Vaughan Megan
Institute of Advanced Studies, University College London, Gower St, London WC1E 6BT, UK.
Biosocieties. 2019 Apr;14(1):123-142. doi: 10.1057/s41292-018-0122-3. Epub 2018 Jun 20.
This paper traces the history of the concept of metabolic disorder in global health and its application to the collection of health metrics relating to the 'epidemic' of non-communicable diseases in Southern Africa, with a focus on Malawi. Although the contemporary science of metabolism points to complexity and contingency, the application of a simplified version of 'metabolic disorder' or 'metabolic syndrome' as the supposed central driver of non-communicable disease in low- and middle-income countries runs the risk of obscuring the ways in which local circumstances and histories interact with global forces to produce epidemiological change. The paper discusses health data collection and its interpretation in Malawi to demonstrate how the use of this concept has led to a narrowing of the category of non-communicable disease and a neglect of the role of infectious disease in producing chronic conditions. Finally, the paper points to alternative approaches which might yield a better understanding of pressing health problems.
本文追溯了全球健康领域中代谢紊乱概念的历史及其在收集与南部非洲非传染性疾病“流行”相关的健康指标方面的应用，重点关注马拉维。尽管当代代谢科学指出了其复杂性和偶然性，但在低收入和中等收入国家将简化版的“代谢紊乱”或“代谢综合征”用作非传染性疾病的假定核心驱动因素，存在掩盖当地情况和历史与全球力量相互作用以产生流行病学变化方式的风险。本文讨论了马拉维的健康数据收集及其解读，以说明使用这一概念如何导致非传染性疾病范畴变窄，以及忽视了传染病在导致慢性病方面的作用。最后，本文指出了一些替代方法，这些方法可能有助于更好地理解紧迫的健康问题。
