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

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

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

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

Synopsis

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. In Heart-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-Sick explores 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.

Excerpt

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 aggravated and breathing laboriously because of her congestive heart failure. The living room in which we sat was crowded with sofas and loveseats, a china cabinet, a huge stuffed animal, and Ms. Miller’s wheelchair. She preferred to sit in the wheelchair because it had leg rests that she used to alternately elevate and then lower her legs during my visit. She had . . .

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