“Healthier Than Just Healthy”: Families Transmitting Health as Cultural Capital

Abstract

As the relationship between social class and health strengthens and socioeconomic and health inequalities widen, understanding how parents’ socioeconomic advantage translates into health and class advantages in the next generation is increasingly important. Our analyses illustrate how a classed performance of “health” is a fundamental component of transmitting cultural capital in families and communities. Socially advantaged parents’ health and class goals for children are often met simultaneously by building children’s cultural capital in community-specific ways. This study uses observational, interview, and focus group data from families in two middle-class communities to illustrate how health-focused cultural capital acquisition plays out in everyday life. As parents manage children’s lives to ensure future advantages, they often focus on health-related behaviors and performances as symbols of class-based distinction for their children. The synergy between family and community cultural capital is strengthening class and health advantages for some children, even as health-focused cultural capital often has drawbacks for stress and well-being. The intensification of and value placed on “health” in cultural capital may have long-term implications for health, socioeconomic attainment, and inequalities. If health-focused cultural capital continues to become increasingly salient for status attainment, its importance could grow, widening these gaps and reducing intergenerational mobility.

The United States has increasing levels of socioeconomic inequality, as well as lower intergenerational class mobility compared to other developed countries (Saez 2008). The relationship between social class and health is strengthening (Marmot et al. 2008), giving these trends more urgency. Life expectancy in the United States has fallen since 2015 after longstanding steady increases (Xu et al. 2016), largely driven by declines in some lower-socioeconomic-status (SES) groups (Case and Deaton 2015; Masters, Tilstra, and Simon 2017). Understanding how social class is reproduced and translates into good health across generations are crucial goals for social scientists today.

We turn to families and communities to understand intergenerational processes of advantage that are happening concurrently in health and social class. Most research has focused on either health or SES; we integrate these literatures to inform our analysis grounded in ethnographic and interview data. We illuminate processes through which contemporary middle-class parenting intimately interweaves social class and health to reproduce inequalities. Analyses focus on the transmission of cultural capital and habitus, finding that both families and communities matter for cultural capital and habitus processes. Our analysis illustrates how health is now a fundamental aspect of cultural capital and class distinction that has implications for future socioeconomic attainment, health, and social disparities.

Our multimethod qualitative study from two demographically and culturally similar but distinct middle-class communities combines observations of families with elementary-age children with interviews and focus groups with parents, as well as interviews with adults who work with children. Participants’ class-based “intensive parenting” (Hays 1996; Shirani, Henwood, and Coltart 2012), used to transmit cultural capital, involves an extensive emphasis on inculcating specific health behaviors, ways of understanding and talking about health, and embodied performances of health. These efforts result in habitus and physical appearances that signal class distinction and socially classed “moral” values such as discipline, deferred gratification, and self-autonomy (LeBesco 2011; Luna 2019; Saguy and Gruys 2010). Communities are also crucial in shaping intensive parenting cultures and magnifying the cultural capital and habitus advantages higher-SES parents work to provide to their children in both social class and health. Yet intensive parenting and the inculcation of health-focused cultural capital have downsides for children—particularly girls—in terms of body image, stress, and mental health.

INTEGRATING THEORIES ON CLASS-BASED TRANSMISSION OF HEALTH AND CLASS

Three distinct literatures inform our understanding of how parents’ socioeconomic advantages translate into socioeconomic and health advantages for children. The first focuses on health, the second on families, and the third is a theoretical lens used in research on both families and health.

Health

First, fundamental cause theory is a dominant perspective for understanding health disparities (Freese and Lutfey 2011; Link and Phelan 1995). As in our study, this perspective broadly construes health to include physical and mental health and health-related behaviors. It considers SES a fundamental cause of health disparities because higher-SES individuals consistently deploy resources—including knowledge, power, and social connections—to improve their health, regardless of the specific health condition. Resources represent a metamechanism that yields socioeconomic health disparities, through a multiplicity of health condition-specific mechanisms, as soon as medical knowledge is available for prevention or treatment. Shim (2010) expanded fundamental cause mechanisms to include “cultural health capital”—cultural capital deployed in health care interactions, which can be purposeful or include unconscious dispositions and habits in an individual’s habitus (Bourdieu 1986b). Shifting focus to the collective, Freese and Lutfey (2011:72) articulated the related concept of SES “spillovers,” in which “the actions of other people have consequences that accrue differently to people of different social positions.” Even if a higher-SES person does not take concerted action to improve their own health, their relationships with advantaged people and their advantaged contexts will improve their health—their social ties may unconsciously instill more healthful habits, or their more advantaged neighborhood may have less pollution or violence. This implicates communities and groups in perpetuating socioeconomic disparities in health. Fundamental cause research has focused almost entirely on adults.

Parenting

Independently of the health inequality literature, a second body of work on families and social inequalities has also examined how people translate social advantages into benefits for themselves and others. This research typically focuses on social class and education more than on health (Calarco 2014; Lareau 2011; Streib 2013). “Intensive mothering/parenting” is a strategy expected of parents—but particularly mothers who experience more pressure—to build cultural capital and generate educational advantages for their children (Bourdieu 1986a; Elliott and Bowen 2018; Hays 1996; Shirani, Henwood, and Coltart 2012), with the goal of giving children knowledge and skills that benefit them socioeconomically. Intensive parenting can reproduce social advantage; provide social, human, and, particularly, cultural capital for children; and give children competencies that increase their success when interacting with social institutions (Bourdieu 1986a; Calarco 2014; Lareau 2011). Parenting intensively demands considerable time, money, and energy for managing children’s lives. Higher-SES parents greatly outspend lower-SES counterparts on enrichment activities (Duncan and Murnane 2011), and disparities in academic achievement have increased over time (Reardon 2011). Intensive parenting is responsive to higher social inequality, which intensifies the importance of children’s socioeconomic success: Schneider, Hastings, and LaBriola (2018) found that states with higher income inequality had greater socioeconomic disparities in parental financial investments in children, concentrated among the highest-income parents.

