Janet K Shim
Biographic Data
| ID | 85852 |
|---|---|
| NAME | Janet K Shim |
| GIVEN NAMES | Janet K |
| FAMILY NAME | Shim |
| SIGNATURE | SHIM J K |
| AFFILIATIONS | University of California, San Francisco |
| ORCID | 0000-0002-4597-7961 |
| VERIFIED | Yes |
| TOTAL WORKS | 48 |
| TOTAL CITATIONS | 1236 |
| AUTHOR COUNT | 47 |
| EDITOR COUNT | 1 |
| FIRST PUBLICATION YEAR | 2002 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 13 |
Active surveillance and trajectories of decision-making among patients with low-risk prostate cancer
Objectives Prostate cancer is the most common cancer among men in the United States. This study examines factors associated with active surveillance (AS) uptake, timing of treatment decision making, and whether timing affects quality of life. Methods We used data from a population-based observational study of 512 patients aged 40–79 diagnosed with low-risk prostate cancer from 2016 to 2022. Factors associated with AS receipt and treatment decisio…
Advancing stratified biomedicalization for urgent times
Mixed Methods for Research on Support Networks of People Experiencing Chronic Illness and Social Marginalization
Substantial research has focused on how social networks help individuals navigate the illness experience. Sociologists have begun to theorize beyond the binary of strong and weak social network ties (e.g., compartmental, elastic, and disposable ties), citing the social, economic, and health conditions that shape their formation. However, limited research has employed mixed social network methods, which we argue is especially critical for examinin…
Social Capital and Cultural Health Capital in Primary Care: The Case of Group Medical Visits
This article focuses on an empirical setting that upends the clinician-patient dyadic norm: group medical visits (GMVs), in which multiple patients gather in the same space for medical care, health education and peer support. Our grounded theory analysis draws on participant observation and interviews (N = 53) with patients and staff of GMVs at four safety-net healthcare organisations in the United States. We delineate (1) how group medical visit…
Adverse Childhood Experiences and the Process(es) of Frequent K–12 Student Mobility in Urban Contexts
As part of a larger project focused on the intersection of educational and health trajectories over the life course, we use in-depth interviews with 28 adults who experienced multiple non-promotional school changes during the course of their K-12 schooling in three U.S. urban centers to advance understanding of frequent student mobility. Prior research focuses predominantly on isolating the impact of student mobility while saying little about pro…
Marginalized measures: The harmonization of diversity in precision medicine research
The production of large, shareable datasets is increasingly prioritized for a wide range of research purposes. In biomedicine, especially in the United States, calls to enhance representation of historically underrepresented populations in databases that integrate genomic, health history, demographic and lifestyle data have also increased in order to support the goals of precision medicine. Understanding the assumptions and values that shape the …
Social support in the urban safety net: Assessing tie activation among individuals with complex care needs
Activating social ties is a critical mechanism for satisfying individuals' social, emotional, and material needs. Researchers have offered a number of hypotheses around tie activation about when and why particular supporters step in to help, ranging from strategic activation via functional specificity to opportunistic mobilization. To date, few studies have examined multiple tie activation strategies in tandem. This project focuses on people faci…
Using Photographs to Understand the Context of Health: A Novel Two-Step Systematic Process for Coding Visual Data
In qualitative research, photographs and other visual data have been used with oral narratives in ethnography, interviews, and focus groups to convey and understand the perceptions, attitudes, and lived experiences of participants. Visual methodologies that incorporate photographic data include photo elicitation, which has varied approaches with the inclusion of photographs generated by researchers or participants, and Photovoice, which is a form…
Strategies of inclusion: The tradeoffs of pursuing "baked in" diversity through place-based recruitment
US funding agencies have begun to institutionalize expectations that biomedical studies achieve defined thresholds for diversity among research participants, including in precision medicine research (PMR). In this paper, we examine how practices of recruitment have unfolded in the wake of these diversity mandates. We find that a very common approach to seeking diverse participants leverages understandings of spatial, geographic, and site diversit…
Housing Is Health Care: Treating Homelessness in Safety-net Hospitals
