The Social Transformation of Health Inequities

226 Pages·2017·1.35 MB·English

University of New Mexico
UNM Digital Repository
Sociology ETDs Electronic Teses and Dissertations
7-2-2013
Te Social Transformation of Health Inequities:
Understanding the Discourse on Health Disparities
in the United States
Sonia Betez
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Recommended Citation
Betez, Sonia. "Te Social Transformation of Health Inequities: Understanding the Discourse on Health Disparities in the United
States." (2013). htps://digitalrepository.unm.edu/soc_etds/6
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Sonia Bettez
Candidate

Sociology
Department

This dissertation is approved, and it is acceptable in quality
and form for publication:

Approved by the Dissertation Committee:

Howard Waitzkin, Co-Chairperson

Nancy Lopez, Co-Chairperson

Jason Beckfield

Lisa Cacari-Stone

Laura Gomez
The Social Transformation of Health Inequities: Understanding the Discourse
on Health Disparities in the United States

By

Sonia Bettez

B.A., English and Psychology, Merrimack College, North Andover, MA, 1976
Masters in Social Work, University of North Carolina at Chapel Hill, 1992

DISSERTATION

Submitted in Partial Fulfillment of the
Requirements for the Degree of

Doctor of Philosophy
Sociology

The University of New Mexico
Albuquerque, New Mexico

May 2013
iii

©2013, Sonia Bettez
iv
Dedication

To Janice Kando, partner and best friend, whose continued love and support always
encourages and nourishes me
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Acknowledgements
Throughout the journey of developing and writing this dissertation I received
invaluable gifts of support that I will always treasure. Family, friends, colleagues, and
professors served as emotional and intellectual mentors whose encouragement got
me through what could have been a lonely road. I thank them all and want to
acknowledge them. And I beg forgiveness from those who I will inevitably omit due
to lapses of memory.
Thank you to my committee members: Howard Waitzkin, chair, whose first
lecture hooked me into studying up and asking big questions, who made me a better
scholar and tirelessly guided and mentored me through the painstaking dissertation
process; Nancy Lopez, professor, mentor, friend, sister; Lisa Cacari-Stone who
seemed to come up with just the right words I needed to hear at stressful times;
Laura Gomez who agreed to stay in my committee as she got busier and moved
away; and Jason Beckfield who, without knowing anything about me, took interest in
my project.
Thank you to the University of New Mexico (UNM), my home away from
home during the past four and a half years, and the professors in Sociology and
other departments whose lectures, insights and experiences provided inspiration,
ideas and resources: Beverly Burris, Andrew Schrank, Robert Ibarra, Jane Hood,
Rich Wood, Robert Fiala, Kimberly Huyser, Kristin Barker, Owen Whooley, Ricky
Lee Allen, Nina Wallerstein, Tassy Parker, Lorenda Belone, Celia Iriart and Laura
Nervi. I also want to acknowledge the staff at the department who were always
ready to help: Dorothy Esquivel, Donna Lewis, Caitlin Coalson and the student
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interns whose assistance did not go unnoticed. A special thanks to Maria Velez with
whom I felt comfortable discussing anything during our nourishing, in more ways
than one, lunch meetings.
I am indebted to the Robert Wood Johnson Foundation (RWJF) for its
financial and academic support, and to the RWJF Center for Health Policy at UNM:
Robert Valdez, Gabe Sanchez, Carolyn Richardson, Blake Buoursaw, extraordinary
tutor and supporter, Gina Urias Sandoval, Charlene Porsild, Lee Drake, Ana
Cabrera and the incredibly helpful staff: Thu Luu, Antoinette Maestas, Vanessa
Tafoya, David Hansen and others who, behind the scenes, worked day after day to
make days easier for the fellows. Thank you also to the Mellon Foundation for their
financial support during a year when I needed it, and specifically to Adriana Ramirez
de Arellano for often going the extra mile. I will always have a special place in my
heart and memory for other RWJF fellows Tennille Marley, Shannon Sanchez-
Youngman, Yajaira Peña-Esparza, Michael Muhammad, Estela Vasquez, Julie
Lucero, Patricia Rodriguez, Ron Nikora, Alexis Ortiz, Elvira Pichardo- Delacour,
Alma Hernández, Belinda Vicuña, Sean Bruno Lewis, Luis Robles, Angelina
González-Aller, Vickie Ibarra, Andrea M. López, Louis Castro Alvarado, Justin Tevie,
Felicha Candelaria-Cook, Marita Luz Campos-Melady and Veronica Salinas.
The individuals who agreed to be key informants for my study deserve a
special thank you. I appreciated their willingness to make time in their busy
schedules to talk to a stranger and be willing to openly share and trust that I would
represent their confidential information accurately. They made an essential
contribution to my dissertation.
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And at last, I cannot thank my family and friends enough: My late father,
Alfredo Cuervo, who always modeled a sense of social justice and fairness, hard
work, and persistence and my mother, Ligia Catelblanco de Cuervo, who instilled a
clear to make a positive impact in the world. My siblings and their children have
been supportive and excited about my embarking on this venture. My older daughter
Silvia, who got her PhD a few years before I did, inspired, supported and mentored
me throughout my time as a graduate student; we have seen each other through our
academic achievements (I finished undergraduate school when she was six years
old). Vanesa, my younger daughter, has always been a firm supporter and
cheerleader, willing to listen and encourage when I needed it. My friends have
patiently listened to my refusals to go out and join them in fun activities and gently
nudged me away from the computer when I did not think I had the time. And last but
most importantly, I am immensely grateful to my partner, Janice, who has been at
my side every step of the way, loving, supportive, patient throughout all the time
when my head was in dissertation mode, encouraging and serving as a reader,
editor and sounding board throughout.
viii
The Social Transformation of Health Inequities: Understanding the Discourse
on Health Disparities in the United States
By

