Hunt Linda M, Kreiner Meta, Rodriguez-Mejia Fredy
Department of Anthropology, Michigan State University, East Lansing, MI.
Hum Organ. 2013;72(3):242-253. doi: 10.17730/humo.72.3.835160243631713k.
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 over-diagnosis and over-treatment, drawing them into an expensive chronic patient role with uncertain benefit.
低收入的西班牙裔人群通常被认为尤其容易患糖尿病等常见慢性病，因此成为积极筛查和治疗的目标对象。人类学家和其他社会科学家广泛探讨了少数族裔人群慢性病管理的障碍和促进因素，但尚未考虑近期降低的诊断和治疗阈值对这类群体的影响。在本文中，我们批判性地回顾了糖尿病、高血压和高胆固醇诊断及治疗标准的近期变化，这些变化显著增加了接受这些疾病治疗的人数。基于对中西部两家为西班牙裔服务的诊所慢性病管理的人种志研究，我们研究了这些新标准是如何应用的，并考虑了这些西班牙裔患者由此面临的医疗保健挑战。我们的分析使我们质疑推行狭义治疗目标的价值，尤其是当患者无法可靠地获得这些目标所需的医疗保健资源时。虽然改善低收入西班牙裔人群的健康是一个值得追求的目标，但重要的是要考虑这些努力是否可能导致过度诊断和过度治疗，使他们陷入昂贵的慢性病患者角色，而益处却不确定。