There are important parallels between fundamental cause theory and research on parenting and social inequalities: More advantaged parents work to improve their children’s futures by consistently deploying a flexible set of resources to maximize their well-being and development as information about suitable mechanisms becomes available. We show how instilling cultural capital is a major way in which parents deploy resources, with specific health-related behaviors and performances as a substantial focus. But the ultimate goal of parents’ efforts is different in the two perspectives. In fundamental cause theory, people work to maximize health. In the parenting literature, socioeconomic advantage is maximized instead.

These two goals do not usually conflict—indeed, SES is a fundamental cause of health. We argue that the lack of attention to the early life course in fundamental cause theory and to health in the literature on class-based parenting and cultural capital has resulted in relatively little theorizing about how health and class can dovetail in intensive parenting efforts. King, Jennings, and Fletcher studied class differences in children’s prescription stimulant use, which has uncertain long-term health consequences but tends to improve academic performance. They found class-advantaged parents’ selective use of stimulants during the school year suggests that “school-based selective stimulant use offers a new pathway through which medical interventions may act as a resource for higher-SES families to transmit educational advantages to their children” (2014:1060).

At other times, the goals of health and socioeconomic advantage may conflict. Children build human capital in early life, and pursuing this long-term goal can sometimes incentivize behaviors that harm short-term health. For example, teen sleep deprivation has led to debates about academic schedules and pressures (Eaton et al. 2010). We analyze how parents work to resolve conflicts between health and socioeconomic interests. But more commonly, health and class advantages can be transmitted to children simultaneously. The parenting literature has underemphasized the ways in which signaling health and encouraging “healthy” behaviors and bodies are key aspects of intensive parenting and class distinction today. We document processes through which this growing phenomenon occurs and how it integrates with class-related parenting practices.

Cultural Capital and Habitus

We argue that socioeconomic and health considerations typically merge in the creation and transmission of cultural capital—a theoretical tool that, as can be seen above, is used actively in the health and family literatures. As articulated by Bourdieu (1986a), cultural capital is an important noneconomic resource that is differentially available to people, a resource in which they enact culture to signal membership in a powerful group or deservingness of resources and social connections (Khan 2011). Cultural capital can be objectified (i.e., cultural goods), institutionalized (i.e., educational systems), or embodied. Bodies are physical capital (Williams 1995) and important repositories of cultural capital through classed signals, such as clothing, teeth, height, hair, and mannerisms. The embodied form is particularly relevant when thinking about cultural capital that relates to health. Bourdieu (1986a:244) characterized the work of acquiring embodied cultural capital as “work on oneself (self-improvement), an effort that presupposes a personal cost … an investment, above all, of time.” Cultural capital facilitates the conversion of social inequalities into health disparities by shaping people’s behaviors (Abel 2008).

Transmitting cultural capital is important for reproducing social class inter-generationally in families, and a primary mechanism for this transmission is the development of habitus (Bourdieu 1986b). Habitus—unconscious habits and dispositions that are often embodied—is acquired over time and can result from both strategic and unconscious socialization. Although an individual may not be aware of their habitus or its advantages for future status attainment and health, it shapes interactions and perpetuates social advantages throughout life (Lareau 2011). Bourdieu (1986a:246) singles out childhood as crucial for acquiring cultural capital:

The process of appropriating objectified cultural capital and the time necessary for it to take place mainly depend on the cultural capital embodied in the whole family. … the precondition for the fast, easy accumulation of every kind of useful cultural capital, starts … without wasted time only for the offspring of families endowed with strong cultural capital.

The transmission of cultural capital in childhood is a slow, subtle process that cannot be matched among people who first start acquiring this cultural capital as adults.

Cultural capital and habitus are not only acquired within the family, but also collectively in communities and schools (Khan 2011), a process we are able to begin uncovering with our data. Previous work has primarily emphasized families and studied implications for school success: Parents teach children a sense of entitlement and specific competencies that provide advantages when engaging with schools and other institutions (Calarco 2014; Lareau 2011). We expand this work in four ways. First, we focus on interactions between family and community when examining how health-focused cultural capital and habitus develop. Second, our data disentangle family from community-level SES, showing how they can reinforce or undermine each other. Third, our focus on two middle-class communities, rather than communities with starkly different SES, permits us to investigate cultural differences in community-level processes, such as collective habitus, that are not attributable to SES alone. Finally, we emphasize processes through which specific health-related behaviors and performances form a core part of cultural capital today.

How do health and health behaviors fit into cultural capital? Our focus is not on how cultural capital shapes health care (e.g., Gage-Bouchard 2017; Shim 2010), but rather on how contemporary inequalities cannot be understood without viewing health as a fundamental component of cultural capital. We study the formation of such “health-focused cultural capital.”

Socioeconomic disparities in health are growing in many settings, and the relationship between health and SES is bidirectional and strong (Marmot et al. 2008). Neoliberal trends emphasizing that individuals should regulate their own health (LeBesco 2011) increase pressure on parents to construct their children’s health correctly. In this context, health behaviors and body size are increasingly effective forms of distinction between social classes (Bourdieu 1986b; Saguy and Gruys 2010; Williams 1995), making it hard for people to succeed socioeconomically unless they possess the necessary cultural capital to perform and embody health correctly. Parents seeking to transmit socioeconomic advantages to children must, therefore, address these health-related aspects of cultural capital beyond other, more commonly cited aspects such as education-related practices. Most parents are motivated to help their children in life, but parents who have more capital, including cultural capital, are more likely to succeed in their efforts (Chin and Phillips 2004). In parallel with the rise of health as a form of distinction, the “medicalization of motherhood” has made it imperative for parents—particularly mothers—to manage children’s health behaviors in order to correctly perform social advantage (Elliott and Bowen 2018; Lee 2008). Beyond class distinction, health has not coincidentally become increasingly tied to morality (LeBesco 2011; Luna 2019). Similarly, parenting in the United States is strongly moralized (Shirani, Henwood, and Coltart 2012).

