteen songs than to admire celebrities who pursue power for its own sake—none more so than Trump.

    The argument over which matters more, economics or culture, may obsess the political class, but Americans living paycheck to paycheck, ill-served by decades of financial neglect and polarizing culture wars, can’t easily separate the two. All of it—wages, migrants, police, guns, classrooms, trade, the price of gas, the meaning of the flag—can be a source of chaos or of dignity. The real question is this: Can our politics, in its current state, deliver hard-pressed Americans greater stability and independence, or will it only inflict more disruption and pain? The working class isn’t a puzzle whose solution comes with a prize—it isn’t a means to the end of realignment and long-term power. It is a constituency comprising half the country, whose thriving is necessary for the good of the whole.


    This article appears in the January/February 2024 print edition with the headline “What Does the Working Class Really Want?”


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    George Packer

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  • How Black Americans Kept Reconstruction Alive

    How Black Americans Kept Reconstruction Alive

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    The Civil War produced two competing narratives, each an attempt to make sense of a conflict that had eradicated the pestilence of slavery.

    Black Americans who believed in multiracial democracy extolled the emancipationist legacy of the war. These Reconstructionists envisioned a new America finally capable of safeguarding Black dignity and claims of citizenship. Black women and men created new civic, religious, political, educational, and economic institutions. They built thriving towns and districts, churches and schools. In so doing, they helped reimagine the purpose and promise of American democracy.

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    For a time after the war, Black Reconstructionists also shaped the American government. They found allies in the Republican Party, where white abolitionists hoped to honor freedpeople’s demands and to create a progressive country in which all workers earned wages. Republicans in Congress pushed through amendments abolishing slavery, granting citizenship, and giving Black men the ballot. Congress also created the Freedmen’s Bureau, which offered provisions, clothing, fuel, and medical assistance to the formerly enslaved, and negotiated contracts to protect their newly won rights. With backing from the Union army, millions of Black people in the South received education, performed paid labor, voted in presidential elections, and held some of the highest offices in the country—all for the first time.

    Black Reconstructionists told the country a new story about itself. These were people who believed in freedom beyond emancipation. They shared an expansive vision of a compassionate nation with a true democratic ethos.

    Those who longed for the days of antebellum slavery felt differently. Advocates of the Lost Cause—who believed that the South’s defeat did nothing to diminish its moral superiority—sought to “redeem” their fellow white citizens from the scourge of “Negro rule.” Redemptionists did more than offer a different story about the nation. They demanded that their point of view be sanctified with blood. They threatened the nation’s infrastructure and institutions, and backed up their threats with violence.

    The Redemption campaign was astoundingly successful. Intimidation and lynchings of Black voters and politicians quickly reversed gains in turnout. Reprisals against any white person who supported Black civil rights largely silenced dissent. This second rebellion hastened the national retreat from Reconstruction. Federal troops effectively withdrew from the Confederate states in 1877. White southerners soon dominated state legislatures once again, and passed Jim Crow laws designed to subjugate Black people and destroy their political power.

    The official Reconstruction timeline usually ends there, in 1877. But this implies that the Reconstructionist vision of American democracy ceased to exist, or went dormant, without the backing of federal troops. Instead, we should consider a long Reconstruction—one that stretches well beyond 1877, and offers a view that transcends false binaries of political failure and success.

    This view allows us to follow the travails of the Black activists and ordinary citizens who kept the struggle for freedom and dignity alive long after the Republican Party and white abolitionists had abandoned it. Black institutions, including the church, the schoolhouse, and the press, kept public vigil over promises made, broken, and, in some instances, renewed during the long march toward liberation. Their stories show that freedom’s flame, once boldly lit, could not be extinguished by the specter of white violence.

    The concept of a long Reconstruction recognizes that a nation can be two things at once. After 1877, freedom and repression journeyed along parallel paths. Black Americans preserved a vision of a truly free nation in an archipelago of communities and institutions. Many of them exist today, and continue their work. This, perhaps, is the most important reason to resist the idea that Reconstruction ended when the North withdrew from the South: In a sense, the work of Reconstruction never ended, because the goal of a multiracial democracy has never been fully realized. And America has made its greatest gains toward that goal when it has rejected the Redemptionist narrative.

    That the work of Reconstruction continued well after 1877 is illustrated by the life of Ida B. Wells, a woman who witnessed the death of slavery and fought against the beginning of Jim Crow. Wells kept alive the radical ideals of the Reconstructionists and punctured, through her journalism, the virulent mythology peddled by the Redemptionists. When Wells was born—in Holly Springs, Mississippi, on July 16, 1862—her parents, Jim and Lizzie Wells, were enslaved. Later that year, the Union army took control of the town while staging an attack on Vicksburg. As they did elsewhere across the dying Confederacy, enslaved people in and around Holly Springs fled plantations for Union lines and emancipated themselves. But freedom proved contingent. Even when Union General Ulysses S. Grant made his headquarters in the town, Black refugees feared reprisals from their former enslavers. Their vulnerability to white violence, even under the watch of Union troops, foreshadowed the coming era.

    After the war, Jim and Lizzie Wells chose to stay in Holly Springs. Jim joined the local Union League, which supported Republican Party politics and was committed to advancing Black male suffrage. In fall 1867, when Ida was 5 years old, her father cast his first ballot. Ida remembered her mother as an exemplar of domestic rectitude whose achievements were reflected in her children’s perfect Sunday-school attendance and good manners.

    Ida grew up in a Mississippi full of miraculous change. She attended the first “colored” school in Holly Springs, a remarkable opportunity in a state that had been considered the most inhospitable to Black education and aspiration in the entire Confederacy. As a young girl, Ida read the newspaper aloud to her father’s admiring friends; just a few years earlier, it would have been illegal in Mississippi to teach her the alphabet.

    In 1874, when Wells was 12, 69 Black men were serving in the Mississippi legislature, and a white governor, Adelbert Ames—placed in office partly by the votes of the formerly enslaved—promised to commit the state to equality for all. Around that time, Mississippi’s secretary of state, superintendent of education, and speaker of the House were all Black men.

    The world around Ida was full of fiercely independent and economically prosperous Black citizens. These attainments buoyed her optimism for the rest of her life.

    But the idyll of her childhood was brief. Redemptionist forces in Mississippi struck back against Black political power with naked racist terror. In December 1874, a white mob in Vicksburg killed as many as 300 Black citizens after forcing the elected Black sheriff, Peter Crosby, to resign. Massacres and lynchings continued unabated across the state through 1875. By 1876, the number of Black men in the state legislature had fallen by more than half. Following the contested election that year, the new president, the Republican Rutherford B. Hayes, ordered the remaining active northern troops in the South to return to their barracks. Without the protection of federal troops, and with the symbolic abandonment by the president, Black people were on their own, completely vulnerable to voting restrictions, economic reprisals, and racial violence.

    For Wells, the collapse of Reconstruction came at a moment of profound personal struggles. In 1878, her parents and one of her brothers died in a yellow-fever outbreak that killed hundreds in Holly Springs, leaving her, at 16, to care for five siblings, including her disabled sister, Eugenia. After Eugenia died, Wells moved to Memphis at the invitation of an aunt.

    Wells’s escape from Mississippi did not protect her from the indignities of racism. In 1883, after a visit to Holly Springs, Wells purchased a train ticket back to Memphis, riding first class on a segregated train. She moved to the first-class car for white ladies after being bothered by another passenger’s smoking, and refused to go back to Black first class. Though barely five feet tall, Wells stood her ground until the white conductor physically removed her. She promptly filed suit and, initially at least, won $700 in damages before her two cases were reversed on appeal by the Tennessee State Supreme Court.

    The defeat spurred Wells to find another means of fighting Jim Crow. She longed to attend Fisk University, and took summer classes there. By the end of the decade, she had become the editor and a co-owner of the Memphis Free Speech and Headlight, the newspaper founded by the Beale Street Church pastor Taylor Nightingale.

    Wells took over editorial duties amid a surge of anti-Black violence, which had remained a feature of the South even after the Redemptionists achieved their goal of removing federal troops from the region. In the 1880s, the incidents began to intensify. In 1886, at least 13 Black citizens were lynched in a Mississippi courthouse, where free Black men were testifying against a white lawyer accused of assault. Attacks on Reconstructionists continued from there. The more that Black men and women engaged in political self-determination—choosing to own homes and businesses, to defend their families—the more thunderbolts of violence struck them. The bloodshed of Redemption was intended to touch the lives of all Black people in the South.

    On March 9, 1892, that violence came to Wells’s life, when a mob of 75 white men in Memphis kidnapped three Black men: Thomas Moss, Calvin McDowell, and Will Stewart. Moss was an owner of the People’s Grocery, an upstart Black cooperative that competed with the local grocery owned by William Barrett, who was white. The rivalry between the stores had escalated into a larger racial conflict, and Moss, McDowell, and Stewart had been sent to jail after guns were fired at a white mob that had attacked the People’s Grocery. Wells knew Moss and his wife, Betty, whom she considered one of her best friends. She was godmother to their daughter Maurine.

    Moss, McDowell, and Stewart were given no due process or trial. Another mob took the men from jail and shot each to death, refusing Moss’s plea to spare his life for the sake of his daughter and pregnant wife. Their bodies were left in the Chesapeake & Ohio rail yard. The white-owned Memphis Appeal-Avalanche documented the horrors as fair justice for the troublesome Black men who had dared to fight white men.

