Publications

Rachel Kahn Best, Yan Fang, Catherine Fisk, Linda Hamilton Krieger, and Dianna Reddy, 2025. “Disputed and Disfavored: Pain, Mental Illness, and Invisible Conditions in Disability Discrimination Cases.” Social Science & Medicine.

When they sue their employers for disability discrimination, do plaintiffs with some types of conditions fare better than others? This paper analyzes legal outcomes for three types of conditions that are potentially disputed (subject to suspicion and doubt) or disfavored (subject to stigma or judgment): mental illnesses, invisible conditions, and subjectively diagnosed pain conditions. Using logistic regression to analyze over 1,100 judicial opinions in the US federal courts, we find that invisible conditions tend to be disputed and mental illnesses tend to be disfavored. We find the strongest and most consistent disadvantages for subjectively diagnosed pain conditions; plaintiffs with these conditions are significantly less likely to be deemed a person with a disability and to win in court. The disadvantages for plaintiffs with difficult-to-document pain conditions persist even if they are deemed to be persons with disabilities, suggesting that skepticism about these conditions pollutes judges’ overall impression of plaintiffs.

Rachel Kahn Best and Alina Arseniev-Koehler, 2023. “The Stigma of Diseases: Unequal Burden, Uneven Decline.” American Sociological Review 88(5):938-969.

Why are some diseases more stigmatized than others? And, has disease stigma declined over time? Answers to these questions have been hampered by a lack of comparable data. Using word embedding methods, we analyze 4.7 million news articles to create new measures of stigma for 106 health conditions from 1980-2018. Using mixed effects regressions, we find that behavioral health conditions and preventable diseases attract the strongest connotations of immorality and negative personality traits. Meanwhile, infectious diseases are marked by disgust. These results lend new empirical support to theories that norm enforcement and contagion avoidance drive disease stigma. Challenging existing theories, we find no evidence for a link between medicalization and stigma, and only suggestive evidence that advocacy can reduce stigma. Finally, we find that stigma has declined dramatically over time, but only for chronic physical illnesses. In the past four decades, stigma has transformed from a sea of negative connotations surrounding most diseases to two primary conduits of meaning: infectious diseases spark disgust, and behavioral health conditions cue negative stereotypes. These results show that cultural meanings are especially durable when they are anchored by interests, and that cultural changes intertwine in ways that only become visible through large-scale research.

Rachel Kahn Best, 2019. Common Enemies: Disease Campaigns in America. New York: Oxford University Press.

For over a hundred years, millions of Americans have joined together to fight a common enemy by campaigning against diseases. Common Enemies asks why disease campaigns have dominated a century of American philanthropy and health policy and how the fixation on diseases shapes efforts to improve lives. Combining quantitative and qualitative analyses in an unprecedented history of disease politics, Best shows that to achieve consensus, disease campaigns tend to neglect stigmatized diseases and avoid controversial goals. But despite their limitations, disease campaigns do not crowd out efforts to solve other problems. Instead, they teach Americans to give and volunteer and build up public health infrastructure, bringing us together to solve problems and improve our lives.

Sandra R. Levitsky, Rachel Kahn Best, and Jessica Garrick, 2018. “‘Legality With a Vengeance:’ Re-Claiming Distribution for Socio-Legal Studies.” Law and Society Review 52(3):709-739.

Abstract: The law and society community has argued for decades for an expansive understanding of what counts as “law.”  But a content analysis of articles published in the Law & Society Review from its 1966 founding to the present finds that since the 1970s, the law and society community has focused its attention on laws in which the state regulates behavior, and largely ignored laws in which the state distributes resources, goods, and services. Why did socio-legal scholars avoid studying how laws determine access to such things as health, wealth, housing, education, and food?  We find that socio-legal scholarship has always used “law on the books” as a starting point for analyses (often to identify departures in “law in action”) without ever offering a programmatic vision for how law might ameliorate economic inequality. As a result, when social welfare laws on the books began disappearing, socio-legal scholars lacked the conceptual tools for studying law’s role in creating, sustaining, and reinforcing economic inequality.  We begin the search for those tools by outlining a theory of law’s relationship to social welfare.

Rachel Kahn Best, 2017. “Disease Campaigns and the Decline of Treatment Advocacy.” Journal of Health Politics, Policy and Law 42(3):425-457.

Abstract: In the past 50 years, disease advocacy organizations have multiplied and gained political influence, but they have often been reluctant to ask the government to intervene in healthcare provision. This article asks why. Using original quantitative and qualitative data on the goals and political claims of over 1,000 organizations from the 1960s through the 2000s, I find that many early disease advocacy organizations prioritized healthcare access. But unfavorable political climates discouraged new organizations from focusing on access to treatment. When healthcare became particularly controversial, even organizations with healthcare-related missions refrained from pursuing this goal politically. Eventually, politically active organizations began to drop treatment provision from their missions. Over the decades, the troubled politics of healthcare reshaped the field of disease advocacy, diminishing its focus on medical treatment.

Hana E. Brown and Rachel Kahn Best, 2016. “Logics of Redistribution: Determinants of Generosity in Three Social Welfare Programs.” Sociological Perspectives 60(4):786-809.

