This article examines the history of concepts and frames (such as “equity” or “disparities”) and how these frames have guided public policies and explanations about differences in health across the population. Considering the emblematic case of cancer, which has stimulated long and heated debate over social, economic, and biological causes, the article argues that the vocabularies of health reform are both semantic and also deeply political—framing different reform agendas. The article describes the evolving US debate over the biological, social, or environmental origins of differential cancer mortality along lines of social difference and race, tracing important shifts and reversal over time. Through this analysis, the article explains how and why equity concerns have figured (sometimes implicitly, sometimes explicitly) in health reform discussions, often in tension with other frames. It examines how Americans have used these frameworks to justify different kinds of action and inaction, concluding with a discussion of how these frameworks of “disparities” and “equity” should be understood today in scientific, political, and policy discourse.1

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