    In the Free Speech, Wells wrote a series of editorials decrying the killings and the constant threat of violence that Black Americans faced in the South, and urged northerners to renew their support for full Black citizenship. In one of those editorials, Wells called out the “threadbare lie that Negro men rape white women,” which was the justification for many lynchings. She filed the editorial shortly before a trip to the North. While she was gone, a group of men went to the Free Speech’s offices and destroyed the printing press, leaving a note warning that “anyone trying to publish the paper again would be punished with death.” She chose not to return to Memphis, and continued her campaign from New York.

    That June, Wells wrote an essay, “The Truth About Lynching,” in the influential Black newspaper The New York Age. Wells reasoned that most anti-Black violence claimed its roots in economic competition, personal jealousy, and white supremacy. She also dispelled, again, the myth of Black-male sexual violence against white women. Wells pointed instead to the number of mixed-race children in the old Confederacy—evidence of the sexual violence that white men had inflicted on Black women.

    Wells’s activism was more than a crusade to end lynching. She traveled the country and Great Britain to describe her vision of multiracial democracy. Frederick Douglass, who had escaped slavery and become the foremost civil-rights activist and journalist of the antebellum and Reconstruction eras, admired Wells and characterized her contributions as a “service which can neither be weighed nor measured.”

    Wells first met Douglass in the summer of 1892, when he was 74; Douglass had written a letter to her saying he was inspired by her courage. The two developed a close friendship. “There has been no word equal to it in convincing power,” Douglass wrote of Southern Horrors, a pamphlet Wells published in 1892 based on her groundbreaking anti-lynching essay. The pair corresponded and worked together for the rest of Douglass’s life. With his death, in 1895, a torch was passed.

    Wells’s efforts, in a period of racial fatigue among white audiences, helped continue the central political struggle of Reconstruction. She delivered hundreds of speeches, organized anti-lynching campaigns, and worked to galvanize the public against the Redemptionists. Wells told America a story it needed, but did not want, to hear.

    Wells’s work also intersected with that of W. E. B. Du Bois, the scholar, journalist, and civil-rights activist who took a forceful stand against lynching. Their relationship was sometimes collegial, sometimes contentious; Wells never found with Du Bois the same rapport she’d had with Douglass. But she supported Du Bois’s then-radical view of the importance of Black liberal-arts education, and Du Bois was shaped by Wells’s advocacy and critiques.

    Du Bois viewed the legacy of Reconstruction as crucial to understanding America. At the behest of another Black intellectual and scholar, Anna Julia Cooper, he published in 1935 his monumental Black Reconstruction. The book traced the origins of the violence that Wells denounced. He wrote that “inter-racial sex jealousy and accompanying sadism” were the main basis of lynching, and echoed Wells’s argument that white men’s violence against Black women had been the true scourge of the South. Du Bois also wrote that the Reconstructionists were engaged in “abolition-democracy,” which he defined as a broader movement for social equality that went beyond political rights.

    Du Bois’s scholarship paved the way for a reconsideration of the era. He challenged the Redemptionist narrative of venal corruption and Black men who were either in over their head or merely served white northern puppet masters and southern race traitors.

    Du Bois’s work is a starting point for contemporary histories. Eric Foner’s magisterial Reconstruction: America’s Unfinished Revolution, 1863–1877, published more than half a century after Black Reconstruction, added texture to the story of the period, then largely untold. Foner’s work reframed the era as an unfinished experiment in multiracial democracy.

    In this tradition of expansion, the historian Steven Hahn’s Pulitzer Prize–winning A Nation Under Our Feet, published in 2003, widens earlier historical frameworks by looking beyond Reconstruction’s constitutional reforms. Hahn sought out the Black men and women who shaped Reconstruction at the state and local levels. More recently, the historian Kidada E. Williams’s I Saw Death Coming focuses on the daily lives of Black men and women during Reconstruction—witnesses to the violence of Redemption.

    All of these works expand our conception of what Reconstruction was, and challenge the notion that the era came to an abrupt ending in 1877. They portray the era as a contested epic, where parallel movements for Reconstruction and Redemption rise, fall, and are recovered.

    I first learned about Reconstruction from my late mother, Germaine Joseph, a Haitian immigrant turned American citizen whose love of history could be gauged by the crammed bookcases in our home in Queens, New York. My first lesson on Reconstruction came in the form of a story about Haiti’s revolution. Mom proudly informed me that Haiti had been the key to unlocking freedom for Black Americans: The Haitian Revolution, she explained, led to revolts of the enslaved, frightened so-called masters, and inspired Frederick Douglass.

    Later, I found my way back to Reconstruction through an interest in the Black radical tradition, especially post–World War II movements for racial justice and equality. My mentor, the late historian Manning Marable, described the civil-rights movement, and the age of Black Power that followed, as a second Reconstruction. During this time, with a renewed interest in slavery and its aftermath, scholars rediscovered Du Bois’s work.

    My research and writing of late has revolved around interpreting the past 15 years of American history, from Barack Obama’s ascent to the White House in 2008, to the rise of the Black Lives Matter movement in 2013, to Donald Trump’s 2016 presidential election, to the events that followed George Floyd’s murder in 2020. In my 2022 book, The Third Reconstruction, I argued that we might be living through another era filled with the kind of dizzying possibility and intense backlash that whipsawed the South during Wells’s life.

    Today’s Reconstructionists have a vision for multiracial democracy that might astonish even Douglass, Wells, and Du Bois. Black women, queer folk, poor people, disabled people, prisoners, and formerly incarcerated people have adopted the term abolition from Du Bois’s idea of abolition-democracy, and now use it to refer to a broad movement to dismantle interlocking systems of oppression—many of which originated in Redemption policy. They have achieved important victories in taking down Confederate monuments; sharing a more accurate telling of America’s origin story and its relationship to slavery; and questioning systems of punishment, surveillance, and poverty.

    But today’s Redemptionists have had their victories as well. Their apocalyptic story of the present, one in which crime and moral decay threaten to destroy America, rationalizes a return to a past America and aims to dismantle the Reconstruction amendments that underpin fundamental civil rights. Redemptionists promote a regime of education that reverses the gains historians have made since the revival of Black Reconstruction.

    The health of American democracy continues to rest upon whether we believe the Reconstructionist or Redemptionist version of history. Reconstruction, as a belief, as an ideal, outlasted the federal government’s political commitments by decades. Black people, the country’s most improbable architects, continued to make and shape history by preserving this rich legacy, and bequeathing it to their children. Their story has remained the heart of the American experiment both when the country has acknowledged them—and, most especially, when it has not.


    This article appears in the December 2023 print edition with the headline “The Revolution Never Ended.” When you buy a book using a link on this page, we receive a commission. Thank you for supporting The Atlantic.

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    Peniel E. Joseph

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  • The Men Who Started the War

    The Men Who Started the War

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    Harpers Ferry seemed almost a part of the neighborhood when I was growing up. Granted, it was across the state line, in West Virginia, and slightly more than a half-hour drive away from our Virginia farm. But it took us almost that long to get to the nearest supermarket. And I felt connected by more than roads. The placid, slow-moving Shenandoah River, which flowed past our bottom pasture, becomes raging white water by the time it joins the Potomac River at Harpers Ferry, 35 miles downstream.

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    Nature itself seems to have designed Harpers Ferry to be a violent place. Cliffs border the confluence of the two rivers, and the raw power generated by their angry convergence made the site ideal for the national armory established there around 1800. It manufactured some 600,000 firearms before Union troops burned it down in 1861 to keep it out of Confederate hands. Five battles took place at Harpers Ferry, and the town changed hands 12 times.

    But none of this is what Harpers Ferry is primarily remembered for. It is known instead for an event referred to at the time as an “insurrection,” a “rebellion,” or a “crusade,” but today most often called just a “raid.” On October 16, 1859, a year and a half before the attack on Fort Sumter, in South Carolina, the white abolitionist John Brown set out to seize the federal arsenal and distribute arms to enable the enslaved to claim their freedom. His effort ended quickly and ignominiously. Badly wounded, he was carted off to jail in nearby Charles Town to be tried and executed, as were a number of his followers. In a sense, though, his insurrection was never put down.

    Brown, a brilliant publicist, made himself a martyr. He used the six weeks between his capture and his execution to define and defend his actions. He grounded them in a moral imperative to free the enslaved, invoked the nation’s revolutionary legacies, and warned of the conflagration to come. The “crimes of this guilty land,” he scrawled in a note he pressed on a guard shortly before his hanging, “will never be purged away; but with Blood.”

    Within just a few years, Americans would look back at Brown across the gulf of the Civil War and identify him as a sign of what was ahead, imbuing his sacrifice with almost supernatural meaning. Showers of meteors had filled the skies in the weeks between Brown’s capture and his execution, reinforcing perceptions that his life and death had been a singular, numinous occurrence. In the words of a song improvised by a battalion of Union soldiers as they headed south to war not two years after his death, “John Brown’s body lies a-mouldering in the grave, but his soul goes marching on.” Even the attendees at his hanging seemed in retrospect to prefigure the future: Brevet Colonel Robert E. Lee was present as the commander of the U.S. troops who had captured Brown. Thomas J. (not yet “Stonewall”) Jackson led a unit of Virginia Military Institute cadets. John Wilkes Booth, President Abraham Lincoln’s future assassin, hurried from Richmond to Charles Town in a borrowed uniform to join a militia troop sent to police the hanging. He hated Brown’s cause but admired his audacity.

