Constructing 'race' across the science-lay divide: Racial formation in the epidemiology and experience of cardiovascular disease

Social disparities in cardiovascular disease (CVD) have increasingly engaged the concern of the biomedical, epidemiological, and public health communities. In this context, cardiovascular epidemiology has emerged as an essential tool for understanding the determinants, risk factors, and distribution of CVD across populations. Race, ethnicity, culture, and related differences are studied for their effects on cardiovascular risk and are being constructed in heterogeneous ways as scientifically legitimate contributors to CVD risk. This paper presents findings from a qualitative, sociological study that compares epidemiological and lay conceptions of the meanings of 'race' and their accounts of the mechanisms through which racial differences in cardiovascular disease are produced. In particular, I analyze current conventions for classifying race in epidemiology, and identify multiple ways in which the lived experiences of race undermine the validity of scientific measurement. I describe a science-lay divide between the two accounts of cardiovascular risk, in which epidemiologists principally understand race as cultural difference, whereas lay people living with CVD tend to construct race in structural terms. I identify various aspects of these two kinds of constructions and offer reasons for their prominence. Finally, I discuss some of the implications of such disparate conceptions of the relationships between race and health, and important issues around lay knowledge and expertise that remain problematic for science studies scholarship.