Sweet blood and social suffering: Rethinking cause-effect relationships in diabetes, distress, and duress

Abstract

I draw upon anthropological engagements with bioscience and embodiment in order to unpack current approaches to defining and preventing diabetes mellitus. The analysis stems from the conviction that carefully considering the symbolic frames through which we conceive of diseases, their origins, their distribution, and their consequences will assist us in planning and implementing interventions to improve population health. I argue that research and interventions focused on the sweetness of blood would benefit from rethinking intersections between diabetes, distress, and duress. In many instances, the lived experience of diabetes is consonant with an understanding of distress (i.e., "social suffering") that expands conventional understandings of population health problems. Diabetes incidence is rising worldwide, but it is rising especially rapidly in Aboriginal and other disadvantaged populations. Notably, diabetes is now three to five times more common in Canada's First Nations population than it is in its non-Aboriginal population. Yet as recently as 50 years ago, diabetes and associated health problems were rare in these groups. To come to grips with such transformations and disparities is to advance the population health research agenda.

La diabetes como metáfora de vulnerabilidad. El caso de los ikojts de Oaxaca

“…[…] Estoy muy débil, por eso voy a escuchar una cosa y no aguanto». El enfoque biologicista del modelo médico hegemónico pone poca atención en la experiencia del padecer (Rock 2003) y no está diseñado para atender los aspectos espirituales de la enfermedad. Por ende, aunque los ikojts entrevistados asocian la diabetes con las curas biomédicas («esta enfermedad es para doctor, no para curandero»), con frecuencia recurren a sus terapeutas tradicionales, quienes curan sus almas, atienden sus sustos y tratan la causa última de su enfermedad, a la que evidentemente consideran de tipo social y espiritual.…”

Solutions to Issues of Equity in Primary Healthcare for Aboriginal People Living in Canada

“…However, in contrast to nonAboriginal populations, these mental disorders often go unchecked in Aboriginal communities due to their decaying primary healthcare system (10,11). For example, a short attention span, limited comprehension, and a lack of motivation to complete homework are becoming common problems experienced by Aboriginal students.…”

“…In a study conducted by Statistics Canada, it was found that the Indigenous people living in Nunavut and the Northwest Territories have a two to five-fold higher rate of suicide when compared to the general Canadian population (17). Other psychological and emotional illnesses that disproportionately plague Canada's First Nations include depression, feelings of helplessness, and a lack of motivation (11).…”

“…In Canada, type 2 diabetes is three times more common in First Nations communities than it is in the non-Aboriginal population. However, fifty years ago, diabetes and its associated health concerns were nearly nonexistent amongst these populations (11). The consequence of having a high rate of diabetes has been devastating with many First Nations communities experiencing a surge in cardiovascular disease, retinopathy, nephropathy, and peripheral neuropathy (9,12,13).…”

Aboriginal Homelessness: A Framework for Best Practice in the Context of Structural Violence

“…Cultural safety is defined as effective practice determined by the individual or family, while "unsafe cultural practice comprises any action which diminishes, demeans or disempowers the cultural identity and well-being of an individual," (Nursing Council of New Zealand, 2005, p. 4). Furthermore, it is important to note that an aggregate of individuals also differs from a population, and exploring factors that describe both individuals and populations results in better definitions of problems and solutions (Rock, 2003). Homelessness, like illness and other social problems, is not determined by choice nor is it a lifestyle issue, but results from "power-or, more specifically, the various ways in which capacity develops and is exercised" (Rock, 2003, p. 133).…”