Author ORCID Identifier

https://orcid.org/0000-0002-2134-7156

Semester

Fall

Date of Graduation

2023

Document Type

Dissertation

Degree Type

PhD

College

Eberly College of Arts and Sciences

Department

Sociology and Anthropology

Committee Chair

James Nolan

Committee Co-Chair

Lynne Cossman

Committee Member

Melissa Latimer

Committee Member

Ann Chester

Abstract

The objective of this dissertation is to investigate how class and stigma influence spatial inequalities in health across the US, from the structural to the individual level. Class, stigma, and subsequent access to capital resources are not equally distributed across the US. Women, poor, and minority populations continue to have unequal access to capital resources across the country, though this is spatially determined. Similarly, while there are health inequalities along the same social cleavages at the national level, they differ significantly across localities. Research has not paid enough attention to the fundamental social causes of inequities, resulting in the inability to address questions about how the foundational structure of American society influences health and well-being.

I link the theory of the fundamental social causes of health inequalities to the theoretical toolkit of Pierre Bourdieu to investigate the influence of class and stigma on spatial health inequalities. I use a mixed-methods approach to capture data at multiple levels of analysis. First, I investigate how class and stigma at the structural level are related to spatial health inequalities in the US. I use national quantitative data from the U.S. Census Bureau, the Kaiser Family Foundation, the Robert Wood Johnson Foundation, and the United Health Foundation to investigate the distribution of economic and cultural capital in the US using Bourdieu’s field of power as a heuristic device to explicate the relationship between access to capital resources and self-rated health and life-expectancy in the US. To further contextualize the place that West Virginia holds in the national social landscape I carry out a content analysis to determine how the state is represented in national media, with a focus on the portrayal of health.

I then use state level data to map the counties of West Virginia on the social field of the state based on access to economic and cultural capital. Finally, I turn to one county in the state of West Virginia, and the county high school, to carry out an ethnographic study following an academic cohort of adolescents. I pair participant observations in the high school and communities with surveys of nearly the whole class (n=71) at two time points and personal diaries recording daily practices in the lives of a subset of these students as they experience the coronavirus pandemic gripping the nation. I use this data to map students and families, and their health-related practices and behaviors on the social field, defined by the county parameters of available capital resources and youth’s own perceptions of their place in the social hierarchy.

Place-based studies often end up disconnecting communities from the larger society and it is my aim to present a model that can be used to situate any community within the larger social fields in which they are embedded. Ultimately, it is my goal to contextualize, as richly as possibly, one community in America to understand the statistical and perceived differences and distances in the social structure to power, or economic and cultural capital, and how that position relates to health inequities. I use theory and method to facilitate a double gaze—up at how power is used to divide and categorize at the structural level and down at how social arrangements influence perceptions and outcomes—bridging the macro-level determinants and micro-level consequences of class and stigma in the production and reproduction of health inequalities.

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