The medical anthropology of type 2 diabetes at the intersection of race, class and gender.

摘要

Emerging rates of type 2 diabetes around the world presage a pandemic of this debilitating and costly chronic disease. Racial and ethnic minority communities in both developed and developing countries appear to experience excessive rates of diabetes complications (e.g., visual loss, lower extremity amputations and end-stage renal disease)--rates 1.5 to 4 times higher than those observed among comparable white communities. Anthropologists have not to date examined the cultural and structural determinants of type 2 diabetes among African Americans in the U.S. or posited anthropological arguments for the disproportionate burden of diabetes, its associated risk factors, and complications in this population that defy traditional biomedical explanations. For example, the rise in the prevalence of type 2 diabetes coincides with the national and international rise in obesity. However, while African American men have comparable rates of overweight and obesity as white men, they have a prevalence of type 2 diabetes that is almost twice the rate experienced by white men. Another conundrum of the scourge of diabetes among African Americans is that advanced education and middle income is not protective against the development of this disease as one might find in the white population.; In this applied medical anthropology project, I invert the traditional biomedical view of type 2 diabetes and obesity in networks of African American men and women and explore the lived experience of type 2 diabetes and obesity in the cultural contexts of race, class, and gender. In this study, I combine theoretical and methodological perspectives from "conventional" medical anthropology and "critical" medical anthropology to examine indigenous or emic understandings of type 2 diabetes and obesity and the historical and social production of type 2 diabetes among African Americans. I find that the disproportionate burden of type 2 diabetes and its associated risk factors and complications among African American men and women reflect the cumulative health impact of a historical patterning of social and political inequality that is reproduced at the nexus of the lived experience and cultural contexts of "race," class, and gender. Fieldwork was conducted in Atlanta, GA and Raleigh, North Carolina.