Changing Diagnostic and Treatment Criteria for Chronic Illness: A Critical Consideration of Their Impact on Low-Income Hispanic Patients

Abstract

Low-income Hispanics are often identified as especially at risk for common chronic conditions like diabetes, and targeted for aggressive screening and treatment. Anthropologists and other social scientists have extensively explored barriers and facilitators to chronic illnesses management in minority populations, but have not yet considered the impact of recently lowered diagnostic and treatment thresholds on such groups. In this paper, we critically review recent changes in diabetes, hypertension and high cholesterol diagnostic and treatment standards which have dramatically increased the number of people being treated for these conditions. Drawing on an ethnographic study of chronic illness management in two Hispanic-serving clinics in the Midwest, we examine how these new standards are being applied, and consider the resulting health care challenges these Hispanic patients face. Our analysis leads us to question the value of promoting narrowly defined treatment goals, particularly when patients lack reliable access to the health care resources these goals require. While improving the health of low-income Hispanics is a worthwhile goal, it is important to consider whether these efforts may be promoting overdiagnosis and over-treatment, drawing them into an expensive chronic patient role with uncertain benefit. KeywordsHispanics; Pharmaceuticals; Access to Health Care; Diabetes Diagnosis of common chronic conditions has reached epidemic proportions in the U.S, with an estimated 45% of the population having been told they have diabetes, high blood pressure and/or high cholesterol (Cory, et al. 2010). Minority populations have been found to be especially at risk for these conditions (ADA 2011;Carroll, et al. 2012; CDC 2011;Fryar, et al. 2010). Anthropologists and other social scientists have extensively explored the vexing question of the causes and remedies for these disparities, and a good deal of effort is going toward identifying the barriers and facilitators of screening and management for these populations (Aroian, et al. 2012;Ferzacca 2012;Hunt, et al. 1998b Smith-Morris 2005;Weller, et al. 2012). While such efforts have made important contributions to improving access to quality health care, recent changes in clinical diagnostic and treatment guidelines raise new sets of issues for social scientists concerned with chronic illness among marginalized populations. HHS Public AccessAn important, but little considered factor which directly affects the frequency of these diagnoses is that standards for diagnosing and managing such illnesses have changed over time, with systematically lower diagnostic criteria, and the addition of new "pre-disease" categories which are targeted for treatment as well (ADA 2010;Brody 2010;Rosendorff, et al. 2007;Vigersky 2012). This has resulted in millions of people being diagnosed with these conditions, as well as a dramatic expansion of the market for the pharmaceuticals used in their control (Brody and Light 2011;Hunt, et al. 2012; Welch, et al. 2011).Hispanics have lo...

Racialized Risk in Clinical Care: Clinician Vigilance and Patient Responsibility

“…Thus, racialized medicine may promote and perpetuate further disempowerment for racially marked patients, undermining their agency in managing their disease, and casting blame and stigma on them. Unmarked white patients are simply tasked with complying with clinical recommendations; those of an at-risk race/ethnicity encounter more limited expectations for self-control, greater responsibility to manage their risk, and more aggressive oversight and treatment (Bonham, et al 2016; Hunt, Kreiner and Rodriguez-Mejia 2013a).…”