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Medical clinicians, who are already overworked and burned out, are increasingly expected to understand and treat systemic social issues like poverty and racism. One aspect of this is documenting patient’s social risk factors in electronic health records (EHRs). But EHRs do not aways give the full story. Critically, they omit patients’ voices and perspectives about their lives, care, and whether their needs are being met. In Seen But Not Heard, sociologist Jennifer M. Silva and epidemiologist Annemarie G. Hirsch explore the gaps between what clinicians document in EHRs and women’s lived experiences.

Drawing on interviews with 87 non-college-educated, economically disadvantaged women living in rural America and their health records from a large, non-profit health system, Silva and Hirsch find that the stories that medical records provide and the stories that women tell about themselves differ dramatically. Medical charts often translate women’s suffering into sterile diagnostic codes, prescriptions, and treatment plans. Some women felt heard by their clinicians, believed they received adequate care. Many of these women thought their clinicians went above and beyond to help meet their needs by offering them information on how to apply for benefits like food stamps or childcare subsidies and helping them obtain necessary items like mattress covers and winter coats. More often, however, women felt that clinicians were detached from their everyday struggles to survive, whether that meant keeping their families intact even in the face of violence or finding money to pay the never-ending string of bills.

Silva and Hirsch argue that because the system of healthcare delivery interprets social problems as individual failings it often reproduces long-standing injurious stereotypes of women as hysterical, recalcitrant, impure, and gluttonous. For some healthcare providers, knowledge about patients’ social risk factors can become a source of control and punishment, such as denying patients care or reporting patients to child welfare services. Patients described clinicians mobilizing harmful stereotypes about marriage and motherhood, race, and poverty during their appointments. Some of the women’s most traumatic experiences in the healthcare system were completely missing from their EHRs. These troubling experiences ultimately deter women from accessing healthcare, discourages them from sharing their experiences with clinicians, and in some cases, makes their health and social problems worse. Silva and Hirsch offer several policies and practices that would improve women’s experiences in clinical encounters, such as training clinicians in trauma-informed and culturally responsive care, as well as national investments in housing, food security, transportation, and environmental justice.

Seen But Not Heard is a disturbing but necessary examination of the ways vulnerable women are often failed by the healthcare system and offers solutions that will allow healthcare workers to better address the structural barriers faced by their patients. 

How does the experience of sickness, death, and loss change over time? We know that the incidence and virulence of particular diseases have varied from one period to another, as has their medical treatment. But what was it like for the individuals who suffered and died from those illnesses, for the health practitioners and institutions that attended to them, and for the families who buried and mourned them?

In Shadows in the Valley, Alan Swedlund addresses these questions by closely examining the history of mortality in several small communities in western Massachusetts from the mid-nineteenth to the early twentieth century—from just before the acceptance of the germ theory of disease through the early days of public health reform in the United States. This was a time when most Americans lived in rural areas or small towns rather than large cities. It was also a time when a wide range of healing practices was available to the American public, and when the modern form of Western medicine was striving for dominance and authority. As Swedlund shows, this juncture of competing practices and ideologies provides a rich opportunity for exploring the rise of modern medicine and its impact on the everyday lives of ordinary Americans.

To indicate how individuals in different stages of their lives were exposed to varying assaults on their health, the book is structured in a way that superimposes what the author calls “life-course time” onto chronological time. Thus the early chapters look at issues of infancy and childhood in the 1840s and 1850s and the last chapters at the problems of old age after 1900. The reader becomes familiar with specific individuals and families as they cope with the recurrent loss of children, struggle to understand the causes of new contagions, and seek to find meaning in untimely death. By using a broad time frame and a narrow geographical lens, Swedlund is able to engage with both the particularities and generalities of evolving medical knowledge and changing practice, and to highlight the differences in personal as well as collective responses to illness and loss.

An event-by-event look at how institutionalized racism harms the health of African Americans in the twenty-first century
 

A crucial component of anti-Black racism is the unconscionable disparity in health outcomes between Black and white Americans. Sickening examines this institutionalized inequality through dramatic, concrete events from the past two decades, revealing how unequal living conditions and inadequate medical care have become routine. 