    Many upstanding northern citizens—as well as much of the press—condemned Brown’s lawlessness. But others, Black and white, hailed his attack on slavery and mourned his death. On the day of his execution, 3,000 people gathered in Worcester, Massachusetts, to honor Brown; 1,400 attended a service in Cleveland. A gathering of Black Americans in Detroit honored the “martyr” who had “freely delivered up his life for the liberty of our race in this country.” The celebration of John Brown by Black Americans rested in the hope, and later the conviction, that his actions had set an irreversible course toward freedom—a second founding, its birth in violence as legitimate as the first one had been.

    When does war start? When does violence become justified? When does it shift from prohibited to permitted and even necessary? Those questions hang in the air at Harpers Ferry, compelling us to ask: When did the Civil War actually begin—and end?

    Brown drew the admiring attention of almost every prominent American writer—Emerson, Thoreau, Whitman, Melville, Longfellow, Whittier. But some among the nation’s northern elite did more than praise and defend Brown. Thinking back in his autobiography to events half a century earlier, and relying on a diary he kept in the 1850s, the abolitionist and writer Thomas Wentworth Higginson reflected on what a duty to morality demands when “law and order” stand on “the wrong side” of right and justice.

    For him, this was not a theoretical question. He was thinking about the role he’d played long before armies massed on battlefields. He was thinking about the process by which “honest American men” had evolved into “conscientious law-breakers,” until “good citizenship” became a “sin” and bad citizenship a “duty.” Higginson was one among a small group of prominent white men who had known about the Harpers Ferry raid in advance and provided the financial support that enabled Brown to buy weapons and equipment. They came to be known as the Secret Six.

    During the 1850s, a succession of legislative and judicial measures had tightened slavery’s grip on the nation. The Fugitive Slave Act of 1850 compelled the North to become complicit in returning those who had escaped slavery to southern bondage. The Kansas-Nebraska Act of 1854 overturned the Missouri Compromise of a generation earlier, which had restricted the expansion of slavery into the northern territories. The Supreme Court’s Dred Scott decision, in 1857, established that no Black person could be considered a citizen or hold any “rights which the white man was bound to respect.” The perpetuation of slavery and racial injustice appeared to have become enshrined as an enduring national commitment, with the federal government assuming the role of active enforcer. Faced with such developments, the Black abolitionist Frederick Douglass found himself losing hope of ending slavery through moral suasion or political action; he came to see violence as necessary if emancipation was ever to be accomplished. Slavery itself, he believed, represented an act of war. The justification for violence already existed; whether—and how—to use it became more a pragmatic decision than a moral one.

    White abolitionists, too, became radicalized by the developments of the 1850s. The group that became the Secret Six included five Boston Brahmins and a lone New Yorker, all highly respectable citizens, well educated, of good families and heritage; all men of means and in several cases very substantial means. The path that the Six took toward violence began with the passage of the Fugitive Slave Act. The prospect and, soon, the reality of Black people being apprehended on the streets of Boston or New York and summarily shipped to the South brought the cruelty and arbitrariness of slavery directly before northerners’ eyes. Three men who would later be part of the Six were early members of the Boston Vigilance Committee, established to prevent the enforcement of fugitive-slave legislation.

    Samuel Gridley Howe was a graduate of Brown University and Harvard Medical School. He claimed descent from a participant in the Boston Tea Party, and had demonstrated his commitment to republican government by serving as a surgeon in the Greek Revolution in the 1820s.

    Theodore Parker was a powerful preacher and Transcendentalist whose radicalism so marginalized him within Unitarianism that he established his own independent congregation of some 2,000 members. His oratory attracted legions of followers, who shared his reformist and antislavery views.

    Higginson, descended from one of the original settlers of the Massachusetts Bay Colony, was a graduate of Harvard College and Harvard Divinity School and held a pulpit with a fervently antislavery Worcester congregation. He suffered his first battle wound in the unsuccessful effort to free Anthony Burns, who had fled enslavement in Virginia and was seized in Boston in 1854 under the provisions of the new act. With the encouragement of the Boston Vigilance Committee, the city erupted. Parker incited a crowd with a fiery speech at Faneuil Hall, and Higginson distributed axes to those assembled outside the courthouse where Burns was being held. He himself led an assault on the building with a battering ram. In the ensuing melee, a courthouse guard was killed and Higginson suffered a saber wound on his chin, leaving a scar he proudly displayed for the rest of his life. Higginson viewed the effort to free Burns as the beginning of a “revolution”—the shift from words to action he had sought. The killing of the guard, he later reflected, was “proof that war had really begun.” Violence had become both necessary and legitimate. (Burns was captured and returned to Virginia, but his freedom was eventually purchased by northern abolitionists. He attended Oberlin and became a minister.)

    Higginson, Parker, and Howe soon turned their attention to Kansas, where a battle was escalating over whether the territory should become a slave state or a free state. In the spring of 1856, proslavery forces attacked a town founded by antislavery settlers from Massachusetts. John Brown, a longtime opponent of slavery who had joined his sons in Kansas with the intention of preventing its permanent establishment there, sought retribution; he and his allies killed five proslavery men in front of their families in a place called Pottawatomie. This murderous act hovered over Brown’s reputation—and later his legacy—instilling doubts in some potential supporters and leading others simply to deny that Brown had played a role in the killings, a stance that was aided by Brown’s own misrepresentations.

    But to many, Brown’s extremism was a source of attraction, not revulsion. The newly created Massachusetts State Kansas Aid Committee channeled outside support. Higginson sent crates of rifles, revolvers, knives, and ammunition, as well as a cannon, to Kansas. He celebrated Kansas as the equivalent of Bunker Hill—a “rehearsal,” he later called it, for the more extensive violence to come.

    It was because of Kansas that the six men who would conspire to support the Harpers Ferry raid found one another and identified Brown as the instrument of what they had come to regard as necessary violence. Like Parker, Higginson, and Howe, Franklin Benjamin Sanborn and George Luther Stearns had become active supporters of the Massachusetts State Kansas Aid Committee. A Harvard graduate who was a schoolteacher in Concord, Sanborn had been deeply influenced by Parker’s preaching while he was in college. Sanborn’s Transcendentalist ideas, with their skepticism about existing social structures and institutions, were further reinforced by his Concord neighbors Ralph Waldo Emerson and Henry David Thoreau. Stearns was a wealthy manufacturer whose ancestors included some of the original settlers of the Massachusetts Bay Colony as well as an officer in the American Revolution. Long active in abolition, he had established a station of the Underground Railroad near his Medford home and drew on his considerable fortune to send weapons to Kansas free-state settlers.

    The last of the Six was Gerrit Smith, said to be the wealthiest man in New York State. Smith, like Stearns, would supply significant financial support to Brown. He had long been active in politics, seeking the destruction of slavery through political means, but by 1856 he had come to believe that it was time, as he put it, to move beyond ballots and start “looking to bayonets.” Parker, too, was preaching more forceful measures. “I used to think this terrible question of freedom or slavery in America would be settled without bloodshed,” he wrote to Higginson. “I believe it no longer.”

    TK
    The attempted arrest, in April 1860, of the Secret Six member Franklin Benjamin Sanborn by federal authorities—which the citizens of Concord, Massachusetts, prevented. A contemporaneous etching from Harper’s Weekly. (Wikimedia)

    By the end of 1856, under the leadership of a commanding new territorial governor, violence in Kansas had begun to subside, and a free-state electoral victory seemed all but assured. The following year, Brown began traveling throughout New England and New York to raise money for a fresh attack on human bondage—his new plan as yet unspecified. In Boston, he presented Sanborn with a letter of introduction from Smith. Sanborn in turn arranged for Stearns, Howe, and Parker to meet Brown. Uncertain what Brown intended, Higginson at first kept his distance, even though Sanborn pressed him, insisting that Brown could do “more to split the Union than any man alive.” The ideals of the once noble American experiment could be sustained only by separating from slavery or by destroying it.

    In February 1858, Brown revealed his plan for the Harpers Ferry attack to Smith and Sanborn. Not long after, all of the Massachusetts conspirators met with Brown in his Boston hotel room and formally constituted themselves as the Secret Committee of Six to support Brown in planning and financing the raid. Stearns was to be the official chair, Sanborn the secretary. They would keep careful records, with an elaborate ledger and a dues schedule. It was as if a clandestine organization of accountants had set to planning an uprising.

    The raid’s actual occurrence surprised them—with both its timing and its swift and disastrous outcome. On October 16, 1859, Brown and a party of 21 seized the federal arsenal, eventually taking several dozen hostages. The uprising of the enslaved that Brown expected never materialized, and local militia soon cut off the bridges that were the only escape route. Brown and his men blockaded themselves in the armory’s fire-engine house, where they exchanged intermittent gunfire with the troops surrounding them. On October 18, Colonel Lee and a regiment of U.S. Marines broke down the engine-house door. Wounded by a saber cut, Brown was taken prisoner and transported to the nearby Charles Town jail. Ten of Brown’s men, including two of his sons, were killed; seven, including Brown, were captured and later executed. Four civilians were killed, as was one Marine. To the great dismay of the Secret Six, Brown’s papers and correspondence were found at the farm where Brown had been living in Maryland.

    The Six were stunned. In the press and in government offices, accusations flew. Many suspected that Frederick Douglass must have played a role. More than a decade before the raid, Douglass had met Brown and been moved by their conversations to question his own belief in the possibility of a peaceful end to slavery. “My utterances,” he later wrote, “became more and more tinged by the color of this man’s strong impressions.” When Brown took up arms in Kansas, Douglass’s appreciation for his boldness and conviction was only enhanced. Yet Douglass proved unwilling to join Brown when he revealed his Harpers Ferry plans. The scheme struck him as dangerously impractical and risky—“a steel-trap.”