As medicine integrates social and structural determinants into health care, some health workers redefinehousingas medical treatment. This article discusses how health workers in two U.S. urban safety-net hospitals worked with patients without stable housing. We observed ethnographically how health workers helped patients seek housing in a sharply stratified housing economy. Analyzing in-depth interviews and observations, we show how health worker…
Social Literacy: Nurses’ Contribution Toward the Co-Production of Self-Management
We share findings from a larger ethnographic study of two urban complex care management programs in the Western United States. The data presented stem from in-depth interviews conducted with 17 complex care management RNs and participant observations of home visits. We advance the concept of social literacy as a nursing attribute that comprises an RN's recognition and responses to the varied types of hinderances to self-management with which pati…
Patient Engagement, Chronic Illness, and the Subject of Health Care Reform
In the United States, in the wake of health care reform, health care systems have been subject to intensifying demands to increase patient engagement , a term that refers broadly to participation in care. We draw from ethnographic research in urban health care safety-net settings in California to examine efforts to increase patient engagement among chronically ill, marginalized patients who have long been disconnected from outpatient care. We sug…
"Managing the "hot spots: Health care, policing, and the governance of poverty in the US
Health care systems in the United States are experimenting with a form of surveillance and intervention known as "hot spotting," which targets high-cost patients-the so-called "super-utilizers" of emergency departments-with intensive health and social services. Through a calculative deployment of resources to the costliest patients, health care hot spotting promises to simultaneously improve population health and decrease financial expenditures o…
Hysteresis - or the mismatch of expectations and possibilities among relatives in a transforming health care system
When a person experiences a severe stroke, their relatives must assume the role of partners in the rehabilitation process. Drawing on Bourdieu's field theory, we investigated the potential gap between the subjective expectations of relatives in terms of the assistance and care they can offer patients with severe brain injuries and the objective constraints of a healthcare field. Using data from observations, as well as interviews with relatives a…
"Caring for "Super-utilizers: Neoliberal Social Assistance in the Safety-net
Hospitals throughout the United States are implementing new forms of care delivery meant to address social needs for structurally vulnerable patients as a strategy to prevent emergency department visits and hospitalizations and to thereby reduce costs. This article examines how the deployment of social assistance within a neoliberal institutional logic involves the negotiation and alignment of economistic values with ethics of care. We focus on c…
Knowing something versus feeling different: The effects and non-effects of genetic ancestry on racial identity
Since the completion of the Human Genome Project, there have been pitched debates about its implications and the research it enables. One prominent thread of concern focuses on the role of post-genomic science on technically enabling and generating interest in genetic ancestry testing (GAT). Critical analyses of GAT have pointed to multiple issues, raising the alarm on consumers' experiences with such technologies. This paper describes the result…
Stratified citizenship, stratified health: Examining latinx legal status in the U.S. healthcare safety net
Like a Fish out of Water: Managing Chronic Pain in the Urban Safety Net
The subjective nature of pain has always rendered it a point of entry for power and corresponding stratifying processes within biomedicine. The opioid crisis has further exacerbated these challenges by increasing the stakes of prescribing decisions for providers, which in turn has resulted in greater treatment disparities. Using the theoretical frame of cultural health capital (CHC) to account for these disparities in pain management as they unfo…
Complex care and contradictions of choice in the safety net
This article explores the complicated and often-contradictory notions of choice at play in complex care management (CCM) programmes in the US healthcare safety net. Drawing from longitudinal data collected over two years of ethnographic fieldwork at urban safety-net clinics, our study examines the CCM goal of transforming frequent emergency department (ED) utilisers into 'active' patients who will reduce their service utilisation and thereby cont…
The Ethics of Translational Science: Imagining Public Benefit in Gene-Environment Interaction Research