Parenting, class distinction, cultural capital, and habitus at the family and collective levels are at the core of our analysis, which seeks to understand intergenerational processes of advantage that are happening concurrently in health and social class. We ask: Through what processes is contemporary middle-class parenting integrating social class and health and thereby reproducing inequalities?

METHODS

Data

Our qualitative data were collected through parent interviews (our primary data source), home observations, parent focus groups, and key informant interviews in two neighboring communities—Greenville and Springfield¹—in a health-focused region of the U.S. interior West between September 2015 and May 2016 (see Table 1). Thirty-five parents who had a child in fourth or fifth grade participated in both an interview and a home observation (which spanned several hours of a single school night from after school until bedtime) with their 30 families. Twenty-one parents participated in an interview only. Three focus groups were held for each community, including 21 parents (some of whom contributed other data). Stand-alone parent interviews and focus groups were open to parents of elementary-aged children. The nine key informants were local professionals who interacted with families (e.g., teachers, pediatricians). We focused on elementary age, because families are a major influence on children but are being joined by community, peers, and school. Our types of data collection and instruments were refined through pilot research that included additional approaches. The study design was further refined using abduction (Timmermans and Tavory 2012): We initially studied our two communities as part of one broader metropolitan area where health may be particularly relevant for parenting, but upon realizing they were empirically distinct, began collecting similar amounts of data from each community and conducting community-specific focus groups.

Table 1.

Data Summary

		Parent interviews
	Family observations	Observation families	Other parents	Parent focus groups	Key informant interviews
Children (focal child 4th or 5th grade + siblings)	37G/29S
Parents (K-5)	31G/24S	20G/15S	11G/10S	3G/3S
Other adults (work with K-5)					9a
N	30 families	35*	21	21 parents in 6 focus groups	9

Notes: G=Greenville, S=Springfield. Shaded cells indicate data were collected for this group and data type.

^aKey informants typically worked with families from throughout the area that included both communities as well as surrounding towns.

^*35 “primary parents” participated in 30 interviews, 5 of which included both parents together at the parents’ request.

Participants were recruited for a study on “parents, kids, and well-being” through parenting email listservs, public Facebook and Craigslist postings, personal contacts, referrals from participants, and flyers posted throughout the communities (e.g., public libraries, recreation centers, apartment complexes). These strategies were designed to recruit participants broadly from the communities rather than having a narrower focus on certain social networks, schools, or neighborhoods. When a specific school reached 10 of our 51 parent interviews, we stopped collecting data from that school’s families to diversify our non-representative sample. The sample represents many neighborhoods and social networks, includes families from 23 different elementary schools plus homeschoolers, and incorporates sociodemographic variety, particularly in family SES and years lived in the community. Participant comments suggested that common motivations for participating were to earn money, demonstrate good parenting, seek parenting advice, and teach children the importance of research.

The research team comprised one faculty member, two graduate students, and three undergraduates. Team members in the first two groups were white women, and the undergraduates were an African American woman, an Asian American man, and a white man. Interviewees were paid $50 for a stand-alone interview, key informant interview, or focus group; or $200 for a home observation with parent interview. Each participant signed an informed consent form before participating, and parents and children consented for children. The project was approved by a university institutional review board.

All interviews and focus groups were conducted by either a faculty member or graduate student and were recorded and subsequently transcribed. Interviews were semi-structured, asking questions regarding the family’s daily routine, what it is like to be a parent in their community, comparing their child’s life to their own childhood, asking about factors that influence children’s health, how the parent defines “health” and “well-being,” etc. The focus groups included between two and (most commonly) four parents, with no couples in the same group. Observations were conducted by two team members, one either a faculty member or graduate student and the other usually an undergraduate student. When family members were in different rooms, the observers split up, resulting in two sets of field notes for some interactions and one for others. The focal child was always followed, and the child was usually in the same room as at least one parent. Handwritten field notes were typed into a word processing program for subsequent coding. In observations we asked to interview the “primary parent,” who was usually the mother; five families asked to complete tandem interviews that included both parents.

Parent participants had an average age of 43, and 80 percent were mothers. 77 percent were married, 17 percent divorced or separated, 4 percent single, and one parent was widowed. 86 percent of parents identified as white, 8 percent Asian American, and 6 percent Latino, which limits our capacity to draw conclusions based on race/ethnicity. A substantial minority of parents were foreign-born from a variety of regions. Key informants had an average age of 39, 78 percent were female, and all were white except for one multiracial participant. Children in the observation sample ranged from ages 2 to 15, with at least one fourth or fifth grader (typically aged 9-11) per family. Based on parent and partner education and occupation and housing quality, we classified 59 percent of families as upper-middle-class, 29 percent middle-class or mixed SES (e.g., higher income but lower education), and 12 percent working-class or poor.

Communities

The two sample communities are middle- to upper-middle-class, located within the same large metropolitan area, and considered mid-sized cities. The communities have some demographic similarities based on 2011–2015 data. Their median household incomes are close to the state average, and the high proportion of residents identifying as white is similar and somewhat above the state average. However, Springfield is more socioeconomically and ethnically diverse than the more affluent Greenville. One quarter of Springfield’s population identifies as Latino, almost three times higher than that of Greenville. Greenville’s median housing value is twice Springfield’s, and at about 75 percent, nearly twice the proportion of residents have at least a Bachelor’s degree in Greenville, compared to Springfield. Both communities have high rates of favorable health behaviors and low obesity rates compared to demographically similar places. Studying communities where health is particularly salient can provide “heightened analytical clarity,” articulating how health informs parenting and cultural capital (Luna 2019:252).

Springfield is both a similarly sized city with a distinct culture and a commuter satellite of Greenville. Although both communities are middle- to upper-middle-class, participants consistently told us that they have distinct community-level differences in parenting and how people “do” health. Greenville has stronger intensive parenting norms and higher expectations that parents conform, and there is a focus on diet, “clean living,” and academic and physical achievement. Springfield also has many such families, but the expectation is to allow for variation in parenting, and there is a greater focus on well-being, reduced stress, and team sports.