    In the aftermath of the raid, Douglass seemed almost embarrassed that he had not offered Brown more support, that he had permitted realism to trump daring. He could not conceal his admiration for the would-be liberator’s courage, but concerns for his own survival won the day. Douglass fled north to Canada and then to England, where he remained for nearly half a year.

    Although Douglass was all too aware of his vulnerability, the Six, protected by their social position, had been defying authority with seeming impunity for years. Their recognition of personal peril came as a shock. The Six had embraced violence out of both entitlement and desperation. In public and private communications, they frequently invoked their revolutionary heritage, their biological connections to the country’s Founders—to those who had pitched tea into Boston Harbor and fought at Lexington and Bunker Hill. This was a legacy—and a responsibility—that required them to act with equivalent courage and decisiveness. They believed that in some sense, they owned the nation, and their sense of privilege fueled a confident assumption of immunity from serious consequence. But with Harpers Ferry, it seemed, they might have gone a step too far.

    Letters from Smith, Stearns, Howe, and Sanborn were found among Brown’s papers and featured in the press before the end of October. Five of the Six were quickly exposed and excoriated. (Parker, who had left the country before the raid in a futile search for a cure to his tuberculosis, was identified within a few months.) Smith fell into a frenzy of worry about being indicted. After becoming, according to his physician, “quite deranged, intellectually as well as morally,” he was committed in early November to the Utica Lunatic Asylum. After consulting a Boston lawyer, Sanborn, Stearns, and Howe made their way to Canada (and Howe published an article disavowing Brown). All three returned to the U.S., but Canada remained a refuge. Howe and Sanborn went back and forth twice. Higginson, both at the time and later, was contemptuous of his fellow conspirators’ cowardice. John Brown deserved better from them. “We of the Six,” he maintained years later, “were not—are not—great men.” But Brown, he believed, was.

    Higginson neither hid nor fled. He busied himself raising money for Brown’s defense and endeavoring to devise a scheme to facilitate Brown’s escape. But even for Higginson, who seems never to have contemplated a battle or a risk he didn’t relish, these plans seemed too far-fetched. Instead, with admiration, Higginson watched Brown’s display of undaunted courage throughout his trial as he refused to plead insanity or back down in his commitment to ending slavery through whatever means necessary. Brown would do far more from the grave than he could have ever imagined accomplishing in life. Higginson spent the day of his sentencing with Brown’s wife and the remaining members of his family on their bleak and remote upstate–New York farm.

    The congressional committee appointed in December to investigate the origins and supporters of Brown’s raid proved only a feeble threat to the six conspirators. Higginson, to his disappointment, was never called to testify at all. Howe and Stearns dodged, equivocated, and at times outright lied. Smith was judged too unwell to attend. Parker died in Italy in May 1860 without ever returning to the United States. Sanborn’s fears were at last realized when the U.S. Marshals he had eluded for so long arrived at his house in Concord to compel his testimony. Citizens of the town rose up to prevent his removal while a judge sympathetic to Sanborn was located to issue a writ of habeas corpus. In the end, the congressional hearings were a tepid affair, likely because southern representatives came to recognize that the less attention given to abolitionist voices, the better.

    The next battle in the war that Brown had begun would not be long in coming. While he bided his time, Higginson published in February 1860 the first of a series of articles in The Atlantic that he referred to as his “Insurrection Papers.” After writing essays on “The Maroons of Jamaica” and “The Maroons of Surinam”—Black groups who had escaped enslavement to establish their own independent societies on the fringes of white settlement—he proceeded to publish admiring essays on Denmark Vesey, Nat Turner, and Gabriel, men who had embraced violence in their efforts to overturn American slavery. In addition to his writing, Higginson devoted the 16 months between Brown’s execution and the firing on Fort Sumter to reading about military strategy and drills, and to practicing shooting and swordplay. In 1862, this man of words returned to the world of action. He would fulfill “the dream of a lifetime” as the colonel commanding the First South Carolina Volunteers, a regiment of the formerly enslaved. This commission embodied what he had believed in for so long: the mobilization of force in the cause of Black freedom, as well as the arming of Black men in their own liberation.

    Both during and after the war, the careers of the Secret Six fell along a spectrum. Stearns never went to war himself but recruited thousands of Black troops into what he referred to as “John Brown regiments”; when the war was over, he helped found the Freedmen’s Bureau, which provided land and other assistance to newly freed African Americans. Howe worked with the Sanitary Commission, a relief agency founded to support sick and wounded soldiers, and, like Stearns, was involved with the Freedmen’s Bureau after the war. Smith emerged from the Utica asylum fragile and aversive to any conversation about Harpers Ferry. He gave a significant amount of money to Stearns’s Black regiments. And yet, in 1867, he was also among those who paid the bond that freed Jefferson Davis from prison. Sanborn appointed himself the custodian of Brown’s legacy, publishing four books and some 75 articles about him. (Many of the articles appeared in this magazine.) Sanborn cultivated the memory of a kinder, gentler Brown, downplaying the violence he had perpetrated. He did not know until the 1870s that Brown had lied to him about his central and murderous role at Pottawatomie.

    Higginson was unapologetic. In 1879, when he remarried after the death of his first wife, Higginson chose Harpers Ferry as the site for their honeymoon, introducing his bride to prominent landmarks from the raid, the trial, and the hanging. Higginson never forgave himself for not doing more to support Brown and for failing to persuade him to adopt a plan that was more likely to succeed. To commemorate the 50th anniversary of the raid, in 1909, Higginson joined Sanborn, the only other surviving member of the Secret Six, and Howe’s widow, Julia, in Concord, where they were interviewed by a journalist. (Julia Ward Howe had in 1862 published on the cover of The Atlantic different lyrics for the tune of “John Brown’s Body”: the immortal words of “Battle Hymn of the Republic.”) As a writer and an activist, Higginson had remained deeply engaged in public life, notably on behalf of women’s rights; his views on race and Black suffrage tended to shift with time and circumstance, and he was far from the radical of the prewar years. But in the Concord interview, he expressed no second thoughts about his commitment to violence on behalf of abolition—either at Harpers Ferry or within the legitimating framework of the Civil War.

    I learned the story of John Brown at an early age. It might have been that my father told my siblings and me about the history of Harpers Ferry as we drove along Route 340, peering down the cliffsides at the town and the rushing water below. Or Brown might have been one of those historical personages whose names we just knew, inhaled from the Virginia air around us. People like Stonewall Jackson and John Mosby and Turner Ashby, who had all likely ridden across the very fields surrounding our house. When I was growing up, I was always proud to live in a place associated with so many famous forebears. It was many years before I thought to question what their fame and vaunted heroism had been in service of.

    But I knew from the outset that Brown’s renown was different. He was, I was told, a madman, undertaking a scheme that was doomed to fail—a suicide mission. When I wrote about Brown for my first term paper in high school, that was the story I told.

    From 1859 onward, many observers, reporters, and, later, historians adopted the view that Brown was insane, and by the mid-20th century, when I was in school, it had become a widely held assumption among white Americans. Rather than a “meteor” anticipating or inaugurating the larger war that would end slavery, Brown became no more than an aberration. Violence was reduced to a mental-health problem. The interpretation reassuringly diminished the moral force of Brown’s actions and suggested that only madness could lead to dreams of overthrowing white dominance and Black subordination. This message was intended to emphasize the strength and immutability of the racial hierarchies that remained in place well after slavery’s end, surviving Reconstruction and enshrined in Jim Crow. It minimized the threat Brown posed and by implication all but removed him—and his insistence on the moral evil of slavery—from any place in explanations of the Civil War’s origins. The Lost Cause portrait of a conflict fought by two honorable opponents who differed primarily on constitutional views about states’ rights could remain intact and unchallenged.

    Even in the days just after the raid, though, there were those who insisted on acknowledging the historic import of Harpers Ferry as well as the sanity and determination of John Brown. Governor Henry Wise of Virginia came to Harpers Ferry to interview Brown after his capture and rejected the idea that Brown was a lunatic: “They are mistaken who take him to be a madman,” he said. He left with an impression of him as “a man of clear head … cool, collected, and indomitable.” A sane Brown was far more dangerous. If his actions were rational, then the South must regard them as proof that the North was plotting the violent overthrow of slavery. The South, Wise insisted, needed to take active measures to defend itself and its way of life. One South Carolina politician described the raid as “fact coming to the aid of logic”: the South’s worst fears made real. Harpers Ferry was the moment that changed everything. The rabidly proslavery Wise and the radical abolitionist Higginson agreed on little else, but this they regarded as self-evident.

    To accept slavery as the cause of the Civil War dictates setting the conflict within a longer trajectory of violence, one that starts at least with John Brown rather than Fort Sumter. Higginson would perhaps have us date the war from his saber cut in 1854. Douglass might well argue that it began in 1619. And when did the Civil War end? Historians studying the era after Appomattox have in recent years emphasized the persistence of violence through and beyond Reconstruction, as intransigent former Confederates turned from organized military force to beatings, burnings, whippings, shootings, and lynchings in the effort to suppress newly gained Black freedom. The war, the historians argue, simply continued in other forms. It is as difficult and complicated to say when the Civil War ended as to determine when it began.

