Events that have occurred in the past can be traced along a historical trajectory that is evident in our present day, and those decisions greatly influence the success of future posterity. The construction of interstate-40 through the business district of North Nashville effectively placed this area in economic disadvantage for years to come. Only by examining a small number of past grievances that the Nashville city designers and officials have executedâoften times at the expense of minority populations, can we begin to see the similarities between these historical processes of urban renewal and the gentrification that is occurring today. This thesis examines Nashville as a case study to explore how the influence of public works--specifically those of the federal highway can 'make or break' the success of a community. The relevant literature about Nashvilleâs construction of Interstate-40 was analyzed, and the historical narrative surrounding Nashville's Interstate-40 is contextualized in the larger narrative of the federal transportation policy history. The results of this research found that the local and state highway department did not provide adequate information concerning the relocation of Interstate-40 through the business district of Jefferson Street to the residents. The lack of information prevented the African-American community from organizing a successful movement against the interstate-40 construction. The construction of the interstate resulted in the dislocation of many businesses and families, many of which never recovered economically.

Despite public health interventions, racial health disparities have proven very difficult to eliminate, particularly between Blacks and Whites. Each racial category carries its own health burden but most approaches use White people and their âWhitenessâ as normative health entities to contrast the wellbeing of a racial minority. The literature describes a âwhite privilegeâ carried by these individuals, benefiting them and their progeny socially, economically, politically, physically, and so on, giving an invisibility to move throughout life âunmarkedâ by a racial category. However, this socialized invisibility can both prevent White individuals from being âseenâ in conditions that benefit or disenfranchise them, and socially render them fragile (âwhite fragilityâ) from understanding and adequately responding to important health decisions. Explored are the social reactions to the âwelfare queenâ, opposition to the Affordable Care Act, and nationwide responses to the U.S. heroin epidemic to assert that this âwhite fragilityâ is detrimental to white health individually and as a group. The de-centering, problematizing, and direct addressing of the health impact âWhitenessâ has on White bodies is expected to assist advancements in closing racial health gaps to benefit both Blacks and Whites.

Despite being the racial/ethnic group that is disproportionately affected by HIV/AIDS, African Americans are underrepresented in HIV/AIDS clinical trials. The reasons for the inadequate participation of African Americans in HIV/AIDS clinical trials are multidimensional, consisting of individual, investigator, study-related, and structural factors, all of which are shaped by larger social, economic, and political forces. In order to comprehensively address the factors that influence African Americans participation in HIV/AIDS clinical trials and move towards reducing the racial disparity in HIV/AIDS clinical trials participation, the biomedical, clinical trials research approach needs to locate individuals and their decision to participate within the larger sociostructural context in which individuals and their decision to participate exist. Incorporating intersectionality, cultural competency, and structural competency into the training of researchers, increasing community involvement in the research process, and increasing the representation of minority researchers on research teams can help clinical researchers learn how to locate individuals within their broader sociostructural contexts so that they can learn how to navigate the multidimensional factors that influence African Americansâ decision to participate in HIV/AIDS clinical trials.

MEDICINE, HEALTH AND SOCIETY Spirituality and Religion as a Social Determinant and Social Mediator of Health Christopher Lee Gross Thesis under the direction of Professors Jonathan M. Metzl and JuLeigh Petty In recent years, the Association of American Medical Colleges (AAMC) has placed significant attention on social determinants of health (SDH) as making significant contributions to patient health and outcomes (AAMC, 2012). Although the medical community has long understood the influence of a patients lived environment on health, medical education has only recently incorporated SDHs into its curriculums, generally defining them as the social, political and economic influence on race, ethnicity, poverty level, socioeconomic status and education level. I contend that this definition is incomplete. Spirituality and religion (SR) informs behaviors that have health implications to at least an equal degree, and therefore should be included as a social determinant of health, and given equal weight to the aforementioned (Idler, 2014). Currently, most relevant literature focuses on the ethicality of SR and medicine or the specific health benefits associated with various religions. Future research should go beyond these questions and address spirituality and religion as a SDH because SR can inform patient health beliefs, practices and behaviors (Idler, 2014). Not only does SR act as a social determinant of health, it acts as a social mediator of health (SMH). Although certain religious practices promote common behaviors among groups that have health specific implications (i.e. following a SR that proscribes alcohol influences health behaviors in regard to alcohol consumption), individuals in the same group might understand or respond differently to illness (health beliefs). In this way, SR can act as social mediator of health during an illness experience. Given its ubiquity, all physicians should be educated to better understand a patients SR, and its relationship to medical practice and patient health. This means that providers should be open to the possibility that a patients SR might be influencing a patients health beliefs and behaviors as it relates to the lived experience, day-to-day life practices/routines, as well as their response to suggested healthcare treatment. If a clinician desires to include SR care, as a part of pastoral care, into her own practice of medicine, she should have the opportunity and resources to be well-educated and well-trained to do so. Since SR in medical education is limited, I will present a program evaluation of a community-based health clinic that incorporates SR for healthcare trainees. Approved: Jonathan M. Metzl, M.D., Ph.D. Approved: JuLeigh Petty, Ph.D.

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