First published online as a
Review in Advance on
June 14, 2005

This review proposes a model for analyzing the power of ideolo- gies of communication in producing subjectivities, organizing them hierarchically, and recruiting people to occupythem. By way of illus- tration, it compares this productive capacity, which is herein termed communicability, with schemes of racialization and medicalization. The argument draws on critical discourse analysis, conversational analysis, post-Habermasian research on publics, Bakhtin, Bourdieu, Foucault, and work on language ideologies to synthesize a frame- work for studying spheres of communicability. The concept is then used in exploring how constructions of race and health intersect in some of the most powerful spheres of communicability\u2014those asso- ciated with colonial medicine, HIV/AIDS, severe accute respiratory syndrome (SARS), Alzheimer\u2019s, genetics, clinical trials, \u201crace-based medicine,\u201d organ transplant, and biostatistics. The review attempts to connect linguistic anthropology and discourse analysis more pro- ductively to medical anthropology, the history of medicine andpub- lic health, medical sociology, public health, genetics, and science studies.

COMMUNICATING
INFECTIOUS
INEQUALITIES................ 271
Epidemics and Racial

The research trajectories of numerous dis- ciplines and perspectives are converging on issues of productivity. Many scholars are in- terested in how knowledge and social rela- tions are produced, how individuals and in- stitutions gain rights over this process, and how social worlds emerge and people are re- cruited to occupy them. Two crucial loci of attention are racialization and medicalization. Scholars of medicalization (Conrad 1992) are interested in how biomedical knowledge en- genders subjectivities and de\ufb01nitions of the body, health, disease, and life itself and imbues them with social and political force. Social constructionists suggest that biomedical facts are produced by con\ufb01gurations of technolo- gies, social/political relations, and institutions (Cambrosio & Keating 1992, Haraway 1991, 1997, Latour 1993). Omi &Winant (1986, p. 64) de\ufb01ne racialization as \u201cthe extension of racial meaning to a previously racially unclas- si\ufb01ed relationship, social practice or group.\u201d Others suggest that racial meanings are always already embedded in modernity (Mignolo 2000) and the state (Goldberg 2002); racial- ization thus implies continual impositions of old and new racial meanings. Racialization is hardly an isolated process; racial categories \u201cintersect\u201d with other forms of subordina- tion (Crenshaw 1989), and discourses of race

errez 1991, Stoler 1995) and class (Navarro 1989, Williams 1999). The relevance of work on medicalization and racialization\u2014and explorations of their im- brications (Anderson 2003, Briggs 2002, Hunt 1999)\u2014has increased as scholars demonstrate that they are \u201cabout\u201d more than medicine and race; rather, they constitute crucial sites for producing notions of modernity, nation, state, and citizenship (Epstein 2004, Martin 1994, Molina 2005, Ong 1995, Shah 2001).

A little-explored dimension is how this knowledge is disseminated in society. Racial- ization and medicalization include control over the production, circulation, and recep- tion of discourse. Racial and medical knowl- edge does not simply \ufb02ow but is depen- dent on communicative processes structured by inequities of power and resources. Such inequities as differential access to commu- nicative technologies (cell phones, the In- ternet) and to symbolic capital conferred in schools of medicine and public health have been widely acknowledged. Nevertheless, re- search on publics and work in linguistic an- thropology on language ideologies suggest that disseminating racial and medical knowl- edge involves not just communicative circuits but their ideological construction as well.

I have two goals here. First, I propose a theoretical model and research agenda, ar- guing that notions of \u201ccommunication\u201d are no less productive than ideas of \u201crace\u201d or \u201chealth.\u201d This productive capacity, which I refer to as communicability, stands along- side racialization, medicalization, and other power-laden processes as integral to schemas of hegemony, coercion, and violence. I draw on discourse analysis, including critical dis- course analysis, conversational analysis, post- Habermasian research on publics, Bakhtin, Bourdieu, Foucault, and a range of perspec- tives in linguistic anthropology to synthe- size a framework for studying what I refer to as spheres of communicability. Second, I use the notion of communicability in re- viewing literature from medical anthropology,

the history of medicine and public health, medical sociology, public health, genetics, and science studies on intersections between health, race, sexuality, class, and nation. Connecting racialization and medicalization through communicability reveals how their power is derived partly from ideologies of communication with which notions of race and health are imbricated. These links en- able me to explore some of the most pow- erful spheres of communicability\u2014those as- sociated with colonial medicine, HIV/AIDS, severe acute respiratory syndrome (SARS), Alzheimer\u2019s, genetics, clinical trials, \u201crace- based medicine,\u201d organ transplant, and bio- statistics. I also try to weave together linguis- tic and medical anthropology, and analyses of discourse and health, in a novel way, and I suggest that exploring intersections between communicability, medicalization, and racial- ization will be of value for scholars who gen- erally eschew interest in \ufb01elds that are often marginalized as specialized or technical.1

I beginwith an important wake-up call to U.S. health professionals. A number of authors have argued that greater social inequality leads to poorer health (Kawachi & Kennedy 2002, Navarro 1998, Waitzkin 1983). Then in 2002, a report entitledUnequal Treat-

conomic status and type of health insurance, that AfricanAmericans and Latinos/as receive inferior health care (Smedley et al. 2002). Considerable research and intervention now focus onwhat are called, rather blandly, health disparities. How might research on discourse help? Here I critically examine a number of

disciplinary terrain. It was thus necessary to cite only a few works from each \ufb01eld that seemed particularly germane to the argument. My failure to cite other sources should not be construed as a critical judgment regarding their impor- tance.

stereotypes of minority patients affect qual- ity of care. Conversation analysis (CA), the microanalysis of audio and video recordings of social interaction, has explored how in- equalities emerge in and structure doctor- patient communication (Ainsworth-Vaughn 1998). Recent workon talk in institutions illu- minates the everyday work that underlies how expertise is constructed in health and scienti\ufb01c settings (Goodwin 1994) and the routine cat- egorization that informs procedures toutedto be objective and impersonal. Cicourel (1992) and Sarangi & Slembrouck (1996) trace how medical representations are transformed in circulating between classrooms, clinical inter- actions, texts, and laboratories. Rather than relying on surveys of racial perceptions in studies of health disparities, CA could pro- vide insight into how stereotypes emerge in therapeutic encounters and in\ufb02uence treat- ment regimes. Nevertheless, strict CA adher- ents eschew appeals to history, political econ- omy, or broader social relations\u2014to anything that does not appear on the recording. Deter- mining what makes some forms of interaction possible and others unthinkable is accordingly beyond its scope, thereby limiting CA\u2019s useful- ness for analyzing the production of social in- equalities. Moreover, Mart\u00b4\u0131n-Barbero (1987) suggests that we do not live in societies with media but in mediated societies, where images of self and society are shaped by the media. As health-related content in news and, in the United States, advertising increases dramat- ically, media representations shape how pro- fessionals and laypersons imagine and enact roles of doctor, nurse, and patient.

Critical discourse analysis (CDA) analyzes how inequalities are embedded in linguis- tic patterns (Blommaert & Bulcaen 2000, Reisigl & Wodak 2001). Researchers have identi\ufb01ed linguistic strategies for reconciling claims to being color blind with racist state- ments (Bonilla-Silva & Forman 2000, van Dijk 1991). Reisigl & Wodak (2001) argue