    In the years since 1859, John Brown and his raid have become a touchstone in America’s struggle to reconcile—or at least represent—the complex connections between force and freedom. The United States was founded in violent resistance and then guaranteed its survival as a nation eight decades later in a bloody Civil War. Violence is at the heart of our national mythology. The Secret Six drew explicitly on that mythology in their writing. It is central to our national creed. But violence has also, as Frederick Douglass reminds us, rested at the core of the social and legal order that mandated and sustained the oppression of millions of Americans from the early 17th century into our own time. Violence could enslave and violence could free. The purpose mattered. As Douglass declared, looking back on the Civil War in a Decoration Day speech honoring the Union dead in 1883, “Whatever else I may forget, I shall never forget the difference between those who fought for liberty and those who fought for slavery.”

    The Black community did not forget that Brown had fought for liberty. After the war, his raid and his death continued to be commemorated across the North. In a stirring address at Storer College, founded in Harpers Ferry in 1867 to educate African Americans, Douglass insisted that Brown had not failed, but had begun the “war that ended slavery.” W. E. B. Du Bois held Brown in similarly high esteem. In 1906, the second gathering of the Niagara Movement, the predecessor of the NAACP, was held at Harpers Ferry in acknowledgment of Brown’s contributions to Black rights. Delegates from the NAACP met there in 1932 intending to dedicate a plaque in Brown’s honor. In a speech at that meeting titled “The Use of Force in Reform,” Du Bois expressed few compunctions about the use of violence: Brown, he said, “took human lives … He took them in Kansas and he took them here. He meant to take them. He meant to use force to wipe out an evil he could no longer endure.”

    Langston Hughes used poetry rather than oratory to address African American readers as he invoked the lingering memory of John Brown. Hughes, whose grandmother had been married to one of the Black conspirators killed in the raid, celebrated “John Brown / Who took his gun, / Took twenty-one companions / White and black, / Went to shoot your way to freedom.” Hughes recalled that his grandmother had preserved her husband’s bullet-ridden shawl. As a small boy, he was sometimes wrapped in it. “You will remember / John Brown,” Hughes insisted.

    But, fittingly, given his defining commitment to nonviolence, Martin Luther King Jr. remained silent on Brown. Even as the keynote speaker at a centennial observance of Brown’s raid, King did not mention the man once. The place of violence in the centuries of struggle for Black freedom has been long contested, and by the mid-1960s, King faced growing demands from Black activists urging forceful resistance to white threats and assaults instead of the Gandhian passivity that underpinned his philosophy. Malcolm X regarded Brown as “the only good white the country’s ever had.” The Black Power movement that challenged King’s vision of a Beloved Community could claim deep roots.

    Barack Obama reflected the long tradition of Black appreciation for Brown in his 2006 book, The Audacity of Hope. Brown’s “willingness to spill blood,” Obama said, demonstrated that “deliberation alone” would not suffice to end slavery. “Pragmatism,” he concluded, “can sometimes be moral cowardice.”

    As a nation, we are unable to get over John Brown. And as a nation, we have not figured out what violence we will condemn and what we will celebrate. I found myself unspeakably moved as I stood before Nat Turner’s Bible in the National Museum of African American History and Culture. At the same time, I am horrified by the violence of the January 6 rioters and by what I regard as widespread threats to the rule of law. We pride ourselves on being a country with a written Constitution that sets peaceful parameters for government. Yet the Supreme Court established by that Constitution has issued rulings providing that the citizenry may be armed not just for recreational hunting, but with weapons, including assault rifles, that are frequently purchased with an eye toward resisting that very government. Lawmakers walk the floors of the Capitol with pins shaped like AR-15s in their lapels. The rule of law seems historically and inextricably enmeshed in the tolerance—even the encouragement—of violence.

    In the years leading up to the Civil War, antislavery Americans like the Secret Six turned to what Higginson—with a keen awareness of the oxymoron—called conscientious lawbreaking. Douglass came to embrace the legitimacy of violence, but recognized it as justified “only when all other means of progress and enlightenment have failed”—and only when there is a “thing worse than” violence that makes it necessary.

    The existence and endurance of our nation has depended on that careful discernment, on that conscientiousness, in deciding when we truly face a “thing worse than.” It is not merely a historical question. A deep-seated ambivalence about violence defines us still.


    This article appears in the December 2023 print edition with the headline “The Men Who Started the Civil War.” When you buy a book using a link on this page, we receive a commission. Thank you for supporting The Atlantic.

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    Drew Gilpin Faust

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  • Black Success, White Backlash

    Black Success, White Backlash

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    For more than half a century, I have been studying the shifting relations between white and Black Americans. My first journal article, published in 1972, when I was a graduate student at the University of Chicago, was about Black political power in the industrial Midwest after the riots of the late 1960s. My own experience of race relations in America is even longer. I was born in the Mississippi Delta during World War II, in a cabin on what used to be a plantation, and then moved as a young boy to northern Indiana, where as a Black person in the early 1950s, I was constantly reminded of “my place,” and of the penalties for overstepping it. Seeing the image of Emmett Till’s dead body in Jet magazine in 1955 brought home vividly for my generation of Black kids that the consequences of failing to navigate carefully among white people could even be lethal.

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    For the past 16 years, I have been on the faculty of the sociology department at Yale, and in 2018 I was granted a Sterling Professorship, the highest academic rank the university bestows. I say this not to boast, but to illustrate that I have made my way from the bottom of American society to the top, from a sharecropper’s cabin to the pinnacle of the ivory tower. One might think that, as a decorated professor at an Ivy League university, I would have escaped the various indignities that being Black in traditionally white spaces exposes you to. And to be sure, I enjoy many of the privileges my white professional-class peers do. But the Black ghetto—a destitute and fearsome place in the popular imagination, though in reality it is home to legions of decent, hardworking families—remains so powerful that it attaches to all Black Americans, no matter where and how they live. Regardless of their wealth or professional status or years of law-abiding bourgeois decency, Black people simply cannot escape what I call the “iconic ghetto.”

    I know I haven’t. Some years ago, I spent two weeks in Wellfleet, Massachusetts, a pleasant Cape Cod town full of upper-middle-class white vacationers and working-class white year-rounders. On my daily jog one morning, a white man in a pickup truck stopped in the middle of the road, yelling and gesticulating. “Go home!” he shouted.

    Who was this man? Did he assume, because of my Black skin, that I was from the ghetto? Is that where he wanted me to “go home” to?

    This was not an isolated incident. When I jog through upscale white neighborhoods near my home in Connecticut, white people tense up—unless I wear my Yale or University of Pennsylvania sweatshirts. When my jogging outfit associates me with an Ivy League university, it identifies me as a certain kind of Black person: a less scary one who has passed inspection under the “white gaze.” Strangers with dark skin are suspect until they can prove their trustworthiness, which is hard to do in fleeting public interactions. For this reason, Black students attending universities near inner cities know to wear college apparel, in hopes of avoiding racial profiling by the police or others.

    I once accidentally ran a small social experiment about this. When I joined the Yale faculty in 2007, I bought about 20 university baseball caps to give to the young people at my family reunion that year. Later, my nieces and nephews reported to me that wearing the Yale insignia had transformed their casual interactions with white strangers: White people would now approach them to engage in friendly small talk.

    But sometimes these signifiers of professional status and educated-class propriety are not enough. This can be true even in the most rarefied spaces. When I was hired at Yale, the chair of the sociology department invited me for dinner at the Yale Club of New York City. Clad in a blue blazer, I got to the club early and decided to go up to the fourth-floor library to read The New York Times. When the elevator arrived, a crush of people was waiting to get on it, so I entered and moved to the back to make room for others. Everyone except me was white.

    As the car filled up, I politely asked a man of about 35, standing by the controls, to push the button for the library floor. He looked at me and—emboldened, I have to imagine, by drinks in the bar downstairs—said, “You can read?” The car fell silent. After a few tense moments, another man, seeking to defuse the tension, blurted, “I’ve never met a Yalie who couldn’t read.” All eyes turned to me. The car reached the fourth floor. I stepped off, held the door open, and turned back to the people in the elevator. “I’m not a Yalie,” I said. “I’m a new Yale professor.” And I went into the library to read the paper.

    I tell these stories—and I’ve told them before—not to fault any particular institution (I’ve treasured my time at Yale), but to illustrate my personal experience of a recurring cultural phenomenon: Throughout American history, every moment of significant Black advancement has been met by a white backlash. After the Civil War, under the aegis of Reconstruction, Black people for a time became professionals and congressmen. But when federal troops left the former Confederate states in 1877, white politicians in the South tried to reconstitute slavery with the long rule of Jim Crow. Even the Black people who migrated north to escape this new servitude found themselves relegated to shantytowns on the edges of cities, precursors to the modern Black ghetto.

    All of this reinforced what slavery had originally established: the Black body’s place at the bottom of the social order. This racist positioning became institutionalized in innumerable ways, and it persists today.

    I want to emphasize that across the decades, many white Americans have encouraged racial equality, albeit sometimes under duress. In response to the riots of the 1960s, the federal government—led by the former segregationist Lyndon B. Johnson—passed far-reaching legislation that finally extended the full rights of citizenship to Black people, while targeting segregation. These legislative reforms—and, especially, affirmative action, which was implemented via LBJ’s executive order in 1965—combined with years of economic expansion to produce a long period of what I call “racial incorporation,” which substantially elevated the income of many Black people and brought them into previously white spaces. Yes, a lot of affirmative-action efforts stopped at mere tokenism. Even so, many of these “tokens” managed to succeed, and the result is the largest Black middle class in American history.

