Applied medical anthropology has focused much of its attention on processes and interactions within clinical settings. In the case of chronic diseases such as diabetes or hypertension, which require patients to engage in self-care practices, the production of health extends beyond the boundaries of these biomedical spaces and into the lifeworld of the patient. This article explores the intersections and contradictions between biomedical and community spaces that emerged within a chronic disease clinic. Biomedical space, it is argued, privileges White, middle class ideals of self-control and individualism while devalorizing worldviews, such as those prominent in marginalized neighborhoods where social interdependence is vital. Through participant observation and semi-structured interviews, the author found that while one such biomedical space-the Community Health Awareness and Monitoring Program (CHAMP)-has been able to provide a relatively open and egalitarian medical environment for its participants, its practices and philosophy rely on White, middle-class norms of patient motivation and self-care. This emphasis on health education essentially masks the economic, political and racial inequalities beyond the clinic that create barriers to self-care. The article concludes with the suggestion that applied medical anthropology must be aware of the power relations that exist both inside and outside the clinic.