From the spike in chronic disease after Hurricane Katrina to the lack of protection for Black residents during the Flint water crisis—and even the life-threatening childbirth experience for tennis star Serena Williams—author Anne Pollock takes readers on a journey through the diversity of anti-Black racism operating in healthcare. She goes beneath the surface to deconstruct the structures that make these events possible, including mass incarceration, police brutality, and the hypervisibility of Black athletes’ bodies. Ultimately, Sickening shows what these shocking events reveal about the everyday racialization of health in the United States.

Concluding with a vital examination of racialized healthcare during the COVID pandemic and the Black Lives Matter rebellions of 2020, Sickening cuts through the mind-numbing statistics to vividly portray healthcare inequalities. In a gripping and passionate style, Pollock shows the devastating reality and consequences of systemic racism on the lives and health of Black Americans. 

In the US, the most common contraceptive methods rely on women’s time, labor, and vulnerability to risk. Comparatively few people rely on vasectomies as a means of preventing pregnancies. Something is happening rhetorically—through meaning-making symbols and the material practices they manifest—that sustains a collective disinterest in vasectomies. Jenna Vinson draws from her feminist rhetorical study of thirty-seven television and film representations, health insurance policies, and interviews with seventeen people who have experienced vasectomy, surfacing barriers to vasectomy uptake, including problematic tropes and practices that keep vasectomy unappealing, out of mind, and inaccessible. Stop Saying Snip! also illustrates tactics and circumstances that lead people to get a vasectomy, sharing real vasectomy stories and showing that women often play an important (and until now unheeded or pathologized) role in this communication process. This book intervenes in the misogynistic cultural expectation that it is women’s responsibility to endure the pain, labor, and risks of managing fertility by identifying the rhetorics that make men’s reproductive bodies seem unnatural sites for pregnancy prevention work. Fostering a persuasive vision of vasectomy is an urgent project that contributes to the movement toward reproductive justice.

Weaving together a personal narrative and a sociological perspective, Surviving Alex movingly describes how even children from “good families” fall prey to addiction, and recounts the hellish toll it takes on families. Drawing from interviews with Alex’s friends, family members, therapists, teachers, and police officers—as well as files from his stays in hospitals, rehab facilities, and jails—Roos paints a compelling portrait of a young man whose life veered between happiness, anxiety, success, and despair. And as she explores how a punitive system failed her son, she calls for a community of action that would improve care for substance users and reduce addiction, realigning public health policy to address the overdose crisis.

A bold new indictment of the racialization of science

Decades of data cannot be ignored: African American adults are far more likely to develop Type 2 diabetes than white adults. But has science gone so far in racializing diabetes as to undermine the search for solutions? In a rousing indictment of the idea that notions of biological race should drive scientific inquiry, Sweetness in the Blood provides an ethnographic picture of biotechnology’s framings of Type 2 diabetes risk and race and, importantly, offers a critical examination of the assumptions behind the recruitment of African American and African-descent populations for Type 2 diabetes research.

James Doucet-Battle begins with a historical overview of how diabetes has been researched and framed racially over the past century, chronicling one company’s efforts to recruit African Americans to test their new diabetes risk-score algorithm with the aim of increasing the clinical and market value of the firm’s technology. He considers African American reticence about participation in biomedical research and examines race and health disparities in light of advances in genomic sequencing technology. Doucet-Battle concludes by emphasizing that genomic research into sub-Saharan ancestry in fact underlines the importance of analyzing gender before attempting to understand the notion of race. No disease reveals this more than Type 2 diabetes.

Sweetness in the Blood challenges the notion that the best approach to understanding, managing, and curing Type 2 diabetes is through the lens of race. It also transforms how we think about sugar, filling a neglected gap between the sugar- and molasses-sweetened past of the enslaved African laborer and the high-fructose corn syrup- and corporate-fed body of the contemporary consumer-laborer.