    Over the past 50 years, according to a study by the Pew Research Center, the proportion of Black people who are low-income (less than $52,000 a year for a household of three) has fallen seven points, from 48 to 41 percent. The proportion who are middle-income ($52,000 to $156,000 a year) has risen by one point, to 47 percent. The proportion who are high-income (more than $156,000 a year) has risen the most dramatically, from 5 to 12 percent. Overall, Black poverty remains egregiously disproportionate to that of white and Asian Americans. But fewer Black Americans are poor than 50 years ago, and more than twice as many are rich. Substantial numbers now attend the best schools, pursue professions of their choosing, and occupy positions of power and prestige. Affirmative action worked.

    But that very success has inflamed the inevitable white backlash. Notably, the only racial group more likely to be low-income now than 50 years ago is whites—and the only group less likely to be low-income is Blacks.

    For some white people displaced from their jobs by globalization and deindustrialization, the successful Black person with a good job is the embodiment of what’s wrong with America. The spectacle of Black doctors, CEOs, and college professors “out of their place” creates an uncomfortable dissonance, which white people deal with by mentally relegating successful Black people to the ghetto. That Black man who drives a new Lexus and sends his children to private school—he must be a drug kingpin, right?

    In predominantly white professional spaces, this racial anxiety appears in subtler ways. Black people are all too familiar with a particular kind of interaction, in the guise of a casual watercooler conversation, the gist of which is a sort of interrogation: “Where did you come from?”; “How did you get here?”; and “Are you qualified to be here?” (The presumptive answer to the last question is clearly no; Black skin, evoking for white people the iconic ghetto, confers an automatic deficit of credibility.)

    Black newcomers must signal quickly and clearly that they belong. Sometimes this requires something as simple as showing a company ID that white people are not asked for. Other times, a more elaborate dance is required, a performance in which the worker must demonstrate their propriety, their distance from the ghetto. This can involve dressing more formally than the job requires, speaking in a self-consciously educated way, and evincing a placid demeanor, especially in moments of disagreement.

    As part of my ethnographic research, I once embedded in a major financial-services corporation in Philadelphia, where I spent six months observing and interviewing workers. One Black employee I spoke with, a senior vice president, said that people of color who wanted to climb the management ladder must wear the right “uniform” and work hard to perform respectability. “They’re never going to envision you as being a white male,” he told me, “but if you can dress the same and look a certain way and drive a conservative car and whatever else, they’ll say, ‘This guy has a similar attitude, similar values [to we white people]. He’s a team player.’ If you don’t dress with the uniform, obviously you’re on the wrong team.”

    This need to constantly perform respectability for white people is a psychological drain, leaving Black people spent and demoralized. They typically keep this demoralization hidden from their white co-workers because they feel that they need to show they are not whiners. Having to pay a “Black tax” as they move through white areas deepens this demoralization. This tax is levied on people of color in nice restaurants and other public places, or simply while driving, when the fear of a lethal encounter with the police must always be in mind. The existential danger this kind of encounter poses is what necessitates “The Talk” that Black parents—fearful every time their kids go out the door that they might not come back alive—give to their children. The psychological effects of all of this accumulate gradually, sapping the spirit and engendering cynicism.

    Even the most exalted members of the Black elite must live in two worlds. They understand the white elite’s mores and values, and embody them to a substantial extent—but they typically remain keenly conscious of their Blackness. They socialize with both white and Black people of their own professional standing, but also members of the Black middle and working classes with whom they feel more kinship, meeting them at the barbershop, in church, or at gatherings of long-standing friendship groups. The two worlds seldom overlap. This calls to mind W. E. B. Du Bois’ “double consciousness”—a term he used for the first time in this publication, in 1897—referring to the dual cultural mindsets that successful African Americans must simultaneously inhabit.

    For middle-class Black people, a certain fluidity—abetted by family connections—enables them to feel a connection with those at the lower reaches of society. But that connection comes with a risk of contagion; they fear that, meritocratic status notwithstanding, they may be dragged down by their association with the hood.

    When I worked at the University of Pennsylvania, some friends of mine and I mentored at-risk youth in West Philadelphia.

    One of these kids, Kevin Robinson, who goes by KAYR (pronounced “K.R.”), grew up with six siblings in a single-parent household on public assistance. Two of his sisters got pregnant as teenagers, and for a while the whole family was homeless. But he did well in high school and was accepted to Bowdoin College, where he was one of five African Americans in a class of 440. He was then accepted to Dartmouth’s Tuck School of Business, where he was one of 10 or so African Americans in an M.B.A. class of roughly 180. He got into the analyst-training program at Goldman Sachs, where his cohort of 300 had five African Americans. And from there he ended up at a hedge fund, where he was the lone Black employee.

    What’s striking about Robinson’s accomplishments is not just the steepness of his rise or the scantness of Black peers as he climbed, but the extent of cultural assimilation he felt he needed to achieve in order to fit in. He trimmed his Afro. He did a pre-college program before starting Bowdoin, where he had sushi for the first time and learned how to play tennis and golf. “Let me look at how these people live; let me see how they operate,” he recalls saying to himself. He decided to start reading The New Yorker and Time magazine, as they did, and to watch 60 Minutes. “I wanted people to see me more as their peer versus … someone from the hood. I wanted them to see me as, like, ‘Hey, look, he’s just another middle-class Black kid.’ ” When he was about to start at Goldman Sachs, a Latina woman who was mentoring him there told him not to wear a silver watch or prominent jewelry: “ ‘KAYR, go get a Timex with a black leather band. Keep it very simple … Fit in.’ ” My friends and I had given him similar advice earlier on.

    All of this worked; he thrived professionally. Yet even as he occupied elite precincts of wealth and achievement, he was continually getting pulled back to support family in the ghetto, where he felt the need to code-switch, speaking and eating the ways his family did so as not to insult them.

    The year he entered Bowdoin, one of his younger brothers was sent to prison for attempted murder, and a sister who had four children was shot in the face and died. Over the years he would pay for school supplies for his nieces and nephews, and for multiple family funerals—all while keeping his family background a secret from his professional colleagues. Even so, he would get subjected to the standard indignities—being asked to show ID when his white peers were not; enduring the (sometimes obliviously) racist comments from colleagues (“You don’t act like a regular Black”). He would report egregious offenses to HR but would usually just let things go, for fear that developing a reputation as a “race guy” would restrict his professional advancement.

    Robinson’s is a remarkable success story. He is 40 now; he owns a property-management company and is a multimillionaire. But his experience makes clear that no matter what professional or financial heights you ascend to, if you are Black, you can never escape the iconic ghetto, and sometimes not even the actual one.

    The most egregious intrusion of a Black person into white space was the election (and reelection) of Barack Obama as president. A Black man in the White House! For some white people, this was intolerable. Birthers, led by Donald Trump, said he was ineligible for the presidency, claiming falsely that he had been born in Kenya. The white backlash intensified; Republicans opposed Obama with more than the standard amount of partisan vigor. In 2013, at the beginning of Obama’s second term, the Supreme Court gutted the Voting Rights Act, which had protected the franchise for 50 years. Encouraged by this opening, Alabama, Mississippi, North Carolina, and Texas moved forward with voter-suppression laws, setting a course that other states are now following. And this year, the Supreme Court outlawed affirmative action in college admissions. I want to tell a story that illustrates the social gains this puts at risk.

    Many years ago, when I was a professor at Penn, my father came to visit me. Walking around campus, we bumped into various colleagues and students of mine, most of them white, who greeted us warmly. He watched me interact with my secretary and other department administrators. Afterward, Dad and I went back to my house to drink beer and listen to Muddy Waters.

    “So you’re teaching at that white school?” he said.

    “Yeah.”

    “You work with white people. And you teach white students.”

    “Yeah, but they actually come in all colors,” I responded. I got his point, though.

    “Well, let me ask you one thing,” he said, furrowing his brow.

    “What’s that, Dad?”

    “Do they respect you?”

    After thinking about his question a bit, I said, “Well, some do. And some don’t. But you know, Dad, it is hard to tell which is which sometimes.”

    “Oh, I see,” he said.

    He didn’t disbelieve me; it was just that what he’d witnessed on campus was at odds with his experience of the typical Black-white interaction, where the subordinate status of the Black person was automatically assumed by the white one. Growing up in the South, my dad understood that white people simply did not respect Black people. Observing the respectful treatment I received from my students and colleagues, my father had a hard time believing his own eyes. Could race relations have changed so much, so fast?

    They had—in large part because of what affirmative action, and the general processes of racial incorporation and Black economic improvement, had wrought. In the 1960s, the only Black people at the financial-services firm I studied would have been janitors, night watchmen, elevator operators, or secretaries; 30 years later, affirmative action had helped populate the firm with Black executives. Each beneficiary of affirmative action, each member of the growing Black middle class, helped normalize the presence of Black people in professional and other historically white spaces. All of this diminished, in some incremental way, the power of the symbolic ghetto to hold back people of color.

    Too many people forget, if ever they knew it, what a profound cultural shift affirmative action effected. And they overlook affirmative action’s crucial role in forestalling social unrest.

    Some years ago, I was invited to the College of the Atlantic, a small school in Maine, to give the commencement address. As I stood at the sink in the men’s room before the event, checking the mirror to make sure all my academic regalia was properly arrayed, an older white man came up to me and said, with no preamble, “What do you think of affirmative action?”

    “I think it’s a form of reparations,” I said.

    “Well, I think they need to be educated first,” he said, and then walked out.

