Doctoral Dissertation Grant: An Ethnography of Chronic Disease Risk and Pre-Diabetes

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This project examines how risk is made into an object of biomedical intervention. It will explore how biomedical risk practices and discourses are transforming contemporary social life. To illuminate these processes, the investigators will study the phenomenon of pre-diabetes in an urban environment. Pre-diabetes is a new and rapidly expanding diagnostic category. The use of the term speaks to new methods of surveillance and management of glucose in the bloodstream. It is creating a wide and growing at risk population that is situated between ill and healthy. The project will explore discourses of risk and the imperative of risk avoidance. It will be of interest to clinicians, physicians, patients, family members and health care policy makers. The ?pre-diabetes? diagnosis is becoming a marker of individual health-status that is also emerging, alongside type 2 diabetes, as a symbol of national crisis. To analyze the pre-diabetes diagnosis in this context, the investigators will undertake 12 months of ethnographic fieldwork in an urban community. The project will be guided by four research questions: (1) How has pre-diabetes been produced, contested, and consolidated as a formal diagnostic category? (2) How is pre-diabetes communicated, understood, and acted upon both by clinicians and the individuals who receive this prediagnosis? (3) How is the specter of the pre-diabetic population mobilized political and cultural arenas? and (4) How does the case of pre-diabetes advance our understanding of risk as a social phenomenon? To answer these questions the investigators will conduct interviews with diabetes experts, healthcare providers, government and health system officials, health activists, and patients and their families. In addition it will conduct extended participant observation in three primary care clinics, in an educational program directed at pre-diabetics, and at scientific conferences. Findings will contribute to scholarship addressing the rise of preventive medicine, the associated surveillance of biomarkers, and the conversion of risk states into diagnostic categories.