Analysis

Electronic copies of transcriptions and field notes were manually coded with NVivo software. We first coded interview/focus groups by responses to each interview or focus group question, and observations by common behaviors (e.g., eating, doing homework). We assumed that our presence changed in-home interactions but that many child activities are routine enough that we still gained insight into everyday family life. Second, we read entire files and identified important emergent themes, which were then coded in other files. Many themes discussed below came from this category. Finally, we read field notes, parent interview transcripts, and any focus group transcripts for each family together to compare narratives to observed behaviors.

Our methodological approach was inductive and interpretive, treating our data as the site for excavating a greater understanding of processes through which health and class permeate the intergenerational transfer of inequalities. We focused less on preconceived ideas about parenting and class, instead grounding our analysis in what participants told and showed us about their lived experiences and sense-making. These qualitative methodological principles allow themes to be identified organically from data (Lofland et al. 2006). Comparing and contrasting ethnographic and interview data enriched analyses. People’s talk and behavior are often inconsistent in ways that are sociologically interesting and important, rather than simply representing recall inaccuracies (Jerolmack and Khan 2014; Pugh 2013). Because cultural influences are increasingly viewed as both conscious and nonconscious (Vaisey 2009), examining people’s observed behavior in parallel with talk yields important insights. What parents say in the collective setting of a focus group also differs from a private interview, with community norms more clearly articulated in the former and individual justifications for behaviors in the latter. The key informant interviews often focused on generalizations and outside observations of families’ behaviors. The communities had similar intensive parenting and cultural capital practices, so those analyses combine the communities; community differences constitute the last analysis section. Finally, we do not adjudicate whether intensive parenting is good or bad for families, or whether class or health should be the more important parenting goal. Our analysis focuses instead on parents’ narratives and the potential implications of these processes for class, health, and inequalities.

FINDINGS

Like others (Lee 2008; Shirani, Henwood and Coltart 2012), we found that most parent participants—especially mothers—perceive an increased need for intensive parenting today. Because parents think achieving socioeconomic success will be harder for their children than it was for them, their rigorous management of their children’s lives—in particular, sustained efforts to instill cultural capital—feels justified. More effort is needed simply to reproduce their class position in the next generation, let alone increase it. Greenville mother Susan said in a focus group, “There’s just this feeling, you know, that you have to be above and beyond. You have to be—your children have to be—to get anywhere in life.” Susan closely links parents’ efforts to children’s future opportunities. By conforming to these expectations, parents can prove their social group membership and moral worth (Shirani, Henwood, and Coltart 2012).

Our analysis focuses on how health fits into these intensive parenting efforts to build cultural and human capital, with implications for socioeconomic status, health, and intergenerational inequalities. We focus on middle-class communities and cannot speak to the generalizability of these processes to other groups. Health-related aspects of cultural capital are now one of the most major sources of class distinction, although “health” is construed in specific ways. Specific classed performances of health-related behaviors, talk, and physical appearances are paramount and only sometimes relate to actual health. Instilling cultural capital through “health” performances is largely about transmitting social class, yet it directly and indirectly has implications for health. However, the health-focused cultural capital primarily espoused among our parents has considerable downsides for families—in terms of stress, anxiety, and unhealthy body image—that parents recognize and strive to balance. Most rely on their middle- to upper-middle-class communities to reinforce the cultural capital they want to instill, so families, peers, schools, and communities are often carefully orchestrated to transmit similar messages.

Instilling Cultural Capital through “Health” Behaviors and Performances

Our participants view health as a core value they want to transmit to their children. When Bourdieu wrote about cultural capital (Bourdieu 1986a and 1986b), relevant class distinctions included clothing and music. These distinctions have lessened as omnivorous cultural tastes and ease across a variety of social situations have become associated with higher SES (Khan 2011). But one type of cultural capital distinction that may be becoming increasingly universal is having a body, talk, and behaviors that project dominant messages about “health.” These messages, detailed below, include physical fitness, eating nutritious food, and having a thin body that suggests time and money have been spent on its maintenance. Parents were generally uncomfortable talking about social class and transmitting class advantages, but they were open about instilling specific health-related behaviors, performances, and understandings in their children. What they want to transmit closely matches higher-SES performances of health, more than other aspects of health.

Key informant Scott, a Greenville sports coach, characterized this health-focused cultural capital and linked it to intensive parenting: “People in Greenville tend to be known for being healthy. I see why. A lot of the parents–which translates to the kids–value a healthy lifestyle with proper exercise, diet, sleep, and a lot of them are hard workers also it seems like. So it’s kind of that overachiever attitude.” Like many others, Bob confirmed the importance of health as a key goal of intensive parenting in a Springfield focus group: “I think health’s always a concern. You want to make sure you’re doing the best possible” for your children.

Instilling the correct health behaviors in children is seen as a fundamental, prosocial aspect of “good” intensive parenting. A Greenville focus group parent said, “So it’s like, I’m going to run in the morning. I’m going to push my kid in the stroller. Or they’re going to ride their bike with me or whatever. That seems like how people do it… . You see these ways in which people create ways to bring their kids along.” This role modeling of physical activity is likely beneficial for children’s health, as is the children’s biking. But like other examples below, it also creates a specific appearance of health that publicly signals the parent’s adherence to community norms, performing morally “correct” parenting to others and instilling the “right” kind of cultural capital. The parent’s narrative implies that social pressure to exercise may be an important motivation to perform this work alongside its health benefits.

Further illustrating the instillation of cultural capital through health practices in our privileged communities, Greenville mother Hannah talked about her family’s struggles around lunch food in upper elementary and middle school:

We tried for a year to have them pack their own lunches and to be independent. And you know, they packed their lunches, but my husband facilitated the process by buying more packaged foods. And some of them were little packs of seaweed, but even those were super salty or whatever, and there were too many [snack] bars. And I was just like, “Forget it. I am taking over the lunch packing. I will slice the fruit and put it in the little BPA-free containers” … . I think of it as being upper-middle-class privilege of knowing nutrition… . . I think we’re savvy when we read labels, and just because they say that whole bran is good for cholesterol, you still know it’s processed… . . It’s that intellectual thing.

