Virtual Library

This article explores conditions under which global norms change. I use a case study in which the original interpretation of an international agreement on intellectual property rights was modified to address demands for improved access to affordable AIDS drugs. Conventional theories that focus on international negotiations cannot fully account for the events in this case. Drawing on the theory of recursivity and insights from the literature on diffusion, I suggest that shifts in global norms occur through reactive diffusion of policies across states. Experiences accumulated in this ongoing process of reinvention eventually lead to a new, globally accepted reinterpretation of the original obligation.

Between one-fifth and a third of people who are transgender have been refused treatment by a medical provider due to their gender identity. Yet, we know little about the factors that shape public opinion on this issue. We present results from a nationally representative survey experiment (N = 4,876) that examines how common justifications issued by providers for the denial of healthcare, and the race and gender identity of the person being denied care, intersect to shape public opinion concerning the acceptability of treatment refusal. We find that religious objections are viewed as less acceptable compared to a medical justification, in this case, inadequate training. However, the difference between religious objections and inadequate training is larger when the person being denied healthcare is White or Asian than when the person is Black or Latinx. Analysis of open-ended responses indicates the modest effect of doctor’s rationale on attitudes toward treatment refusal with respect to Black and Latinx patients is partially attributable to a racialized, free-market logic. Respondents were more likely to advocate for a doctor’s fundamental right to refuse service when evaluating Black and Latinx patients compared to White patients. We discuss the implications of these findings for intersectional approaches to trans studies and future public opinion research.

Sociologists have long recognized that social problems do not derive solely from objective conditions but from a process of collective definition. At the core of some social issues are framing competitions, struggles over the production of ideas and meanings. This article examines competing cultural meanings about the fat body. Through frame analysis of organizational materials, I map the contested field of obesity and document three cultural frames—medical frame, social justice frame, and market choice frame—as represented by the Centers for Disease Control and Prevention (CDC), the National Association to Advance Fat Acceptance (NAAFA), and the food industry group the Center for Consumer Freedom (CCF), respectively. Using the “framing matrix,” I explore each frame's key signature elements and discuss its social and cultural significance. Notably, each frame leads to different outcomes for social equality and how society thinks about fat bodies, health, and public policy.

Over the past several decades, citizenship status has become more important in immigrant lives and communities in the United States. Undocumented adults who arrived as children, the 1.5 generation, comprise a growing percentage of the immigrant population. Although they are similar to children of immigrants born in the United States (the second generation) they face a variety of barriers to integration due to their lack of legal status. Based on over five years of ethnographic fieldwork with mainly 1.5 and second generation Mexican-American men during a period of major healthcare reform, this paper addresses how citizenship status and embeddedness within multi-status communities impacts immigrant experiences in the healthcare domain. In particular, I argue that the Affordable Care Act (ACA) has contributed to an institutionalization of the status differences and a further differentiation in the social integration of these groups of children of immigrants. The novel methodological approach and the data which emerges through fieldwork reveals important insights into the process whereby healthcare reforms have consequences for immigrant communities which I show through highlighting the status-signaling event that is generated through various forms of direct and indirect interaction with the ACA. The implications of this extend beyond healthcare, and I discuss its impact on issues including ethnic identity and psychological well-being. This paper makes contributions to both our understanding of intergroup dynamics in immigrant integration and the health implications of immigration policies more generally.

