Classifying Diabetes; or, Commensurating Bodies of Unequal Experience

Abstract

Melanie Rock is an assistant professor in the Department of Community Health Sciences at the University of Calgary. She also is affiliated with the Department of Anthropology and the Faculty of Social Work at the University of Calgary as well as with the Groupe de Recherche Interdisciplinaire en Santé at the Université de Montréal. Her current work focuses on social inequality and health knowledges, particularly as manifested in the politics of canine diabetes.

A definition and ethical evaluation of overdiagnosis

“…Throughout history, diagnostic judgements and actions thought to correspond to material reality have repeatedly arisen, become accepted and then been abandoned as the seat of disease was again reconceptualised 14. Diabetes, for example, was understood to be a disorder of carbohydrate metabolism, then a pancreatic dysfunction, then a problem of glucose control and regulation; the corresponding diagnostic tests—urinalysis, then oral glucose tolerance tests, then haemoglobin A1C titres—reflected and shaped understandings of diabetes as a condition 15 16. Unitary conceptions of diseases have given way to diverse pathological conceptions (eg, in cancer).…”

“…Many overdiagnosis-related problems stem from the continuous nature of pathological criteria, such that thresholds for distinguishing disease from non-disease are a matter for negotiation and interpretation 3. Conceptions of ‘correct’ treatment and of how treatments work on disease biology have shifted radically: consider starving therapy, then pancreatic extracts, then insulin and lifestyle therapy for diabetes 15 16. And treatments considered ‘correct’ are never universally effective (so their effectiveness cannot be used as a reliable marker of their correctness) 17.…”

Hijab, niqab, and the religious symbol debates: consequences for health and human rights

“…For example, it is argued that the problem of obesity raises moral dilemmas that are based on 'Euro-Canadian' values and norms, 29 and thin bodies reflect docile, obedient, restrained, controlled 'middle-class whiteness', 30 while casting heavy bodies as a problematic Other. 31 Those norms and values are often rigid (ibid), and render invisible structural factors such as racism, poverty, distress, duress, and colonialism, 32,33 and seldom do those perceptions change.…”

In Biomedicine, Thin Is Still In: Obesity Surveillance among Racialized, (Im)migrant, and Female Bodies

“…In the fat-studies literature, immigrant/racial tensions related obesity are raised as problematic, but they are seldom described through in-depth analysis. To date, there has been some literature about the way obesity challenges docile, obedient, restrained "middle-class whiteness" that is linked to self-control, mind over body, and tightness [64] (p. 200), indigenous and aboriginal people's increased risk of diabetes and obesity, the twin or dual epidemics [65,66], black lesbian women's fatness as a symptom of racism and other forms of oppression [67], and how directing attention to medical or health issues in these groups renders invisible structural factors such as racism, poverty, distress, duress, under-nutrition, and colonialism [68,69]. However, the structural disparities among racialized groups are only briefly mentioned.…”