Biomedical research is increasingly informed by expectations of “translation,” which call for the production of scientific knowledge that can be used to create services and products that improve health outcomes. In this paper, we ask how translation, in particular the idea of social responsibility, is understood and enacted in the post-genomic life sciences. Drawing on theories examining what constitutes “good science,” and interviews with 35 inv…
The odd couple: Using biomedical and intersectional approaches to address health inequities
BACKGROUND: Better understanding and addressing health inequities is a growing global priority. OBJECTIVE: In this paper, we contribute to the literature examining complex relationships between biological and social dimensions in the field of health inequalities. Specifically, we explore the potential of intersectionality to advance current approaches to socio-biological entwinements. DESIGN: We provide a brief overview of current approaches to c…
Assessing Patient Activation among High-Need, High-Cost Patients in Urban Safety Net Care Settings
How Neighborhoods Influence Health: Lessons to be learned from the application of political ecology
Response to commentary, “Trauma and the structuring of complex care: Back to the settlements?” by Elizabeth Bowen
Patient engagement at the margins: Health care providers' assessments of engagement and the structural determinants of health in the safety-net
Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine
The first social transformation of American medicine institutionally established medicine by the end of World War II. In the next decades, medicalization-the expansion of medical jurisdiction, authority, and practices into new realms-became widespread. Since about 1985, dramatic changes in both the organization and practices of contemporary biomedicine, implemented largely through the integration of technoscientific innovations, have been coalesc…
Cultural Health Capital: A Theoretical Approach to Understanding Health Care Interactions and the Dynamics of Unequal Treatment
In this article, I propose and define the new concept of cultural health capital, based on cultural capital theories, to help account for how patient-provider interactions unfold in ways that may generate disparities in health care. I define cultural health capital as the repertoire of cultural skills, verbal and nonverbal competencies, attitudes and behaviors, and interactional styles, cultivated by patients and clinicians alike, that, when depl…
Cultural health capital and the interactional dynamics of patient-centered care
Negotiating substance use stigma: The Role of Cultural Health Capital in Provider-Patient Interactions
Diverse aspects of life and lifestyles, including stigmatised attributes and behaviors are revealed as providers and patients discuss health. In this article, we examine how the stigma associated with substance use issues shapes clinical interactions. We use the theoretical framework of cultural health capital (CHC) to explain how substance use stigma is created, reinforced and sometimes negotiated as providers and patients engage in health inter…
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 const…
Understanding the routinised inclusion of race, socioeconomic status and sex in epidemiology: The Utility of Concepts From Technoscience Studies
The multifactorial model of disease causation constitutes the dominant conceptual framework underwriting the epidemiology of chronic illness. Under this rubric, factors correlated with disease are analysed at the individual level; accordingly, race, social class and gender are routinely conceptualised and incorporated into epidemiological research as individualised measures of racial category, socioeconomic status and sex. This paper employs thre…
Stratified citizenship, stratified health: Examining latinx legal status in the U.S. healthcare safety net
Risk, life extension and the pursuit of medical possibility
With increasing frequency, the oldest members of US society are undergoing medical interventions aimed at prolonging life. Using cardiac care as a case study, this paper explores how a discourse of risk infuses and legitimates high-tech clinical treatments in late life. In particular, we examine how the diminishing risks associated with biomedical procedures produce a sense of medical possibility regarding life extension, and push the definition …
Patient engagement at the margins: Health care providers' assessments of engagement and the structural determinants of health in the safety-net
Enacting the molecular imperative: How gene-environment interaction research links bodies and environments in the post-genomic age
Aged bodies and kinship matters
The number of kidneys transplanted to people over age 70, both from living and cadaver donors, has increased steadily in the past two decades in the United States. Live kidney donation, on the rise for all age groups, opens up new dimensions of intergenerational relationship and medical responsibility when the transfer of organs is from younger to older people. There is little public knowledge or discussion of this phenomenon, in which the site o…
Is There Life on Dialysis: Time and Aging in a Clinically Sustained Existence
