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Heart-Sick: The Politics of Risk, Inequality, and Heart Disease

Janet K. Shim
Copyright Date: 2014
Published by: NYU Press
Pages: 264
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  • Book Info
    Book Description:

    Heart disease, the leading cause of death in the United States, affects people from all walks of life, yet who lives and who dies from heart disease still depends on race, class, and gender. While scientists and clinicians understand and treat heart disease more effectively than ever before, and industrialized countries have made substantial investments in research and treatment over the past six decades, patterns of inequality persist. InHeart-Sick, Janet K. Shim argues that official accounts of cardiovascular health inequalities are unconvincing and inadequate, and that clinical and public health interventions grounded in these accounts ignore many critical causes of those inequalities.Examining the routine activities of epidemiology - grant applications, data collection, representations of research findings, and post-publication discussions of the interpretations and implications of study results - Shim shows how social differences of race, social class, and gender are upheld by the scientific community. She argues that such sites of expert knowledge routinely, yet often invisibly, make claims about how biological and cultural differences matter - claims that differ substantially from the lived experiences of individuals who themselves suffer from health problems. Based on firsthand research at epidemiologic conferences, conversations with epidemiologists, and in-depth interviews with people of color who live with heart disease, Shim explores how both scientists and lay people define difference and its consequences for health. Ultimately,Heart-Sickexplores the deep rifts regarding the meanings and consequences of social difference for heart disease, and the changes that would be required to generate more convincing accounts of the significance of inequality for health and well-being.

    eISBN: 978-1-4798-6674-8
    Subjects: Sociology

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
    (pp. ix-xii)
  4. Introduction
    (pp. 1-28)

    Juanita Miller lives in a first-floor apartment on a quiet residential street in a predominantly African American community in the San Francisco Bay Area. Her neighborhood, lined with older two-story homes now split into smaller apartment units, is just blocks away from an industrial strip located in the shadows of an elevated highway. I came to visit Ms. Miller on an overcast afternoon in late summer. She took a long time to come to the door. A tall black woman in her fifties, she moved slowly and gingerly, wincing in pain from the arthritis that the recent wet weather had...

  5. 1 The Politics of Disease Causation
    (pp. 29-47)

    In order to interrogate, account for, and make sense of the politics of disease causation, I rely on several sets of concepts and theoretical arguments: biopower and biopolitics, intersectionality theory, and fundamental causality. This chapter’s intent is to provide a selective review of the works, concepts, and arguments I have found most valuable and to offer a taste of how I use them to think with throughout this book. While to date these literatures have not regularly been brought into conversation with one another, I hope to show that doing so helps to articulate a set of questions that can...

  6. 2 Disciplining Difference: A Selective Contemporary History of Cardiovascular Epidemiology
    (pp. 48-76)

    This chapter provides a contemporary history of cardiovascular epidemiology, drawing mostly on secondary sources, supplemented with ethnographic data collected from epidemiologic conferences and interviews with epidemiologists. It emphasizes the contemporary social and historical developments most pertinent to the conceptualization and study of individual and population differences, particularly those of race, class, and sex/gender. I also include conceptual, methodological, and epistemological debates circulating both within and outside the world of epidemiology that are relevant to research on human differences. This history underscores the social and cultural shaping of epidemiologic practices and their significance for our current state of official knowledge on...

  7. 3 The Contested Meanings and Intersections of Race
    (pp. 77-111)

    In this first of three chapters on the meanings of difference, I show the complicated and highly contested terrain of epidemiologic and lay considerations of race and its intersections with class and gender. This terrain is deeply divided, in that scientists in my study tended to attribute racial disparities to cultural differences, while those living with heart disease foregrounded thestructural, relational, andintersectionalprocesses of racialization to make sense of their risks. It is no wonder, then, that the lay people I interviewed consistently critiqued conventional racial and ethnic categories used in epidemiology, as well as in everyday life,...

  8. 4 An Apparent Consensus on Class
    (pp. 112-138)

    Interviews with both groups of participants and ethnographic data from conference proceedings convey that there exists a relatively significant amount of consensus between epidemiologic researchers and people with heart disease on the relevance of social class differences for health. Both groups clearly and unequivocally pointed to class and its intersections with race and gender as significantsocialandstructuraldeterminants of the stratification of cardiovascular health. That is, the consequences of class differences for heart disease were seen to reside in their multiple and complex effects, in conjunction with race and gender, on people’s exposures to risks and the resources...

  9. 5 The Dichotomy of Gender
    (pp. 139-161)

    As the last of the three dimensions of difference explored in this book, sex and gender pose an interesting counterpoint to race and class. The title of this chapter refers to two ways in which I found gender to be dichotomized. First, both epidemiologists and lay people alike do not question that gender and sex are binary in nature, and self-evidently so. But in a second sense, gender is viewed and constructed in fundamentally contrasting ways by epidemiologists and lay people. While epidemiologists overwhelmingly and consistently constructed gender differences in cardiovascular risk as attributable to biological, hormonal distinctions between men...

  10. 6 Individualizing “Difference” and the Production of Scientific Credibility
    (pp. 162-190)

    Scientific practices as well as their products—scientific claims, facts, and the content of what counts as “science”—bear the imprint of social, political, historical, and economic forces. In previous chapters, I described epidemiologists’ and lay people’s accounts of the effects of race, class, and gender on cardiovascular risk and disease causation. In this chapter, I turn my attention to the paradigms, practices, and technologies that govern epidemiologic research on heart disease, in order to illuminate the linkages between how the science is practiced—under what conditions and constraints, and with what tools—and the content of the scientific claims...

  11. Conclusion
    (pp. 191-214)

    Despite more than a century and a half of medical and epidemiologic research into the causes of social inequalities in heart disease, vast, systematic differences persist in who develops it, who lives with it, and who dies from it. These durable disparities in heart disease incidence and outcomes have raised public concerns and prompted research explicitly aimed at uncovering the causes for such inequalities. Thus racial, socioeconomic, and sex categorizations of various forms have consistently been a part of the epidemiologic endeavor, in which population variations are identified and mined for clues to the etiology of disease. However, when considering...

    (pp. 215-224)
  13. NOTES
    (pp. 225-244)
    (pp. 245-270)
  15. INDEX
    (pp. 271-276)
    (pp. 277-277)