“Balshem conducted anthropological research as a means of exploring the limitations and possibilities of community-based approaches to cancer prevention. . . . [Her] study serves as a useful first step to a multidisciplinary literature on cancer, broadening analyses of this complex disease in much the same way that social science and grassroots perspectives helped inform the transition from gay-related immune deficiency (GRID) to HIV disease.”—American Journal of Preventative Medicine
“One of the finest pieces of urban ethnography to emerge in recent years. . . . By focusing on cancer and a program set up to reduce its incidence, Balshem illuminates the basic struggles of social class, power inequalities, and control of knowledge. Any pharmacist or other health-care professional who works, or may work, with communities that resemble Tannerstown should find this book insightful, informative, and helpful. Similarly, medical social scientists interested in the dynamics of class conflict in urban America will appreciate the profound anthropological analyses of this humane work.”—American Journal of Health-System Pharmacy
“Fascinating and thought-provoking. Showing clearly that the relationship between patients' families and physicians is a class-based phenomenon, Balshem explores community residents' feelings that health education is an outsider's attempt at control. . . . Her book is not only a report of a project but also a guide and a warning to those setting up similar programs.”—Booklist
“[Cancer in the Community
] raises questions not often asked by health-care professionals, yet necessary to achieve any success with current national health-care proposals.”—Choice
“Anthropologist Balshem worked as a health educator in a blue-collar white ethnic neighborhood in northeast Philadelphia, a cancer hot spot she calls ‘Tannerstown,’ and she offers some worthwhile reflections on ‘negotiating professional authority.’ Balshem’s interviews . . . clearly show how medical professionals both shy away from environmental factors and act in an authoritarian way toward their working-class patients. She argues that health educators should listen more to community critiques.”—Publishers Weekly
From the Back Cover
Focusing on deep conflicts between the medical establishment and the working class, Martha Balshem chronicles a health education project in "Tannerstown", a pseudonym for a blue-collar neighborhood in northeast Philadelphia. Her study is based on her experience as a health educator and anthropologist at the Fox Chase Cancer Center, working with a team of behavioral scientists to educate the public about cancer risk factors. Incorporating emotional, vivid interviews and rich personal narratives, Cancer in the Community addresses such issues as the ethics of professional authority, class antagonisms, and the politicization of cancer. Identified in an epidemiological report as a "cancer hot spot", Tannerstown was targeted by Fox Chase's Project CAN-DO as a community in need of professional guidance. Health educators advised residents to stop smoking, improve their diets, and schedule regular cancer screening tests. This advice, supposedly regarded by the American public as sound and "true", nevertheless was rejected by most Tannerstowners, who believed industrial pollution from nearby chemical plants and air pollution from traffic were the major causes of cancer in their community. Probing the chronic frustration and distrust that persisted between the two groups, Balshem found that medical professionals tended to view working-class patients as problems in need of correction, while Tannerstowners saw doctors as arrogant and controlling. The medical professionals believed that cancer risk was largely attributable to lifestyle factors, but community residents refused to accept "blame" for their disease. While still part of the Fox Chase team, Balshem began to question the right of medicalauthorities to dictate changes in lifestyle while discounting the residents' self-diagnosis of environmental risk factors. Cancer in the Community includes a case history of one Tannerstown resident who died of cancer. Extensive - and wrenching - interviews with the patient's wife and his physician illuminate the underlying struggles concerning social class, power inequalities, and the control of knowledge. In a passionate critique of health education and the constraints of medical professionalism, Balshem traces the sources of conflict about the causes of and treatment for cancer to deeper oppositions concerning truth, justice, and meaning.