In weighing the merits of her children learning to pack their lunches independently against their nutritional health, Hannah deploys detailed knowledge, such as understanding that even a superfood like seaweed can have too much salt and that whole bran is still a processed food. Recognizing the class privilege inherent in having this knowledge, she ultimately decides to manage her children’s nutrition. The intellectual and emotional work behind this kind of strategizing is substantial, upholds class distinctions, and is often gendered (Cairns and Johnston 2015). Hannah’s comments point to additional pressures on mothers to be ultimately responsible for their children’s health, as she emphasizes the need and her ability to step in and do extra work to improve her children’s diets. Through lunches and negotiations around them, Hannah’s children are developing ingrained habitus around food that will become unconscious, further embodying class advantage.

Greenville pediatrician and parent Mary identifies collective respect for this intensive health-related parenting, grounded in massive effort and parents’ sense that these behaviors will help their children: “There’s this subpopulation who thinks … that through constant vigilance, manipulation of diet and supplements, that their kid will be somehow healthier even than just healthy… . Their kid is like this project for them, and they feel responsible to do everything they can to ensure perfection of health at the cellular level.” The links between “ensuring perfection of health” and intensive parenting are clear in Mary’s account, reflecting the classed notion that bodies are evolving “projects” to be continually improved (Talukdar and Linders 2013; Turner 1984). Like many who talked openly about these processes, Mary was conflicted and not fully supportive.

Molly, a Springfield mother, showed how this parenting “project” can play out in health-focused negotiations between parents and children:

Joe wanted to play tackle football. I was not okay with that. But I said, “Okay, give me some examples of why you want to play, and let’s talk about it.” So we did have a conversation. And then ultimately I made him look up the American [Academy of] Pediatrics website where it says, “Do not play tackle football because of concussions until this age.” So ultimately I did put my foot down, but we had a discussion… . And he hasn’t brought it up since.

Molly is instilling health-focused cultural capital through negotiation. If her goal were simply to protect Joe’s health, Molly could have saved herself parenting work by forbidding him to play football. Instead, her goal is instilling in Joe a “deep” internalized understanding of why playing football is wrong. Molly knows the goal is met when Joe stops asking to play football. By internalizing this cultural capital, Joe is learning how to think and talk about his health behaviors, fusing class and health advantages for his future.

In these communities, a seemingly effortless appearance of health is a fundamental source of class distinction (Luna 2019). This classed appearance of health signals a value on health for its own sake and encourages others to impute classed values that reflect a “moral” person such as discipline, deferred gratification, and self-autonomy (LeBesco 2011; Saguy and Gruys 2010). The appearance of health, which is fundamental to the cultural capital parents implicitly seek to instill, is a mixture of physical embodiment and the performance of specific health behaviors, particularly diet and physical activity. The appearance of health should ideally seem natural and be driven by children’s own preferences, rather than by parental pressure.

Springfield parent Nancy inadvertently illustrated the primacy of the appearance of health when answering our question about whether she thinks her son is healthy: “Yes, besides the occasional crap that we eat, he eats, very healthy. And I think he has good [bone] structure and is tall, and he’s in the 95th percentile for height. He’s not overweight, good hair, good skin, good teeth. Drinks tons of water. Don’t have to worry about him not eating or drinking the right thing.” Her son’s height, hair, lack of acne, and straight teeth matter little for his physical health, but rather for his socially classed appearance. Nancy portrays a naturalness to his body that may actually have been the result of time-consuming, expensive investments in products such as braces and skin care products.

The importance of an appearance of health is further made clear in a “funny story” Nancy told. After going to McDonald’s for the first time as a toddler, her son got very sick and vomited the next day. Nancy summed up, “And he still to this day will not eat there. So that was the best lesson ever learned about–yuck. What directly you put in your body will have an effect on you. Immediately. So it was a good lesson to learn as a young kid.” In the communities we studied, children’s dislike of McDonald’s is a status marker. Nancy is proud that her son has learned to dislike fast food, perform that dislike appropriately to others, and link it to a classed understanding of nutrition. The fairly extreme discipline he went through to learn the correct performance of health—getting sick—seems appropriate to Nancy.

Many parents simultaneously espouse and distance themselves from intensive parenting and the inculcation of cultural capital through health. Beth called her Springfield community “a little bit crazy about the success” (characterizing Greenville as “a lot crazy”) and called overly intensive parents “whack jobs.” Yet she struggled with similar parenting concerns. Her third-grade son’s sports involvement left him staying out until bedtime on many weeknights. She said:

He wants to do this basketball league this summer. It's $900, and they do 39 games. And he’s already doing a basketball summer camp, and he’s already doing soccer. And I’m like, “Don't you think that’s a little much?” And he really wants to do it. So right now I’m thinking, no, we’re not going to. But we’re talking about it and how he won’t have a summer other than basketball if he does all that. So it’s more of a negotiation, I guess.

As Beth’s encouragement of a negotiation suggests, beyond the normative messages they are taught about health, children learn different competencies that, consciously or not, become part of their habitus, building cultural capital and facilitating future class standing (Lareau 2011). By becoming conversant with nutritional information and “good” foods, children are gaining competency in making socially approved health behavior choices, talking to doctors in the “right” way about nutrition, and negotiating with parents. By taking bicycle rides with parents, children are learning to navigate a skill that, in this context, greatly enables peer interactions and garners public praise from teachers and school administrators. Beyond a skill, children in this setting are learning the socially constructed meaning of bike riding as a moral, classed activity. In many other communities, bike riding would have less significant social meaning as a form of cultural capital—so even though it would still be a beneficial health behavior, it might have fewer class implications. Transmitting cultural capital through health teaches children specific interactional styles and can allow them to navigate diverse social and health-related interactions with ease, which is another classed aspect of cultural capital (Khan 2011).