    I was so provoked by this that I scrambled back to my hotel room and rewrote my speech. I’d already been planning to talk about the benefits of affirmative action, but I sharpened and expanded my case, explaining that it not only had lifted many Black people out of the ghetto, but had been a weapon in the Cold War, when unaligned countries and former colonies were trying to decide which superpower to follow. Back then, Democrats and some Republicans were united in believing that affirmative action, by demonstrating the country’s commitment to racial justice and equality, helped project American greatness to the world.

    Beyond that, I said to this almost entirely white audience, affirmative action had helped keep the racial unrest of the ’60s from flaring up again. When the kin—the mothers, fathers, cousins, nephews, sons, daughters, baby mamas, uncles, aunts—of ghetto residents secure middle-class livelihoods, those ghetto relatives hear about it. This gives the young people who live there a modicum of hope that they might do the same. Hope takes the edge off distress and desperation; it lessens the incentives for people to loot and burn. What opponents of affirmative action fail to understand is that without a ladder of upward mobility for Black Americans, and a general sense that justice will prevail, a powerful nurturer of social concord gets lost.

    Yes, continuing to expand the Black professional and middle classes will lead to more instances of “the dance,” and the loaded interrogations, and the other awkward moments and indignities that people of color experience in white spaces. But the greater the number of affluent, successful Black people in such places, the faster this awkwardness will diminish, and the less power the recurrent waves of white reaction will have to set people of color back. I would like to believe that future generations of Black Americans will someday find themselves as pleasantly surprised as my dad once was by the new levels of racial respect and equality they discover.


    This article appears in the November 2023 print edition with the headline “Black Success, White Backlash.”

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    Elijah Anderson

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  • Where End-of-Life Care Falls Short

    Where End-of-Life Care Falls Short

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    This article originally appeared in Undark Magazine.

    When Kevin E. Taylor became a pastor 22 years ago, he didn’t expect how often he’d have to help families make gut-wrenching decisions for a loved one who was very ill or about to die. The families in his predominantly Black church in New Jersey generally didn’t have any written instructions, or conversations to recall, to help them know if their relative wanted—or didn’t want—certain types of medical treatment.

    So Taylor started encouraging church members to ask their elders questions, such as whether they would want to be kept on life support if they became sick and were unable to make decisions for themselves.

    “Each time you have the conversation, you destigmatize it,” says Taylor, now the senior pastor at Unity Fellowship Church NewArk, a Christian church with about 120 regular members.

    Taylor is part of an initiative led by Compassion & Choices, a nonprofit advocacy group that encourages more Black Americans to consider and document their medical wishes for the end of their life.

    End-of-life planning—also known as advance care planning, or ACP—usually requires a person to fill out legal documents that indicate the care they would want if they were to become unable to speak for themselves because of injury or illness. There are options to specify whether they would want life-sustaining care, even if it were unlikely to cure or improve their condition, or comfort care to manage pain, even if it hastened death. Medical groups have supported ACP, and proposed public-awareness campaigns aim to promote the practice.

    Yet research has found that many Americans—particularly Black Americans—have not bought into the promise of ACP. Advocates say that such plans are especially important for Black Americans, who are more likely to experience racial discrimination and lower-quality care throughout the health-care system. Advance care planning, they say, could help patients understand their options and document their wishes, as well as reduce anxiety for family members.

    However, the practice has also come under scrutiny in recent years: Some research suggests that it might not actually help patients get the kind of care they want at the end of life. It’s unclear whether those results are due to research methods or to a failure of ACP itself; comparing the care that individuals said they want in the future with the care they actually received while dying is exceedingly difficult. And many studies that show the shortcomings of ACP look predominantly at white patients.

    Still, researchers maintain that encouraging discussions about end-of-life care is important, while also acknowledging that ACP needs either improvement or an overhaul. “We should be looking for, okay, what else can we do other than advance care planning?” says Karen Bullock, a social-work professor at Boston College, who researches decision-making and acceptance around ACP in Black communities. “Or can we do something different with advance care planning?”

    Advance care planning was first proposed in the U.S. in 1967, when a lawyer for the now-defunct Euthanasia Society of America advocated for the idea of a living will—a document that would allow a person to indicate whether to withhold or withdraw life-sustaining treatment if they were no longer capable of making health-care decisions. By 1986, most states had adopted living-will laws that established standardized documents for patients, as well as protections for physicians who complied with patients’ wishes.

    Over the past four decades, ACP has expanded to include a range of legal documents, called advance directives, for detailing one’s wishes for end-of-life care. In addition to do-not-resuscitate, or DNR, orders, patients can list treatments they would want and under which scenarios, as well as appoint a surrogate to make health-care decisions for them. Health-care facilities that receive Medicare or Medicaid reimbursement are required to ask whether patients have advance directives, and to provide them with relevant information. And in most states, doctors can record a patient’s end-of-life wishes in a form called a Provider Order for Life-Sustaining Treatment. These documents encourage patients to talk with their physician about their wishes, which are then added to the patient chart, unlike advance directives, which usually consist of the patient filling out forms themselves without discussing them directly with their doctor.

    But as far as who makes those plans, research has shown a racial disparity: A 2016 study of more than 2,000 adults, all of whom were over the age of 50, showed that 44 percent of white participants had completed an advance directive, compared with 24 percent of Black participants. Many people simply aren’t aware of ACP or don’t fully understand it. And for Black individuals, that knowledge may be especially hard to come by—one study found that clinicians tend to avoid discussions with Black and other nonwhite patients about the care they want at the end of life, because they feel uncomfortable broaching these conversations or are unsure of whether patients want to have them.

    Other research has found that Black Americans may be more hesitant to fill out documents in part because of a mistrust in the health-care system, rooted in a long history of racist treatment. “It’s a direct, in my opinion, outcome from segregated health-care systems,” Bullock says. “When we forced integration, integration didn’t mean equitable care.”

    Religion can also be a major barrier to ACP. A large proportion of Black Americans are religious, and some say they are hesitant to engage in ACP because of the belief that God, rather than clinicians, should decide their fate. That’s one reason programs such as Compassion & Choices have looked to churches to make ACP more accessible. Several studies support the effectiveness of sharing health messages, including about smoking cessation and heart health, in church communities. “Black people tend to trust their faith leaders, and so if the church is saying this is a good thing to do, then we will be willing to try it,” Bullock says.

    But in 2021, an article by palliative-care doctors laid bare the growing evidence that ACP may be failing to get patients the end-of-life care they want, also known as goal-concordant care. The paper summarized the findings of numerous studies investigating the effectiveness of the practice, and concluded that “despite the intrinsic logic of ACP, the evidence suggests it does not have the desired effect.”

    For example, although some studies identified benefits such as increased likelihood of a patient dying in the place they desired or avoiding unwanted resuscitation, others found the opposite. One study found that seriously ill patients who prioritized comfort care in their advance directive spent practically just as many days in the hospital as did patients who prioritized life-extending experiences. The authors of the 2021 summary paper suggested several reasons that goal-concordant care might not occur: Patients may request treatments that are not available; clinicians may not have access to the documentation; surrogates may override patients’ requests.

    A pair of older studies suggested that these issues might be especially pronounced for Black patients; they found that Black patients with cancer who had signed DNR orders were more likely to be resuscitated, for example. These studies have been held up as evidence that Black Americans receive less goal-concordant care. But Holly Prigerson, a researcher at Cornell University who oversaw the studies, notes that her team investigated the care of Black participants who were resuscitated against their wishes, and in those cases, clinicians did not have access to their records because the patients had been transferred from another hospital.

    One issue facing research on advance care planning is that so many studies focus on white patients, giving little insight into whether ACP helps Black patients. For example, in two recent studies on the subject, more than 90 percent of patients were white.

    Many experts, including Prigerson, agree that it’s important to devise new approaches to assess goal-concordant care, which generally relies on what patients indicated in advance directives or what they told family members months or years before dying. But patients change their mind, and relatives may not understand or accept their wishes.

    “It’s a very problematic thing to assess,” Prigerson says. “It’s not impossible, but there are so many issues with it.”

    As for whether ACP can manage to improve end-of-life care specifically in areas where Black patients receive worse care, such as pain management, experts such as Bullock note that studies have not really explored that question. But addressing other racial disparities—including correcting physicians’ false beliefs about Black patients being less sensitive to pain, improving how physicians communicate with Black patients, and strengthening social supports for patients who want to enroll in hospice—is likely more crucial than expanding ACP.

    ACP “may be part of the solution, but it is not going to be sufficient,” says Robert M. Arnold, a University of Pittsburgh professor of palliative care and medical ethics, and one of the authors of the 2021 article that questioned the benefits of ACP.

    Many of the shortcomings of ACP, including the low engagement rate and the unclear benefits, have prompted researchers and clinicians to think about how to overhaul the practice.

    Efforts to make ACP more accessible have spanned creating easy-to-read versions absent any legalese, and short, simple videos. A 2023 study found that one program that incorporated these elements, called PREPARE for Your Care, helped both white and Black adults with chronic medical conditions get goal-concordant care. The study stood out because it asked patients who were still able to communicate if they were getting the medical care they wanted, rather than waiting until after they died to evaluate goal-concordant care.

    “That, to me, is incredibly important,” says Rebecca Sudore, a geriatrician and researcher at UC San Francisco, who was the senior author of the study and helped develop PREPARE for Your Care. Sudore and her colleagues have proposed “real-time assessment from patients and their caregivers” to more accurately measure goal-concordant care.