Sonia Bettez

B.A., English and Psychology, Merrimack College, North Andover, MA, 1976
Masters in Social Work, University of North Carolina at Chapel Hill, 1992
Ph.D., Sociology, The University of New Mexico, 2013

ABSTRACT

Discourse in the United States characterized “health disparities” as the
disproportionate burden of morbidity and mortality suffered by racial, ethnic and
other disadvantaged populations. This dissertation contributes a theory of social
construction that transformed health inequalities and inequities into “health
disparities,” a hegemonic (dominant) concept that prevented structural analysis of
root causes and effective solutions. Consequently health disparities remain.
My study focuses on the discourse during the latter part of President Clinton’s
administration (1999-2001), when eliminating “health disparities” became a major
objective. Anchored by hegemony and racial formation theories, and using critical
discourse analysis as the principal research method, I study the social construction
of “health disparities.“ I also discuss the differences in discourse between the United
States and other countries. I analyze a selection of official government reports
published between 1979 and 2010 and interviews with a sample of key informants
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involved in policy and/or academia at the time of the study. In addition I perform
limited quantitative content analysis to look at the change in use of the term
“disparities” through time.
I find that the discourse on “health disparities” emphasized race and ethnicity,
individual responsibility, and medical care. This narrow focus omitted and diverted
attention from root causes such as growing structural inequality, thus exculpating
government of responsibility and forestalling socio-economic change. My analysis
suggests that, because of their elite positions and qualifications, individuals who
contributed to the discourse in government participated in transforming health
inequities into “health disparities.”
This study contributes to sociology, population health and social epidemiology
by applying racial formation theory to the study of health inequalities and inequities,
and extending its principles to class formation; thus, it adds a greater understanding
of the social construction of health inequities, as affecting racial and ethnic
minorities, as well as other disadvantaged populations. My study also helps make
sense of how hegemony operates at the individual and institutional levels. Through
omissions, contradictions, fears and capitulation, individuals who express passion
and desire for social change and eliminating inequities in society contribute to
maintaining the status quo by diverting attention from more fundamental
transformations in inequities and inequalities.