UCSF

Addressing racial inequalities in health requires attending to the multiple social mechanisms through which such inequalities are produced. By exploring the range of social factors that influences the experiences of African Americans living with coronary heart disease (CHD), this dissertation describes the processes through which race remains a powerful determinant of health status in the United States and why it continues to be so disproportionately consequential for African Americans in particular. From a methodological standpoint, I argue that critical interactionism provides an innovative approach to the study of racial inequalities by highlighting participants' health and illness experiences at the micro level while providing an analytical framework to study how meso and macro level social factors influence those experiences. Second, I demonstrate that for African Americans, the development and progression of CHD cannot be separated from their social, cultural and racial moorings and that most of the participants consider CHD a "black disease" that carries with it a strong historical and culturally sustaining legacy. Third, using Carpiano's Bourdieusian based framework of social capital, this dissertation takes account of within neighborhood variations of social capital, adding a more nuanced and in-depth understanding of the local conditions and contingent mechanisms through which social capital is generated. By focusing on the types of resources inhered within various forms of social capital, I demonstrate how the costs of cultivating and sustaining social capital can outweigh its potential health related benefits. Fourth, through an extended narrative, I provide a portrait of how the lived environment shapes one's sense of place and how health is produced or undermined through everyday contexts, experiences and burdens. I employ the concepts of habitus and collective habitus as analytics to explore the ways in which bodies, place, and social space are linked together and the effect that linkage has on stress production, perception and experience. I demonstrate how even within the same geographically defined neighborhoods, different lived environments exist producing different types of collective habitus where different attributes, values, expectations and ways of being predominate. I argue that when one collective habitus intrudes upon another, social tensions are created and manifested bodily through stress production, perception and experience. Lastly, I emphasize the importance of taking account of ongoing racial and social dynamics through which inequalities in health are created, sustained and reproduced.