Sociology ETDs


Sonia Bettez

Publication Date



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 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.

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Level of Degree


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First Committee Member (Chair)

Lopez, Nancy

Second Committee Member

Cacari-Stone, Lisa

Third Committee Member

Gomez, Laura

Fourth Committee Member

Beckfield, Jason


Social construction, Health, Inequities, Inequalities, Policy, Theory, Sociological



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