    In the past few years, clinicians have become more aware that ACP should involve ongoing conversations and shared decision-making among patients, clinicians, and surrogates, rather than just legal documents, says Ramona Rhodes, a geriatrician affiliated with the University of Arkansas for Medical Sciences.

    Rhodes and her colleagues are leading a study to address whether certain types of ACP can promote engagement and improve care for Black patients. A group of older patients—half are Black, and half are white—with serious illnesses at clinics across the South are receiving materials either for Respecting Choices, an ACP guide that focuses on conversations with patients and families, or Five Wishes, a short patient questionnaire and the most widely used advance directive in the United States. The team hypothesizes that Respecting Choices will lead to greater participation among Black patients and possibly more goal-concordant care, if it prepares patients and families to talk with clinicians about their wishes, Rhodes says.

    Taylor, the pastor, notes that when he talks with church members about planning for end-of-life care, they often see the importance of it for the first time. And it usually persuades them to take action. “Sometimes it’s awkward,” he says. “But it’s now awkward and informed.”

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    Carina Storrs

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  • A Supreme Court Ruling That Could Tip the House

    A Supreme Court Ruling That Could Tip the House

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    A decade’s worth of disappointment has conditioned Black Americans and Democrats to fear voting-rights rulings from the Supreme Court. In 2013, a 5–4 majority invalidated a core tenet of the Voting Rights Act of 1965. Subsequent decisions have chipped away at the rest of the law, and in 2019, a majority of the justices declared that federal courts have no power to bar partisan gerrymandering.

    So this morning, when two conservatives joined the high court’s three liberals in reaffirming a central part of the Voting Rights Act, Democrats reacted as much with shock as with relief. Chief Justice John Roberts, who wrote the 2013 decision in Shelby v. Holder that stripped the government’s power to vet state voting laws in advance, today released an opinion ruling that Alabama’s congressional map illegally diluted the votes of Black people by packing them into one majority-minority district rather than two.

    The decision in the case known as Allen v. Milligan preserves, for now, the landmark civil-rights law that many legal observers worried the Court would render all but moot. It also could have important ramifications for the 2024 elections and control of the House of Representatives, where Republicans hold just a five-seat majority.

    Many Democrats believe that the ruling will have a domino effect on other pending cases and ultimately force three southern states—not only Alabama but also Louisiana and Georgia—to each add a new majority-minority district before the congressional election, which would almost certainly flip seats currently held by Republicans. Texas might have to add as many as five majority-minority districts to its map. “It really clears the path for these cases to move forward hopefully in a quick resolution,” Abha Khanna, a Democratic lawyer who argued the Allen case before the Supreme Court on behalf of Black voters from Alabama, told me.

    These potential gains could more than offset the losses that Democrats are anticipating in North Carolina, where a new conservative majority on the state supreme court is expected to draw a congressional map more favorable to Republicans. After the ruling, the nonpartisan prognosticator Cook Political Report immediately shifted its projections for the 2024 elections by moving five House seats in the Democrats’ direction.

    Justice Brett Kavanaugh, a 2018 appointee of former President Donald Trump, joined Roberts and the Court’s three Democratic appointees, Justices Sonia Sotomayor, Elena Kagan, and Ketanji Brown Jackson, in the 5–4 ruling. The decision was surprising not only because it ran counter to the Court’s recent jurisprudence on voting rights but also because last year, a majority of justices left in place the same maps that the Court today deemed illegal. That ruling, which came in an unsigned opinion on the Court’s so-called shadow docket, might have made the difference in the Democrats losing their House majority.

    “While we were certainly disappointed,” Khanna told me of that decision, “I think today’s victory shows that in this case, justice delayed was not justice denied.”

    Advocates for voting rights were caught off guard. “Supreme Court Shocks Nation by Doing the Right Thing,” one left-leaning group, Take Back the Court, wrote in the subject line of an email that read like a headline from The Onion. George Cheung, the director of a voting-rights group called More Equitable Democracy, told me he was stunned by the ruling: “I and many others assumed that they would undermine if not completely gut what remained of the federal Voting Rights Act.”

    Instead, the Court’s majority rejected a bid by Alabama to reinterpret the redistricting provisions of Section 2 of the law as “race neutral,” a change that would have reversed the VRA’s original intent to protect disenfranchised Black voters.

    For Democrats, the decision offered a rare moment to celebrate a ruling from an institution in which many in the party have lost faith. The Court’s decisions in earlier voting-rights cases, on gun laws, the environment, campaign finance, and in particular the national right to abortion—which was reversed last year—have led progressives to accuse conservative justices of ruling according to their political preferences instead of the law

    The Court’s decision, Khanna told me, shouldn’t have been surprising—even if, to many people, it clearly was. “It’s certainly a remarkable victory for the Voting Rights Act and for minority voting rights,” she said, “but it’s rather unremarkable, because what it says is the law is as we have said it to be for the last nearly 40 years.”

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    Russell Berman

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  • Black, Hispanic COVID Patients Less Likely to Get Antiviral Paxlovid

    Black, Hispanic COVID Patients Less Likely to Get Antiviral Paxlovid

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    “The issue of equity and distribution of Paxlovid is similar to what we saw in the distribution of the vaccine,” she said. “You have to think about access to primary care pharmacies, particularly in economically disadvantaged communities.”

    Community hesitancy also plays a role, Salas-Lopez noted. “These are new vaccines, new treatments, so the familiarity isn’t there with all of our community members, but in particular, our community members who have experienced a lack of trust in the health care system.

    “In addition, guidelines for testing and vaccines and medications for treatment can quickly change, making it difficult for providers and community members to stay abreast of all the changes — your head spins,” she said.

    Structural racism may also play a role, Salas-Lopez added.

    One weakness of the study, she noted, is that the researchers didn’t account for prescriptions given directly at walk-in clinics and drug stores, which gave out thousands of doses of Paxlovid and might have altered the results.

    Salas-Lopez said that it’s partly the responsibility of health care systems to end these disparities.

    At her health care system, they created a health equity task force to identify the weak spots in health care in their community. They then began outreach programs to close these gaps.

    “Health systems have to work hard to address the issue of inequity,” Salas-Lopez said. “It takes a mission and a vision to do that, and then action.”

    The report, which followed patients from January to July of this year, was published Oct. 28 in the CDC’s Morbidity and Mortality Weekly Report.


    More information

    For more on COVID-19, see the U.S. Centers for Disease Control and Prevention.

     

    SOURCES: Tegan Boehmer, PhD, acting lead, Healthy Community Design Initiative, U.S. Centers for Disease Control and Prevention; Debbie Salas-Lopez, MD, MPH, senior vice president, Community and Population Health, Northwell Health, New Hyde Park, N.Y.; Morbidity and Mortality Weekly Report, Oct. 28, 2022

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  • Monkeypox Case Rates 5 Times Higher in Black Americans

    Monkeypox Case Rates 5 Times Higher in Black Americans

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    Oct. 7, 2022 — Monkeypox cases in the U.S. disproportionately affect Black Americans, with rates five times higher than among white peers, according to a new report from the Kaiser Family Foundation.

    Hispanic Americans, Native Hawaiians and Pacific Islanders also have significantly higher rates of reported monkeypox cases.

    “Disparities in cases persist among Black and Hispanic people, a pattern also seen with HIV and COVID-19,” KFF wrote.

    The analysis was based on CDC data for 68% of monkeypox cases reported in the U.S. as of Sept. 23. Monkeypox case rates are:

    • 14.4 per 100,000 people among Black Americans
    • 10 per 100,000 people among Native Hawaiians and Pacific Islanders
    • 8.3 per 100,000 people among Hispanic Americans
    • 3 per 100,000 people among Asian Americans
    • 2.8 per 100,000 people among American Indians and Alaska Natives
    • 2.6 per 100,000 people among white Americans

    Overall, Black Americans account for the largest share of monkeypox cases, and both Black and Hispanic Americans account for a larger share of cases. About 70% of cases are among people of color, while people of color account for 40% of the U.S. population.

    The monkeypox outbreak in the U.S. appears to be slowing down, KFF wrote, reaching a peak in August and declining in September. However, new cases among Black Americans began to exceed those among white Americans in early August. Although those cases are now declining, the numbers continue to remain higher.

    In addition, Black and Hispanic Americans have received smaller shares of monkeypox vaccines, the report found. As of Sept. 27, 51% of first doses have gone to white Americans, although they represent 30% of cases. In contrast, Black Americans have received 13% of first doses despite accounting for about 35% of cases. Similarly, Hispanic Americans have received 22% of first doses, while they account for 30% of cases.

    “The lower shares of vaccinations among these groups may in part explain why they have had higher numbers of new cases and complicate efforts to address disparities moving forward,” KFF wrote.

    The U.S. has reported 26,385 monkeypox cases during the current outbreak, according to the latest CDC data. More than 70,000 cases and 27 deaths have been reported worldwide.

    KFF noted the ongoing challenge of tracking the outbreak due to data limitations around testing and vaccination. For instance, race and ethnicity data is missing for 32% of reported cases and 9% of vaccinations. Without data, researchers aren’t able to conduct an analysis of disparities across multiple factors, such as race and ethnicity, sex, gender identity, and risk.

    “As has been seen with HIV and COVID-19, underlying structural inequities place people of color at increased risk for public health threats, and focused efforts will be key to minimizing and preventing further disparities going forward,” KFF wrote. “While the federal government has begun piloting efforts to reach communities of color with MPX vaccines in order to address disparities, it is unclear if such efforts will be enough to stave off further disproportionate impact, and much will also depend on what state and local jurisdictions do.”

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