Increasingly, in the United States, lives are being extended at ever-older ages through the implementation of routine medical procedures such as renal dialysis. This paper discusses the lives and experiences of a number of individuals 70 years of age and older at two dialysis units in California. It considers what kind of life it is that is being sustained and prolonged in these units, the meanings of the time gained through (and lost to) dialysi…
Homogeneity and heterogeneity as situational properties: Producing – and moving beyond? – race in post-genomic science
In this article, we explore current thinking and practices around the logics of difference in gene-environment interaction research in the post-genomic era. We find that scientists conducting gene-environment interaction research continue to invoke well-worn notions of racial difference and diversity, but use them strategically to try to examine other kinds of etiologically significant differences among populations. Scientists do this by seeing p…
Like a Fish out of Water: Managing Chronic Pain in the Urban Safety Net
The subjective nature of pain has always rendered it a point of entry for power and corresponding stratifying processes within biomedicine. The opioid crisis has further exacerbated these challenges by increasing the stakes of prescribing decisions for providers, which in turn has resulted in greater treatment disparities. Using the theoretical frame of cultural health capital (CHC) to account for these disparities in pain management as they unfo…
Clinical life: Expectation and the Double Edge of Medical Promise
This article introduces the concept of clinical life to capture a form of life produced in the pursuit and wake of medically achieved longevity. Relying on the retrospective accounts of 28 individuals over age 70 who have undergone cardiac bypass surgery, angioplasty or a stent procedure, as well as interviews with their families and with clinicians, we examine three features of clinical life. First, patients do not distinguish between clinical p…
"Caring for "Super-utilizers: Neoliberal Social Assistance in the Safety-net
Hospitals throughout the United States are implementing new forms of care delivery meant to address social needs for structurally vulnerable patients as a strategy to prevent emergency department visits and hospitalizations and to thereby reduce costs. This article examines how the deployment of social assistance within a neoliberal institutional logic involves the negotiation and alignment of economistic values with ethics of care. We focus on c…
Complex care and contradictions of choice in the safety net
This article explores the complicated and often-contradictory notions of choice at play in complex care management (CCM) programmes in the US healthcare safety net. Drawing from longitudinal data collected over two years of ethnographic fieldwork at urban safety-net clinics, our study examines the CCM goal of transforming frequent emergency department (ED) utilisers into 'active' patients who will reduce their service utilisation and thereby cont…
How Neighborhoods Influence Health: Lessons to be learned from the application of political ecology
Defining trauma in complex care management: Safety-net providers' perspectives on structural vulnerability and time
Accounting for Complexity: Gene-environment Interaction Research and the Moral Economy of Quantification
Scientists now agree that common diseases arise through interactions of genetic and environmental factors, but there is less agreement about how scientific research should account for these interactions. This paper examines the politics of quantification in gene-environment interaction (GEI) research. Drawing on interviews and observations with GEI researchers who study common, complex diseases, we describe quantification as an unfolding moral ec…
Race and Ancestry in the Age of Inclusion: Technique and Meaning in Post-Genomic Science
This article examines how race and ancestry are taken up in gene-environment interaction (GEI) research on complex diseases such as heart disease, diabetes, and cancer. Using 54 in-depth interviews of 33 scientists and over 200 hours of observation at scientific conferences, we explore how GEI researchers use and interpret race, ethnicity, and ancestry in their work. We find that the use of self-identified race and ethnicity (SIRE) exists alongsi…
"The value of "life at any cost: Talk about stopping kidney dialysis
Housing Is Health Care: Treating Homelessness in Safety-net Hospitals
As medicine integrates social and structural determinants into health care, some health workers redefinehousingas medical treatment. This article discusses how health workers in two U.S. urban safety-net hospitals worked with patients without stable housing. We observed ethnographically how health workers helped patients seek housing in a sharply stratified housing economy. Analyzing in-depth interviews and observations, we show how health worker…