Balancing Health and Class Considerations

What is the ultimate goal of parents’ efforts to instill health-related cultural capital—class reproduction or improving health? For our participants, those goals usually seemed fused. Specific health behaviors and body norms are being instilled in children, some of which will likely improve children’s health. Others may be detrimental (see below). But our analysis suggests that parents’ goal, even as it is phrased as boosting children’s health and well-being, is at least as much class reproduction as it is health. Although this aim is often unconscious or at least unspoken, parents’ efforts signal class distinctions with their children’s appearances of health, health behaviors, talk, and bodies. Parents almost never referenced social class explicitly, but many of their messages, such as Nancy’s pride in her son’s height, bone structure, and “good teeth” are implicitly not so much about health as about creating class distinctions (Bourdieu 1986b). When faced with a conflict between encouraging their child to behave in a healthier versus a less healthy way that communicates higher class standing, many parents implicitly chose the latter. For example, we observed families insisting that sleepy children practice piano or finish homework, or refusing to let girls eat extra portions of a healthy meal, presumably in order for them to stay thin. As we examine elsewhere (Rigles 2019), this was not true in all families. Having a family member with a disability or serious health issue makes many parents consciously decide not to compromise their children’s short-term health in pursuit of longer-term class attainment.

Downsides of Health-Focused Cultural Capital

These analyses show that children’s bodies are not only heavily managed but can also become sites of conflict between health and class considerations. From a health perspective, there are substantial downsides to the health-focused cultural capital being instilled in the communities we studied. Many parents, even as they instilled health-focused cultural capital, expressed concerns. Unhealthy body images and eating practices, stress, and anxiety were three main problems our participants identified. Because girls are more strictly held to health norms, even though boys largely hear the same messages, these drawbacks are particularly salient for girls. Downsides for parents—particularly mothers—include stress and anxiety caused by the substantial emotional and cognitive labor involved in this process.

Susan said of Greenville schools, “I love the way they got rid of sodas, and there are salad bars, and I love the lunch gardens and everything. But I think there’s a little too much emphasis on what they [children] weigh, and they’re too aware of obesity… . The focus on them worrying about if they’re fat, I don’t like that aspect of it.” Susan is not at all unusual in identifying and worrying about negative aspects of the health-focused cultural capital being instilled in children.

Several of our family observations illustrated how body image concerns play out in interaction. We wrote in our field notes when observing the Schneider family in Springfield:

Danielle [a slender 11-year-old] asks for seconds on her chicken sausage. Dad says, “Only if you did all your running tonight.” (I can’t tell if he is teasing but guess not.) Mom and Dad say that maybe she doesn’t need more. “Please, it’s good, and I’m hungry,” Danielle says. Mom offers her something that she didn’t eat from her lunch at school. Danielle says, “No, thank you,” then changes her mind. Dad brings up his daughter’s newfound interest in running, talks about two Olympic events that might be interesting for her to train in. Dad suggests that she invite her friends for weekly training all summer. Danielle is doubtful. She asks for a dark chocolate square. She seems to know that her mom’s answer will be “no” because she ate a lollipop today that contained 5 grams of sugar. They all discuss fractions of grams of sugar and how to convert them to decimals. Mom says, “You can get one square of the 80% cocoa since it only has 1 gram of sugar, or you can have one of those treats that I made.” Dad says those treats are equivalent to about three squares of chocolate.

In both communities, girls were often targets of such interactions that centered on body image and largely focused on diet and physical activity. There is intense scrutiny around Danielle’s caloric intake and exercise, communicating the pressure her parents seem to be feeling. The boundary can be blurry between educating children about nutrition and physical activity and fostering anxiety around food and body size that could engender unhealthy feelings or behaviors.

Beyond body image, parents articulated concerns about balancing intensive parenting with healthy limits on stress and anxiety. Greenville parent Susan said in a focus group, “I feel like there’s a big emphasis on developing your children and pushing them… . . I think you see good and bad out of that. You’re in an affluent community, and your children benefit, but it also puts more stress on the family.” In Springfield, Molly told us:

I think it’s stressful being a parent… . My girlfriends who send their kids to all these sports activities are racing around and going crazy, like they’re adding more stress to your life instead of reducing it. But in their mind, they’re thinking that they need to do this because like they want to fulfil their kids’ dreams. I think that you have to weigh the balances and weigh what works for you and your family. Like, I could do more for my kids… . . And I’ve weighed that, and it’s not worth it for us. My kids need down time.

Molly says she has opted out of many sports and other extracurricular activities to protect her children and herself from stress. Her account blends a sense of moral superiority for making a non-normative choice with guilt that she “could do more for her kids.” Our data showed a disjunction between self-perceptions and judgments of others in terms of “opting out.” Many participants said they had opted out of a busy, class-advantaged lifestyle to protect their children, even as they believed almost everyone around them had not done so, and even as our field notes suggested that, like others, they were actually quite busy. Parents regularly worked to distance themselves from instilling cultural capital through pressuring their children while continuing to claim they were doing the cognitive and emotional labor and management of their children’s lives that this instillation requires. This distancing usually happened in private interviews rather than community focus groups, in which parents monitored and sometimes explicitly judged each other.

Communities Developing Health-Focused Cultural Capital

Our analysis has focused so far on parents’ interactions with children when transmitting cultural capital through health. But another core finding is that communities and schools, interacting with families, are crucial for understanding this transmission. The importance of communities for parenting work in families has been emphasized in previous research (Lareau 2011; Pugh 2009), although comparing communities with similar SES to characterize their local cultures, as we do, is rarer. Most participants had chosen their communities in part because of the cultural capital—particularly in terms of health—the community and its schools and families could provide for their children. Institutions and social groups collectively shape individuals’ habitus (Burke, Emmerich, and Ingram 2013) in ways that can reinforce or undermine parents’ efforts. In selecting communities, parents are carefully orchestrating children’s overall environments to impart consistent norms, resources, and opportunities through the family, peer groups, schools, and broader community. Like other intensive parenting strategies related to health, this requires considerable energy and resources, but it is likely to yield desired results. As Susan said above, “You’re in an affluent community, and your children benefit.” These strategies crossed family-level socioeconomic lines. For example, during our observation of a very low-SES family living in a Greenville mobile home, single mother Phoebe debated at length the pros and cons of enrolling her child in various middle schools, including private schools that might offer scholarships.

