Managing and treating risk and uncertainty for health: a case study of diabetes among First Nation's people in Ontario, Canada.
'Risk' has become a key concept for understanding health care policies that are focused on prevention. Intervention no longer depends on the presence of an illness but rather an individual's risk of developing an illness. Through 'risk factors' individuals are subject to medical examination and surveillance to determine the real presence of danger, based on this abstract notion of risk. This paper explores 'risk' and its consequences for medical intervention by focusing on biomedical practices surrounding diabetes care among First Nations on Manitoulin Island, Ontario. The first section explores the process of diagnosing diabetes. The second section outlines the treatment regimens resulting from membership in this category. The theme linking these two processes is that both diagnosis and management of diabetes depend on inclusion into categories of 'risk'. Practices surrounding diagnosis focus on a population described 'at risk' for diabetes. First Nation's people. Similarly, practices surrounding management of diabetes focus on a population 'at risk' for secondary complications, referring to individuals with diabetes. As the following discussion outlines, it is through the quantitative assessment of risk that scientific uncertainty is translated into definitive therapy and the need for constant surveillance.
Sunday
J
J
McMaster Institute of Environment and Health, McMaster University, Hamilton, Ontario, Canada. julie.sunday@ibm.net
Eyles
J
J
D016022:Case-Control Studies; D003469:Culture; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology / Q000628:therapy*; D005260:Female; D006303:Health Services, Indigenous; D006801:Humans; D004930:Inuit / Q000523:psychology; D008019:Life Style; D008297:Male; D009864:Ontario; D010349:Patient Compliance; D010686:Philosophy, Medical; D012306:Risk