Abstract: Social policy scholars disagree about which factors best predict U.S. welfare state generosity. We argue that this disagreement is an artifact of study designs. Researchers usually study either the totality of a state’s social expenditures or one specific program. These approaches overlook the fact that individual social programs were born of different circumstances and serve different constituencies. Comparing state-level policies for Temporary Assistance for Needy Families, the Children’s Health Insurance Program, and the Supplemental Nutritional Assistance Program, we find that these programs are governed by distinct logics of redistribution. Racial characteristics drive TANF generosity. Economic forces best predict CHIP generosity. SNAP generosity is a function of political factors. Qualitative data from Congressional hearings confirm these findings. These results not only adjudicate between conflicting accounts of the contemporary welfare state, they highlight which aspects of a program’s design make it most susceptible to the effects of racial bias and to partisan politics.

Linda Hamilton Krieger, Rachel Kahn Best, and Lauren B. Edelman, 2015. “When ‘Best Practices’ Win, Employees Lose: Symbolic Compliance and Judicial Inference in Federal Equal Employment Opportunity Cases.” Law and Social Inquiry 40(4):843-879.

2016 Honorable Mention, Law and Society Association Article Prize

Abstract: This article provides a new account of employers’ advantages over employees in federal employment discrimination cases. We analyze the effects of “judicial deference,” in which judges use institutionalized employment structures to infer non-discrimination without scrutinizing those structures in any meaningful way. Using logistic regression to analyze a representative sample of judicial opinions in federal EEO cases during the first thirty-five years after the passage of the 1964 Civil Rights Act, we find that when judges uncritically use the presence of organizational structures to reason about whether discrimination occurred, employers are much more likely to prevail. This pattern is especially pronounced in opinions written by liberal judges. In light of these findings, we offer recommendations for judges, lawyers, and policy makers – including legal academics – who seek to improve the accuracy and efficacy of employment discrimination adjudications.

Rachel Kahn Best, 2012. “Disease Politics and Medical Research Funding: Three Ways Advocacy Shapes Policy.” American Sociological Review 77(5):780-803. PDF

2013 Winner, Eliot Freidson Outstanding Publication Award, Medical Sociology Section, American Sociological Association

Abstract: In the 1980s and 1990s, single-disease interest groups emerged as an influential force in U.S. politics. This article explores their effects on federal medical research priority-setting. Previous studies of advocacy’s political effects focused narrowly on direct benefits for constituents. Using data on 53 diseases over 19 years, I find that in addition to securing direct benefits, advocacy organizations have aggregate effects and can systemically change the culture of policy arenas. Disease advocacy reshaped funding distributions, changed the perceived beneficiaries of policies, promoted metrics for commensuration, and made cultural categories of worth increasingly relevant to policymaking.

Rachel Kahn Best, Lauren B. Edelman, Linda Hamilton Krieger, and Scott R. Eliason, 2011. “Multiple Disadvantages: An Empirical Test of Intersectionality Theory in EEO Litigation.” Law and Society Review 45(4):991-1025. PDF

Abstract: A rich theoretical literature describes the disadvantages facing plaintiffs who suffer multiple, or “intersecting” axes of discrimination. This article extends extant literature by distinguishing two forms of intersectionality: demographic intersectionality, in which overlapping demographic characteristics produce disadvantages that are more than the sum of their parts, and claim intersectionality, in which plaintiffs who allege discrimination on the basis of intersecting ascriptive characteristics (e.g., race and sex) are unlikely to win their cases. To date, there has been virtually no empirical research on the effects of either type of intersectionality on litigation outcomes. This article addresses that lacuna with an empirical analysis of a representative sample of judicial opinions in Equal Employment Opportunity (EEO) cases in the federal courts from 1965 through 1999. Using generalized ordered logistic regression and controlling for numerous variables, we find that intersectional demographic characteristics and legal claims are each associated with dramatically reduced odds of plaintiff victory. Strikingly, plaintiffs who make intersectional claims are only half as likely to win their cases as plaintiffs who allege a single basis of discrimination. Our findings support and elaborate predictions about the socio-legal effects of intersectionality.

Rachel Best, 2010. “Situation or Social Problem: The influence of events on media coverage of homelessness.” Social Problems 57(1):74-91. PDF

Abstract: Despite a strong interest in media coverage of social problems, sociologists have failed to examine when and why news outlets present issues as problems in need of public action within short time periods. Through content analysis of 475 newspaper articles and negative binomial regression, I show that coverage of homelessness varies in the extent to which it presents homelessness as a social problem. The fact that not all news coverage discusses social problems challenges the claim that social problems necessarily compete for attention in a zero-sum game. I also examine the effects of three types of events (events promoted to the media by their actors and high- and low-profile events not promoted by their actors) on newspapers’ likelihood of describing homelessness as a social problem. While previous researchers predicted that events not promoted by their actors would lead to media coverage that challenged the status quo, I find that actor-promoted events are much more likely to do so. This finding highlights the importance of institutionalized action in calling attention to social problems.

David L. Kirp and Rachel Best, 2007. “Life Way After Preschool.” Pp. 50-75 in The Sandbox Investment: The Preschool Movement and Kids-First Politics. Cambridge, MA: Harvard University Press.

Abstract: This chapter focuses on the use of social science research in preschool policy debates. We review forty years of social science research on preschool’s effects and track how this research has been used in policymaking.