Risk Medicine – Who is at Risk…and who is not?

By Kirsty Bailey (Editor)

How do we determine who is at risk of disease? How beneficial is it to our health, to be assessed as  ‘at risk’? The parameters of what puts an individual at risk seems, to me, to be constantly evolving. It is an exhausting task to even attempt to keep up with the identification of new risk factors. But is this knowledge of risk beneficial for our health? Does it actually help anyone to know that 1 in 2 of us will develop cancer in our lifetimes? When we hear stories on the news about more people being ‘at risk’, what is meant? And to whom are these statements aimed?  Can risk ever been quantified, qualified or explained within the rational everyday? These questions are, as far as I’m concerned, unanswered within medical practice. Indeed, I believe that the overall concept and understanding of risk within health, is detrimental to patient diagnosis and experience.           

Risk within the context of this discussion, is risk relative to health. It is generally accepted that the unhealthier a patient is, the more ‘at risk’ of certain negative outcomes they are considered to be. Opportunities to question one’s level of risk with regards to health are widespread and frequent. Posters, commercials, etc. ask: Are you overweight? Do you smoke? Do you drink too much? Are you stressed at work? Do you eat the ‘wrong’ foods? Do you have diabetes, high blood pressure or high cholesterol? Do you have a family history of heart disease or cancer? Realistically the average individual can self-assess and find themselves at risk in ways that fit at least some of these criteria. This begs the larger question: is the entire human population is at risk?           

Risk is an aspect of health which cannot be seen, an invisible phenomenon where those who appear healthy, could potentially be victims. Risks are generally defined in terms of a calculation of a probability that something ‘bad’ might happen (1), and tends to be associated with negative rather than positive outcomes (4). With regards to health the patient is either healthy and continually assessing their risk, or they are defined as having succumbed to risk, and consequently a return to full health is never possible, as an element of risk will continually be present (3).

Dumit (2012) has coined the term ‘New Health’ to describe the context within which risk is assessed relative to the fact that the everyday individual is dedicated to measuring their health by understanding their risks and attempting to take practical steps to reduce them (2). ‘New Health’ is a constant analysis and evaluation of the risk factors surrounding patients and how at risk an individual is at any given time. Within our modern society a culture is nurtured in which people are continually exposed to the knowledge of risks about health and illness and how best to reduce the risk of ‘bad health’ occurring to them. It is through this continual self-assessing practice that this concept of ‘New Health’ and these perceptions of risk are defined and understood (2). However even if the individual succumbs to ‘New Health’ by constantly assessing their risks, when placed in a medical setting, how advantageous is this to the patient?

The understanding of health relative to risk, when assessed correctly, can be helpful, yet unless the risk is accurately identified, it can work against the patient. The patient may be suffering with a disease, but not being ‘considered’ at risk leads to a biomedical blind spot which can ironically place them more at risk. If the condition is not diagnosed and treated when it should be, the patient is consequently placed at higher risk.

For example; a fifty year old male patient who eats healthily, doesn’t smoke, and doesn’t drink - yet suffers with chest pains, does not ‘qualify’ as at risk. He is not considered to be a medical concern as he does not ‘tick’ all the ‘correct’ risk boxes to be at risk of a heart attack. However if a fifty year old male, who eats ‘junk’ food, smokes, drinks regularly - has chest pains, he is automatically classified as ‘at risk’ and the correct medical treatment is applied and implemented. Does this consequently make it more beneficial for the patient to be less healthy? So when one does have a genuine medical problem, one is more likely to be assessed as ‘at risk’ and the correct medical treatment will be administered? Does this mean the more healthy you are, the more at risk you are as a patient, when placed in a medical setting?

There are, I’m sure, many who would disagree with me. Yet I believe that risk assessments made within the ‘New Health’ paradigm can be disadvantageous to patient treatment. In our modern society, the captivating risk culture could lead physicians to diagnose and consequently treat patients incorrectly. If patients are not actually considered to be at risk, then diseases might go undiagnosed and patients will be left in a vulnerable and a delicate position. Risk and health, as has been defined here, show that in today’s modern society being healthy can ironically place you more at risk.

Measuring health through ‘New Health’, by analysing the risks and taking practical steps to reduce them can actually be severely detrimental to the patients overall health.  Through this, cases are being misdiagnosed and those suffering with more serious and life threatening conditions are not being directly treated. Health diagnosis relative to risk is unreliable, unpredictable and an inadequate way of diagnosing any individual. Everyone and anyone are at risk of everything. Everyone must always be considered for every disease, and risk analysis should not infiltrate the diagnosis process in anyway whatsoever. 

[1] Adam, B, Beck, U and Van Loon, J, (2005). The risk society and beyond – critical issues for social theory, London: Sage publications.

[2] Dumit, J. (2012). Drugs for Life - How pharmaceutical companies define our health, Durham and London: Duke University Press.

[3] Gifford, S.  (1986). ‘The meaning of lumps: A case study of the Ambiguities of Risk’, in Janes, C, Stall, R, and Gifford, S. (Eds).  Anthropology and Epidemiology: Interdisciplinary Approaches to the Study of Health and Disease, Dordrecht: Reidel Publishing Company.

[4] Lupton, D. (2013).  Risk, Abingdon: Routledge