"Managing the "hot spots: Health care, policing, and the governance of poverty in the US
Health care systems in the United States are experimenting with a form of surveillance and intervention known as "hot spotting," which targets high-cost patients-the so-called "super-utilizers" of emergency departments-with intensive health and social services. Through a calculative deployment of resources to the costliest patients, health care hot spotting promises to simultaneously improve population health and decrease financial expenditures o…
Strategies of inclusion: The tradeoffs of pursuing "baked in" diversity through place-based recruitment
US funding agencies have begun to institutionalize expectations that biomedical studies achieve defined thresholds for diversity among research participants, including in precision medicine research (PMR). In this paper, we examine how practices of recruitment have unfolded in the wake of these diversity mandates. We find that a very common approach to seeking diverse participants leverages understandings of spatial, geographic, and site diversit…
Understanding the routinised inclusion of race, socioeconomic status and sex in epidemiology: The Utility of Concepts From Technoscience Studies
The multifactorial model of disease causation constitutes the dominant conceptual framework underwriting the epidemiology of chronic illness. Under this rubric, factors correlated with disease are analysed at the individual level; accordingly, race, social class and gender are routinely conceptualised and incorporated into epidemiological research as individualised measures of racial category, socioeconomic status and sex. This paper employs thre…
Biomedicalization: Technoscientific Transformations of Health, Illness, and U.S. Biomedicine
The first social transformation of American medicine institutionally established medicine by the end of World War II. In the next decades, medicalization-the expansion of medical jurisdiction, authority, and practices into new realms-became widespread. Since about 1985, dramatic changes in both the organization and practices of contemporary biomedicine, implemented largely through the integration of technoscientific innovations, have been coalesc…
Revisiting the Biomedicalization of Aging: Clinical Trends and Ethical Challenges
Developments in the realms of medical innovation and geriatric clinical intervention impact our understanding of the nature of late life, the possibilities for health in advanced age, medical decision making, and family responsibility in ways that could not have been predicted 15 years ago. This essay begins to map new forms of biomedicalization in the U.S. and to underscore their emergence in a new ethical field. We suggest that a new kind of et…
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 const…
Is There Life on Dialysis: Time and Aging in a Clinically Sustained Existence
Increasingly, in the United States, lives are being extended at ever-older ages through the implementation of routine medical procedures such as renal dialysis. This paper discusses the lives and experiences of a number of individuals 70 years of age and older at two dialysis units in California. It considers what kind of life it is that is being sustained and prolonged in these units, the meanings of the time gained through (and lost to) dialysi…
Masculinity and Men's Health: Coronary Heart Disease in Medical and Public Discourse
Aged bodies and kinship matters
The number of kidneys transplanted to people over age 70, both from living and cadaver donors, has increased steadily in the past two decades in the United States. Live kidney donation, on the rise for all age groups, opens up new dimensions of intergenerational relationship and medical responsibility when the transfer of organs is from younger to older people. There is little public knowledge or discussion of this phenomenon, in which the site o…
Risk, life extension and the pursuit of medical possibility
With increasing frequency, the oldest members of US society are undergoing medical interventions aimed at prolonging life. Using cardiac care as a case study, this paper explores how a discourse of risk infuses and legitimates high-tech clinical treatments in late life. In particular, we examine how the diminishing risks associated with biomedical procedures produce a sense of medical possibility regarding life extension, and push the definition …
"The value of "life at any cost: Talk about stopping kidney dialysis
Clinical life: Expectation and the Double Edge of Medical Promise
This article introduces the concept of clinical life to capture a form of life produced in the pursuit and wake of medically achieved longevity. Relying on the retrospective accounts of 28 individuals over age 70 who have undergone cardiac bypass surgery, angioplasty or a stent procedure, as well as interviews with their families and with clinicians, we examine three features of clinical life. First, patients do not distinguish between clinical p…
Biomedicalization: Technoscience, Health, and Illness in the U.S.
