The experience of risk as ‘measured vulnerability’: health screening and lay uses of numerical risk

Abstract

As clinical and epidemiological research turns increasingly to statistical probabilities in the identification and management of disease, numerous risk factors have emerged that are applied to individual health surveillance. However, the application of statistical risk is interpreted differently by lay persons from the way it is by public health or medical professionals. This paper examines the experience of being designated as at risk of a serious health condition. Specifically, an examination of the experiences of people with elevated blood cholesterol levels and men with elevated prostate-specific antigen (PSA) levels is presented in order to characterise the risk experience. This paper deals primarily with how being at risk symbolically alters health identities, with an introduction to the concept of measured vulnerability. Measured vulnerability refers to the capacity for scientifically-derived statistical measures that are intended to tame randomness and provide certainty in managing risk to, instead, produce uncertainty and anxiety in those to whom the statistic is applied.

Biomarkers, the molecular gaze and the transformation of cancer survivorship

“…For example, people deemed to be at genetic risk for cancer are increasingly conceptualised as ‘previvors':2 ‘sur vivors of a pre disposition to cancer' – a community seen to have its own unique needs and concerns (see FORCE, 2011). To a lesser extent, scholars have also highlighted the forms of embodied risk stemming from elevated PSA levels (Evans et al , 2007; Gillespie, 2012) and testing positive for HPV (Kavanagh and Broom, 1997; Aronowitz, 2010) – factors associated with heightened prostate and cervical cancer risk, respectively, but that do not in themselves constitute evidence of the disease. This empirical work speaks to the growing diseasification of risk that molecular screening technologies facilitate, with risk ‘treated' in much the same way as disease itself, through medical means such as medication, behaviour modification and surgical intervention (Armstrong, 1995; Sachs, 1995; Clarke et al , 2003, 2010; Aronowitz, 2009; Sulik, 2011; Gillespie, 2012).…”

“…On the basis of US research with women and men with elevated cholesterol levels and men with elevated PSA levels, Gillespie (2012) develops the concept of ‘measured vulnerability' to describe the experiences of those people who undergo a shift in their health status as a result of numeric scores on health risk assessments and screenings. He argues that the lack of symptoms associated with elevated cholesterol or PSA levels intensified the pervasiveness of participants' sense of vulnerability, as they were unable to determine their risk without undergoing additional tests.…”

The Sociology of Medical Screening: Past, Present and Future

“…Gillespie's concept of measured vulnerability (Gillespie 2012) is a good example, as is Timmermans and Buchbinder's bridging work (Timmermans and Buchbinder 2012) and Hogarth and colleagues' extension of the concept of molecularisation (Hogarth et al 2012). …”

“…Focusing on the cases of high cholesterol and of raised PSA levels, Chris Gillespie uses empirical data to examine how people interpret and experience risk in their everyday lives following receipt of a 'high risk' result (Gillespie 2012). He explores the lay (and sometimes professional) tendency to interpret numerical measures of health, and the importance of numbers not only in the diagnosis of risk but in the management of uncertainty (and vulnerability) arising from that risk.…”

Towards a critical epidemiology approach for applied sexual health research

“…However, such an approach could be seen to cast sexual behaviour as pathological and pregnancy as morbid -operationalising public health interests and constructions which do not necessarily chime with those of lay populations. These concerns are linked to broader debates about public health regulation of individuals' bodies (Petersen and Lupton, 1996) and to critiques of how behavioural -and other -risk factors are now treated as diseases (Gillespie, 2012); both of which build on Foucault's concept of biopower (Petersen and Lupton, 1996).…”