Social studies of medicine have highlighted differences between clinical medicine and public health. Less attention has been paid to how these fields intersect within primary healthcare institutions—particularly in rural settings where providers are expected to deliver prevention, treatment, and culturally respectful, community-engaged care simultaneously. This talk examines how, in practice, their overlapping mandates generate contradictions that shape how care is delivered, and how it falls to healthcare professionals to make sense of them through conceptual reframing, practical decisions, and everyday moral reasoning.

Drawing on long-term ethnographic research on diabetes prevention and management practices in a rural hospital in Mexico, I map out a series of tensions that emerge as preventative public health practices—shaped by longer histories of rural health intervention—collide with clinical and ethical commitments under the hospital’s intercultural, human rights framework. These include tensions between transforming and respecting cultural practices; between coercion, consent, and confidentiality; and between hospital control and patient self-management. I follow healthcare professionals as they navigate these layered tensions practically, conceptually, and morally, while also grappling with contradictory enactments of the disease itself. Finally, I reflect on how patients engage with these interventions based on local understandings of diabetes, responsibility, and self-care.

Commentator: Prof. Mark Harrison (History,University of Oxford)