Illustrating this community selection, Hannah and Nick moved to Greenville to raise their children, even though it is more expensive than surrounding communities, including Springfield. Nick describes it as:

a place where there’s a pretty high value placed on exercise and organic and growing food … I feel like my fifth grader, after being in a Greenville school for six years, has been fairly indoctrinated about the food, which I never was growing up. You know, the food groups, and creating a healthy meal, and eating different colors when we’re eating, and the importance of that.

Nick approves of community “indoctrination” around health. Many Greenville parents acknowledged social pressure approaching “indoctrination” but submitted to this pressure and appeared to view their willingness to do so as a sign of their commitment to intensive parenting. Similarly, Anne’s family moved to Greenville for health- and class-related reasons. Anne said, “We actually chose Greenville. So partially because of the outdoors… . And we did get attracted by the fact of people being ‘foodies’ and healthy and that whole thing… . It’s really just the style. Like, everybody has a Ph.D. almost, everybody loves the outdoors, everybody is really involved in their kids’ education.” The health, social cohesion, and high SES of Greenville appeal to Anne.

Parents seeking to opt out of intensive socialization around health struggle in Greenville. In a focus group, Karen questioned whether community and peer messages align with her own priorities. She said that her kids “look around, and everybody is skinny, and girls don’t eat, and parents are gluten free, no sugar, and we’re not having trans fats… . And so they’re learning about it, which is good, but then it also makes them think, ‘What am I doing?’ You know, it’s a hard balance.” Another focus group parent said, “If you’re not outdoorsy … and really, really healthy, and focused on all of those things, you can absolutely feel like an outsider. And I think there is probably unspoken pressure for a lot of moms, a lot of parents, to meet a certain expectation, whether it’s financially or physically.” These parents are publicly describing strong community norms around the performance of health that, because of their intensity, are hard to attain—yet people who do not meet these expectations face informal sanctions and “feel like outsiders.” Although parents openly leveled these critiques, they still chose to live in Greenville, despite surrounding communities being substantially less expensive.

Although many Springfield parents had moved there for its lower cost of living, most found that the community’s approach, which reflects a distinct collective habitus from Greenville’s, supported their parenting. This resulted from strikingly different community norms around health-focused parenting in Springfield compared to Greenville. As a focus group parent articulated, Springfield is characterized by a norm that “people parent very differently. … That, I think, is fairly well accepted in Springfield, that people can make a choice.” Another parent echoed, “Every family does it different, and no one seems to judge a whole lot.” This acceptance of different parenting practices stands in stark and often explicit contrast to descriptions of Greenville.

School psychologist Carol approves of Springfield’s more “relaxed approach” to instilling cultural capital around health:

Just the idea that health is an important part of your priorities… . .I think that helping them [kids] make choices that are good choices is a long-term message in terms of just knowing that they are going to be exposed to situations. And then just the whole message of flexibility. You know, it’s good to have a bedtime, but sometimes the bedtime deviates. It’s good to have good healthy eating habits, but there’s times where that deviates. Just not having a sense of needing to be so prescribed. I think that permeates choices.

To Carol, Springfield’s more flexible norms may sometimes result in less healthy behaviors, but that flexibility itself is healthy. Mueller and Abrutyn (2016) similarly find that “cultural coherence” in communities like Greenville increases social control in ways that can improve adherence to positive health behaviors but also foster stress and health problems, including suicide.

Whether parents selected their community to support their parenting or whether communities changed parents’ practices, the two usually reinforced each other instead of conflicting. This will presumably result in a more thorough inculcation of cultural capital and advantaged habitus in children because their environments are sending consistent messages, further shoring up the advantages experienced by children in middle-class communities. These community-level advantages were even apparent for our lower-SES families, who parented around health and class in similar ways compared to the more advantaged families.

But a mismatch between community- and family-level SES can weaken the advantages of community processes for cultural capital instillation. Low-SES single Greenville mother Phoebe illustrates that instilling cultural capital and being healthy do not result in social approval without an appropriate accompanying performance of health. Phoebe says that compared to her previous community, “Greenville is much more like the kind of stuff that we’ve always taught her [Phoebe’s daughter Malia]. Like, both my parents and myself are incredibly health and food aware.” Among other examples Phoebe provided, Malia’s hatred of milk chocolate (“she will only eat dark chocolate”) and love of artichokes and cooking illustrate Malia’s internalization and appropriate performance of advantaged cultural capital. Despite Phoebe’s parenting style and Malia’s performances of health matching Greenville norms, Phoebe describes a “gaping chasm” of class that results in “stigma.” Phoebe gets lots of exercise in her outdoor manual job, but her appearance projects the wrong kind of health because it does not proclaim cultural capital—something Malia has picked up on when asking Phoebe to change her appearance before coming to Malia’s school from work. Behaving healthfully by being physically active at work does not gain social approval in Greenville, even when paired with socially approved parenting around health-focused cultural capital. Instead, specific performances of health should reflect leisure-based physical activity, or else Malia faces “embarrassment.” Ultimately, low-SES Malia is gaining socially advantaged competencies and habitus through Phoebe’s parenting and Malia’s exposure to Greenville peers, but her family’s lack of social acceptance blocks Malia from experiencing the full benefits of Greenville’s health-focused cultural capital.

