临床与医学基因组学杂志

Social Determinants of Diabetes.

Abstract

Maninder Singh and A M Khan

In the 21^st century, the glamour of economic and technological development is not free from miseries particularly in the health domain. The quality of life of the people with increasing trend of non-communicable diseases is at great stake. Diabetes is one of the most dangerous killing diseases, which not only affect the individuals but the entire family and ultimately causing burden to the state. So far medical innovations have helped to diagnose the disease and maintain it throughout the life. Diabetes management is becoming market centric and it looks to suffer with deficits of cost effective and patient friendly perspective. The process involved in maintaining the disease is not friendly to human nature. The restrictions, cautions and precautions are much medicine centric; it does not suites completely to the human nature. The doctor treating the diabetic person may consider the fault on the part of patient but it is a natural for the patient to go beyond the prescriptions of Doctor. The medical approach of managing the diabetes carries unbearable cost on individual, family, society and even on the state itself.

Unless underling etiology of the disease is completely understood scientifically, using samples from variety of sections, regions and social groups, ethnic groups, we cannot get the profile of determinants which are rooted into diabetes. It is believed to be a disease of modern times, which is broadly embedded with host of stressors; and it is generally recognized that the environment in which people live is highly stress prone due to paradigm shift in the life style of people, e.g., eating, working, living, communicating etc. In order to get some insight about the disease, it is important to understand the causative factors embedded into the social system in which people are living. It is quite possible that host of incident shocking in nature to a particular individuals may play significant role in causing the diabetes. Keeping this into background retrospective narrative technique was used for in-depth interview with 20 diabetic persons with qualification ranging from primary school to Ph.D. having status of economically middle class. The salient findings are: 1) The in-depth case studies revealed micro level determinants in the changing dynamics of the relationship in the family, which play a critical role in facilitating non-communicable disease. 2) The drastic changes in the -expectation‘s profile‖ of the family members, unexpected changes in the behavior of the family members, unresolved conflicts among the family members, unexpected treatment on small matters like food, clothing, outing, property, etc. play a vital role in causing diabetes as reported in almost all the case studies. From the findings it looks that people need to be prepared from the early stages of life about upcoming situations emerging in the family of contemporary period. The coping skills and communication education about the dynamic changes in the expectations and behavior profile in the family and society should be taken up as preventive and promotive approach with complete intuitional design.