Managing and treating risk and uncertainty for health: a case study of diabetes among First Nation's people in Ontario, Canada

'Risk' has become a key concept for understanding health care policies that are focused on prevention. Intervention no longer depends on the presence of an illness but rather an individual's risk of developing an illness. Thr ough 'risk factors' individuals are subject to medical examination and surv eillance to determine the real presence of danger, based on this abstract n otion of risk. This paper explores 'risk' and its consequences for medical intervention by focusing on biomedical practices surrounding diabetes care among First Nations on Manitoulin Island, Ontario. The first section explor es the process of diagnosing diabetes. The second section outlines the trea tment regimens resulting from membership in this category. The theme linkin g these two processes is that both diagnosis and management of diabetes dep end on inclusion into categories of 'risk'. Practices surroundings diagnosi s focus on a population described 'at risk' for diabetes, First Nation's pe ople. Similarly, practices surrounding management of diabetes focus on a po pulation 'at risk' for secondary complications, referring to individuals wi th diabetes. As the following discussion outlines, it is through the quanti tative assessment of risk that scientific uncertainty is translated into de finitive therapy and the need for constant surveillance. (C) 2001 Elsevier Science Ltd. All rights reserved.