title: Hemoglobin A1c as a diagnostic tool: public health implications from an actor-network perspective.
abstract: Public health arguments for collecting hemoglobin A1c (HbA1c) data, particularly in clinical settings, should be reframed to place more emphasis on nonmedical determinants of population health. We compare individual- with population-level interpretations of HbA1c titers. This comparison reveals that public health researchers need to pay close attention to diagnostic tests and their uses, including rhetorical uses. We also synthesize historical and current evidence to map out 2 possible scenarios for the future. In the first scenario, prevention efforts emphasize primary care and focus almost entirely downstream. The second scenario anticipates downstream interventions but also upstream interventions targeting environments. Our analysis adapts actor-network theory to strategic planning and forecasting in public health.
authors.affiliation: Population Health Intervention Research Centre, Calgary Institute of Population and Public Health, University of Calgary, Calgary, Alberta, Canada. cjdegeli@ucalgary.ca
authors.forename: Chris
authors.initials: C
authors.lastname: Degeling
authors.forename: Melanie
authors.initials: M
authors.lastname: Rock
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000517:prevention & control; D004059:Diffusion of Innovation; D005544:Forecasting; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008403:Mass Screening; D008962:Models, Theoretical; D009765:Obesity / Q000517:prevention & control; D011634:Public Health / Q000379:methods / Q000639:trends; D012931:Social Environment
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
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