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.
