Engaging "Risk" as a Central Concern for Applied Medical Anthropology: Prenatal Genetic Counseling with Latina Women

Heide Castañeda
Peter K. New Award Winner, 2003

In contemporary health care settings, the concept of “risk status” is a central feature of patient care and is fundamental to preventative approaches. However, while the clinical concept of “risk” appears to be rather unambiguous, how it becomes interpreted may involve many layers of complex and even contradictory meanings.  Thus, one of the most fruitful applications for contemporary medical anthropology is the critical examination of risk discourse as socially contingent and culturally embedded. On a practical level, understanding ideas about “risk” is an important factor in assuring the equitable provision of health care technology. 

This paper investigates the role of risk discourse in the field of prenatal genetic counseling, using 23 cases from a larger study of Latina women in South Texas* to investigate how patients and clinicians interpret the clinical construct of “risk.” It appears that differential perceptions of risk are not simply a problem of information transfer in the clinic, but are rooted in the various meanings and values each party brings with them into the consult. These concerns become obscured within shifting personal, clinical, and epidemiological concepts of risk. I argue that the concept of “risk “ -- especially as it is invoked when making judgments about patient care -- is not a neutral, objective construct, but carries important implications for equality in the clinical setting.

Heide Castañeda is a PhD student and research associate at the University of Arizona in Tucson, Arizona. She received her M.A. degree in Anthropology at the University of Texas at San Antonio, and an M.P.H. at the University of Texas -- Houston Health Science Center. Ms. Castañeda is interested in health disparities and migrant health in the U.S. and Europe.

*The project from which this data was drawn was funded by the National Institutes of Health Center for Human Genome Research. The co-investigators of the project are Carole H. Browner (University of California Los Angeles) and Linda M. Hunt (Michigan State University). In addition, some patient interviews were collected through a separate project funded by the San Antonio Area Foundation.