International audience
Social Bodies
Biomedicalization: Technoscience, Health, and Illness in the U. S.
The end of the epidemiology wars? Epidemiological ‘ethics’ and the challenge of translation
Cultural Health Capital: A Theoretical Approach to Understanding Health Care Interactions and the Dynamics of Unequal Treatment
In this article, I propose and define the new concept of cultural health capital, based on cultural capital theories, to help account for how patient-provider interactions unfold in ways that may generate disparities in health care. I define cultural health capital as the repertoire of cultural skills, verbal and nonverbal competencies, attitudes and behaviors, and interactional styles, cultivated by patients and clinicians alike, that, when depl…
Cultural health capital and the interactional dynamics of patient-centered care
Homogeneity and heterogeneity as situational properties: Producing – and moving beyond? – race in post-genomic science
In this article, we explore current thinking and practices around the logics of difference in gene-environment interaction research in the post-genomic era. We find that scientists conducting gene-environment interaction research continue to invoke well-worn notions of racial difference and diversity, but use them strategically to try to examine other kinds of etiologically significant differences among populations. Scientists do this by seeing p…
Race and Ancestry in the Age of Inclusion: Technique and Meaning in Post-Genomic Science
This article examines how race and ancestry are taken up in gene-environment interaction (GEI) research on complex diseases such as heart disease, diabetes, and cancer. Using 54 in-depth interviews of 33 scientists and over 200 hours of observation at scientific conferences, we explore how GEI researchers use and interpret race, ethnicity, and ancestry in their work. We find that the use of self-identified race and ethnicity (SIRE) exists alongsi…
Accounting for Complexity: Gene-environment Interaction Research and the Moral Economy of Quantification
Scientists now agree that common diseases arise through interactions of genetic and environmental factors, but there is less agreement about how scientific research should account for these interactions. This paper examines the politics of quantification in gene-environment interaction (GEI) research. Drawing on interviews and observations with GEI researchers who study common, complex diseases, we describe quantification as an unfolding moral ec…
Enacting the molecular imperative: How gene-environment interaction research links bodies and environments in the post-genomic age
Negotiating substance use stigma: The Role of Cultural Health Capital in Provider-Patient Interactions
Diverse aspects of life and lifestyles, including stigmatised attributes and behaviors are revealed as providers and patients discuss health. In this article, we examine how the stigma associated with substance use issues shapes clinical interactions. We use the theoretical framework of cultural health capital (CHC) to explain how substance use stigma is created, reinforced and sometimes negotiated as providers and patients engage in health inter…
The Ethics of Translational Science: Imagining Public Benefit in Gene-Environment Interaction Research
Biomedical research is increasingly informed by expectations of “translation,” which call for the production of scientific knowledge that can be used to create services and products that improve health outcomes. In this paper, we ask how translation, in particular the idea of social responsibility, is understood and enacted in the post-genomic life sciences. Drawing on theories examining what constitutes “good science,” and interviews with 35 inv…
The odd couple: Using biomedical and intersectional approaches to address health inequities
BACKGROUND: Better understanding and addressing health inequities is a growing global priority. OBJECTIVE: In this paper, we contribute to the literature examining complex relationships between biological and social dimensions in the field of health inequalities. Specifically, we explore the potential of intersectionality to advance current approaches to socio-biological entwinements. DESIGN: We provide a brief overview of current approaches to c…
Assessing Patient Activation among High-Need, High-Cost Patients in Urban Safety Net Care Settings
How Neighborhoods Influence Health: Lessons to be learned from the application of political ecology
Sociology (33 works) · Medicine (30 works) · Psychology (28 works) · Political science (24 works) · Health care (15 works) · Law (11 works) · Nursing (11 works) · Social science (11 works) · Public relations (10 works) · Social Psychology (10 works)