If the global diabetes epidemic now kills more than twice as many people as HIV/AIDS, then why do we still understand so little about what it’s actually like to live with it?

Institutional numbers charting this worldwide epidemic’s human costs range wildly, variously approximating somewhere between one million and four million annual mortalities from diabetes. This leaves the concerning statistical specter of some three million lives and deaths each year that are estimated by some, disputed by others, and frequently unrecorded by anyone.

Anthropologist Amy Moran-Thomas considers this grey area symptomatic of how chronic diseases like diabetes often sit uneasily with global health’s traditional emphasis on prioritizing infectious conditions. In 2010, she returned from fieldwork in the Central American country of Belize—where diabetes is the leading cause of death nationwide—having met people of all ages, classes, and appearances working to survive with the condition. She lived there for more than a year to observe and record ordinary stories that people recounted about care moving in and out of reach—such as insulin sharing in times of need, patients working to obtain parts from far-flung international relatives to repair broken glucometers over time, or protests that became part of advocacy to establish the country’s first public dialysis center. Others struggled to find healthy food each meal, or lived with the unknown consequences of various environmental exposures and newly overlaid co-morbid conditions that patients and doctors alike puzzled over.

Yet it often remains difficult to locate such complex actors in popular media coverage about the global diabetes epidemic, where actual patients frequently get eclipsed by stock caricatures of non-compliance. In charting people’s daily routines and travails as they moved through wider postindustrial landscapes, Moran-Thomas found herself writing against the idea that diabetes is simply the result of people who should stop eating too much. Her book develops the concept of “para-communicable” disease, arguing that diabetes is spreading worldwide in ways that do not fit into the bifurcated paradigm of “infectious” versus “non-communicable” conditions as they have historically been defined by biomedicine. It traces realities that reframe this emerging epidemic as part of sweeping ecological and postcolonial changes that people are struggling to live within, examining diabetes as one of many metabolic disorders now cascading across scales.

To build this case, Moran-Thomas draws from a patchwork of sources including environmental media, science writing, medical humanities, STS, biology, and history alongside anthropology— fields each offering insights that help to contextualize how chronic conditions like diabetes and their technological assemblages actually enter the social fabrics of homes, families, and ongoing lives. “People were often piecing together things from various places, as part of their daily work to stay intact,” she says. “I found myself doing the same in trying to follow their stories.”

Artist Credit: James Young