In this article, I investigate responses to the humanitarian crisis that emerged following the May 2008 xenophobic violence against South African nonnationals that resulted in 62 deaths and the displacement of well over 30,000 people. I focus specifically on how a South African AIDS activist movement, the Treatment Action Campaign (TAC) and its partners, Medecins Sans Frontieres (MSF—Doctors Without Borders) and the AIDS Law Project (ALP), translated a particular style and strategy of AIDS activism into legal, medical, humanitarian, and political responses to the massive population displacement. The TAC provided relief to displaced people in the form of basic needs, such as food, clothes, and blankets, as well as legal aid, and it engaged in activism that promoted the rights of the refugees. I investigate how the ideas and practices of global agencies such as the United Nations High Commission for Refugees (UNHCR) were deployed and reinterpreted by TAC activists. I also examine how TAC activists involved in assisting the refugees drew on a global humanitarian assemblage of categories, legal definitions, norms and standards, and procedures and technologies that went beyond the simple management of “bare life.” TAC’s shift from fighting for antiretroviral drugs (ARVs) to fighting for refugees’ rights reveals a “politics of life” that spans multiple issues, networks, and constituencies. It is also a politics that, at times, strategically deploys standardized bureaucratic logics and biopolitical techniques of humanitarian aid

The author presents a theoretic framework for understanding racism on 3 levels: institutionalized, personally mediated, and internalized. This framework is useful for raising new hypotheses about the basis of race-associated differences in health outcomes, as well as for designing effective interventions to eliminate those differences. She then presents an allegory about a gardener with 2 flower boxes, rich and poor soil, and red and pink flowers. This allegory illustrates the relationship between the 3 levels of racism and may guide our thinking about how to intervene to mitigate the impacts of racism on health. It may also serve as a tool for starting a national conversation on racism.

The tension between public health and individual rights raises key questions in the face of public health crises such as tuberculosis (TB) and Ebola: What are the circumstances that warrant the obligatory detention of individuals with an infectious disease as a measure of protecting the general public? What are the implications for the protection of privacy while managing and controlling the spread of diseases such as HIV? What must be done to obtain informed consent for research and epidemiological studies that benefit public health? Recent handling of TB and Ebola patients in West Africa captures the tensions inherent in the attempt to balance public health and individual rights. In this Perspective, we outline our experiences in handling Petition 329 of 2014, a constitutional petition filed in the High Court of Kenya in 2010, which sought to challenge the arrest and detention of two TB patients for interrupting their TB treatment.

The ability to decide if, when, and how often to reproduce is a human right and a biomedical and sociopolitical goal. Infertility impinges upon this right by restricting the ability of individuals and couples to meet their reproductive desires. While biomedical interventions to address infertility have proliferated recently, their distribution has been inequitable; inequalities in rates of infertility, infertility-specific distress, and access to reproductive healthcare to address infertility abound. Using a reproductive justice framework, and focusing on the United States, we examine the collection and utilization of the Integrated Fertility Survey Series, the inception and provisions of Title X, and the structural limitations of the private healthcare system. This analysis highlights systematic and linked exclusions of marginalized groups from reproductive health surveillance and the public and private provision of reproductive healthcare, including older, non-white, working class, LGBTQ, geographically remote, less educated, HIV-positive, institutionalized, and disabled individuals. Individuals who are excluded from infertility tracking, services, and treatment—the invisible infertile—are limited in their ability to realize their human right to reproductive health. Utilizing existing resources in public and private clinical spaces may be a useful starting point for addressing these disparities, but a broader commitment to equitable and inclusive surveillance and healthcare provision is also needed.

In this article, I build a new line of health inequality research that parallels the emerging structural racism literature. I develop theory and measurement for the concept of structural sexism and examine its relationship to health outcomes. Consistent with contemporary theories of gender as a multilevel social system, I conceptualize and measure structural sexism as systematic gender inequality at the macro level (U.S. state), meso level (marital dyad), and micro level (individual). I use U.S. state-level administrative data linked to geocoded data from the NLSY79, as well as measures of inter-spousal inequality and individual views on women’s roles as predictors of physical health outcomes in random-effects models for men and women. Results show that among women, exposure to more sexism at the macro and meso levels is associated with more chronic conditions, worse self-rated health, and worse physical functioning. Among men, macro-level structural sexism is also associated with worse health. However, greater meso-level structural sexism is associated with better health among men. At the micro level, internalized sexism is not related to physical health among either women or men. I close by outlining how future research on gender inequality and health can be furthered using a structural sexism perspective.