DISCUSSION

The transmission of cultural capital through health-related practices has become fundamental for status attainment, with embodied resources and classed health behaviors that are linked to morality and discipline transferred across generations. Advantage and disadvantage exist beyond the accumulation of tangible resources and are reflected in habitus, identities, interactions, and bodies. For children, growing up in particular communities with particularly situated parents creates differential opportunities for acquiring cultural capital and advantaged habitus. Increasingly, specific classed health-related behaviors, performances, talk, and bodies are key facets of that capital. The appearance of health may have become fundamental to cultural capital both because health is already closely tied to morality in U.S. society and because it relies on embodiment, which is difficult to acquire quickly or with few resources and is, therefore, effective for instilling class distinctions. Our study begins to uncover how the cultural capital children are exposed to, and the ways in which parents and communities together transmit this capital, become part of the scaffolding of reproducing social advantage.

Explicating the focus on health as a fundamental aspect of cultural capital helps us understand how social class translates inter-generationally into socioeconomic and health advantages. We found that most parents emphasized classed health-related behaviors and performances when describing and enacting their intensive parenting, although a major implicit goal of this work was social class reproduction. The cultural capital being instilled in children facilitates class distinction and serves socioeconomic goals, often while simultaneously bolstering health but sometimes at the expense of short-term health. Yet even these short-term health costs may yield longer-term health benefits: Because decades of research on health disparities has shown that social class strongly influences health (Marmot et al. 2008), by improving their children’s class position, parents also raise the odds of their lifelong good health.

Our findings highlight an empirical puzzle: Parents’ efforts to instill health-focused cultural capital often increase children’s stress and anxiety but presumably raise socioeconomic attainment, thereby improving long-term health. Many parents acknowledge this tension and worry about resolving it. Our communities’ versions of health-focused cultural capital address this tension in different ways that carry distinct benefits and disadvantages. Springfield’s emphasis on current well-being likely reduces children’s stress and anxiety, which may positively affect longer-term health. Because Greenville’s stronger prescriptions around children’s health performances likely intensify the acquisition of class-privileged cultural capital, its norms may increase stress but result in more successful socioeconomic outcomes—which is not surprising, given Greenville’s somewhat higher levels of social class. Future research should consider the longer-term socioeconomic and health effects of differential exposure to health-focused cultural capital in childhood.

Emphasizing race, as our study of two predominantly white communities could not do, can provide more nuance about the presumably raced nature of health-focused cultural capital and the implications of race-based residential segregation for the reproduction of social class through intensive parenting in communities. Parent gender was clearly salient in the processes we analyzed, with mothers performing the lion’s share of parenting work, including transmitting messages about health. More father interviews are needed for a fuller analysis. Future research focusing on intersections among social statuses could not only expand theoretical understandings of the convergence between socioeconomic and health inequalities and their intergenerational transmission but also inform programs and policies that aim to help families and support health.

Our study design and analytical focus permitted an examination of the interaction of community-level cultural capital processes with parenting, expanding previous research (Lareau 2011). Although middle-class families “do” cultural capital in different ways, they respond to community norms and strategically use communities to socialize children, making family-community interactions key for understanding cultural capital transmission through health. Our middle-class communities had related but distinct approaches. This cultural heterogeneity in demographically similar communities expands on Brown-Saracino’s (2015) work on adults and can inform understandings of inequalities. A study design comparing a middle-class and a working-class community, rather than two middle-class communities, could not have identified this pattern. Behaviors, norms, competencies, habitus, and understandings of health play out at both family and community levels, instilling cultural capital in children that we anticipate will have considerable long-term implications for their health and socioeconomic attainment. Understanding how social class and health are interwoven in intensive parenting, and how these processes intertwine with communities and schools, are important goals for future research.

This study suggests that although individuals’ health behaviors are somewhat limited in predicting long-term health (Galea et al. 2011), their importance expands when viewed through the lens of cultural capital transmitted through health. Certain health behaviors, often internalized as habitus, signal differential levels of cultural capital, becoming an important pathway through which early social advantage is embodied and transformed into class-based performances of health, subsequently shaping status attainment. Because of the tight links between social class and health throughout the life course, health behaviors developed in childhood have complicated implications that reverberate in both domains. Integrating the study of social class and health through a focus on cultural capital may improve our understanding of each.

What are the implications of health-focused cultural capital processes for the future? Not only have class and health disparities been widening and the relationship between them strengthening, but there has been rapid growth in socioeconomic residential segregation in the United States (Bischoff and Reardon 2014). As communities self-segregate more by class, the transmission of health-focused cultural capital will likely become increasingly concentrated among increasingly advantaged families within increasingly advantaged communities. In their discussion of the unhealthy “default American lifestyle,” Mirowsky and Ross (2015:303) point to advantaged “overriders” who actively choose communities in order to foster the kinds of behaviors that reflect the health-focused cultural capital we analyzed here: “The well-educated, creative, and instrumental Americans are forming overrider enclaves. These are places where the infrastructure and culture help individuals resist the default lifestyle.” When class and health dovetail in both community selection and influence processes like this, inequalities in health-focused cultural capital will likely only intensify with time.

Parents’ goal of making their children “healthier than just healthy,” as Mary said, will likely become more attainable for advantaged families and less attainable for the rest. If health-focused cultural capital continues to become increasingly salient for status attainment, it may be a notable mechanism for widening these gaps and reducing intergenerational mobility. Health-focused cultural capital is an appealing form of class distinction because parents find it acceptable to talk about inculcating it in their children, whereas hoarding class advantage is not permissible to admit. But it may also have real consequences because of its implications for both health and class.

We argue that for these reasons, social scientists should regularly adopt a more complex lens when studying health—one that fuses existing critical and literal views on health. Health is a crucial metric of well-being and inequalities in individuals and populations. Yet simultaneously, “health” is a cultural tool being actively and increasingly deployed to strengthen class distinctions and inequalities. Social scientists studying class, race, and other inequalities often possess such a dual lens when analyzing those phenomena, and health research would likewise benefit from further acknowledgment of health as both an embodied state and a cultural strategy.