Medical Anthropology in Europe by Elisabeth Hsu Caroline Potter

Author:Elisabeth Hsu, Caroline Potter [Elisabeth Hsu, Caroline Potter]
Language: eng
Format: epub
ISBN: 9780367739379
Google: S777zQEACAAJ
Publisher: Taylor & Francis Group
Published: 2020-12-18T05:07:51+00:00

Time

Chronic conditions are by definition ones for which the time dimension is prominent, in several partly-related ways. One set of issues, already touched on above, concerns the historical transformations that are implicated in the increase in NCDs. Public health experts point to demographic ageing, ‘rapid, unplanned urbanization’ and ‘the globalization of unhealthy lifestyles’ (WHO 2011). Anthropologists studying illness perceptions find that lay people too see ‘the new sicknesses’ in the mirror of historical change: loss of ‘traditional foods’, increasing pollution, the stress of modern life, and poverty. While changing life conditions must be examined ethnographically, it is not political economic transformation as the cause of chronic illness that is suggested in this framing. Rather the questions revolve around the ways different kinds of people come to awareness of historical change, and how they make the links between changing conditions and chronic illness.

Illness time is of a different order than historical time. The temporal experience of illness may well be influenced by the health care system – a matter that should be explored. Time and control are linked in intricate ways, as Hsu has suggested. Diagnosis is often assumed to precede treatment, which in turn affects prognosis. Yet, in practice, treatment prospects influence diagnosis; prognosis and hope affect the labeling of illness: ‘treatment, diagnosis and prognosis are bound into a complex web of interdependencies and fleeting temporalities’ (Hsu 2005, 158).

In chronic conditions, there is often no singular acute beginning. As Bury (1982, 170) wrote: ‘One of the most important features of chronic illness is its insidious onset. Non-communicable diseases do not “break-out” they “creep up”.’ In this, HIV resembles NCDs more than the communicable diseases with which it is usually classified. The timing of onset is complicated by the fact that the presence of disease, or risk of disease, may be determined by biomedical tests even before there are definite symptoms of illness. In high-income countries, therapeutic control of risk factors such as high values for cholesterol may be initiated even in the absence of biomedically defined disease, putting people in an ambiguous situation (Sachs 1995).4 In Africa, people sometimes test HIV positive before they have any symptoms, but it is far less common that they are found at risk of cardiovascular disease, diabetes, or cancer without feeling ill, simply because screening is so rare.

A further aspect of timing concerns life-time and onset – the point in a biography when long-term illness sets in. Studies of disability show that the social significance of a condition is partly shaped by point of onset: a congenital impairment has different implications than one acquired late in life (Whyte and Ingstad 1995, 17). Typically, children are most affected by infectious diseases; mortality from malaria and respiratory infections is highest among under-fives. HIV is largely a sickness of young and middle-aged adults, while the prototypical NCDs are diseases of ageing.

Globally, the highest prevalence of type 2 diabetes is in the age group 40–59, but in 20 years it will be among those aged 60–79 (International Diabetes Federation 2009).

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.