The medical diagnosis, on being at higher risk and lay epidemiology: the case of prediabetes: Oral presentation

This paper examines the ways in which an attempt to prevent type 2 diabetes through behavioural changeis managed by those identified as being ‘at higher risk’. Drawing on findings from a multi-site, cross-national lifestyle intervention program, it is demonstrated how the provision of a risk diagnosis becomespart of the way people pursue, maintain and negotiate health and illness. Using the debate that hasdeveloped in medical social science circles about lay epidemiology and the prevention paradox which bysome is seen as a barrier to public health when the public disbelieves or fails to act on public healthmessages, this study suggests that despite the discrepancy between laboratory normality and the livedreality of a symptomless disease, ‘prediabetic’ individuals use and modify science when handling their‘lifestyle’ disease. The findings indicate that numerical thresholds have become publicly authorized as theobjective truth about health. Although unexplained variation in the incidence of prediabetes did not gounrecognized by the lay epidemiologists, there did not seem to be much scepticism about the worth ofbehavioural change or overall plausibility of the health promotion messages. In fact, scientific evidenceconcerning the benefits of changed behaviour was rationally incorporated when practising self-careroutines. Various measurement technologies and numbers and thresholds were used to keep track of their health and manage their body. Our data highlight how lay explanatory notions propose a wider causalitywhich can minimise the moral implications of a ‘lifestyle’ disease and normalise the condition