In recent years, one of the primary topics in human genetics discourse has been the diversity problem, or the fact that most published analyses are conducted in near-exclusively European ancestry populations. To rectify the diversity problem and ensure that genomic applications do not exacerbate existing population health disparities, new initiatives have focused on recruiting “underrepresented” and “underserved” communities into genomic studies. These initiatives, in turn, have reignited the conversation about how to distance population categories used in genomics from race realism, and launched a new debate about the meaning of health equity in the context of genomic knowledge and applications. This dissertation examines how the concept of “population” has come to be so critical and yet so uncertain in genomic research, and what some of the consequences of this ambiguity have been as genomic technologies make their way into healthcare. I focus specifically on how population concepts are intertwined with notions of population health management, in the historical intersections between genetics and epidemiology, and in the contemporary projects of precision health research and genetic risk screening. Using an historical genealogy of the discipline of genetic epidemiology, I first show how the statistical style of scientific reasoning shared between population genetics and epidemiology enabled a form of methodological interdisciplinarity, even as the meaning of population health research has become more of a tension between the fields. Second, using case studies of NIH’s All of Us Research Program and Geisinger Health’s MyCode project, I demonstrate how the translation of genomic research into technologies for genetic risk detection exacerbates this tension by creating new forms of populations at-risk. This project draws together medical sociology’s interest in the structural causes of health outcomes with science and technology studies’ focus on the coproduction of knowledge and social order, to reveal how genetic understandings of populations redefine population health. I show that the process through which genomics has become a population-based science has also rendered it distinctly unable to respond to fundamental causes of health inequalities, forcing the field to into repeat conflicts over the meaning of racial and ethnic categories in social and biological terms.

This dissertation research examines the historical formation of racialized diabetes in Singapore between 1900 – 2020. The specific period was chosen to capture how the association between race and disease was constructed at different junctures of Singapore’s history – the late colonial period between 1900 to 1965, the postcolonial developmental years between 1965-2000, and finally the contemporary biomedical age beginning in 2000 to 2020. My study illuminates how racialization and the emergent meanings change as they interface with social, political, economic, and technoscientific transformations. I utilize a combination of archival research and data from fieldwork to analyze the way that diabetes intersects with race, ethnicity and the nation. Building on the recent resurgence of postcolonial Sociology, I attend to the question of how societies deal with the legacy of colonial racial knowledge in science and medicine. My research shows that colonial constructions of diabetes were informed by anthropological constructs relating to biological race and notions of civilization. These ideas become intensified in the postcolonial period (1965-1990), as Singapore’s political elite engaged with cold war developmentalism and global health narratives to buttress claims of national progress; the increasing prevalence of chronic diseases such as diabetes indicated that Singapore had successfully broken out of the epidemiological profile typical of less developed nations, thereby legitimizing anti-democratic development policies. The convergence between developmentalism and diabetes also produced a framing of disease that drew from eugenics and colonial racism, where the higher prevalence of diabetes among the South Asian Indians in Singapore for instance, was explained to be a consequence of genetic constitution that is ill suited for development. The late 90s saw a shift in the management of life and population as Singapore continued to grapple with the rise of chronic diseases and how it impacts the long-term health of the nation. By health of the nation, I mean the political economic consideration of healthcare financing as well as the maintenance of productive citizen subjects, especially as the discourse of human capital begins to take root. I argue that these conditions capture the formation of a more expansive biopolitics, where mundane, but no less potent governmental technologies such as healthcare financing instruments were utilized to manage sickly and risky bodies through enlisting subjects as ‘partners in health’. The emergent biopolitics constitutes greater research emphasis on the management as opposed to prevention of diabetes, large-scale epidemiological surveys that enable articulations of risky bodies and disease burden, and lastly the creation of racialized risk and responsibility in diabetes under new modes of healthcare financing. The contemporary biomedical era, in which precision medicine became central to Singapore’s healthcare plans and bioeconomic aspirations, captured a new modality of racialization. The Chinese, Malay and Indian populations in Singapore were projected as biologically distinct, and as being a microcosm of Asia. Hypothetically, this allowed for the scaling of policy measures, treatment and therapeutics to the larger region and in Asian diasporas. This era also heralded a new global and transnational research program that reinforced the uniqueness of ‘Asian diabetes’ while obscuring social determinants of health. Lastly, I highlight the distortions in the Singapore as Asia narrative by demonstrating how it tended to focus on the Chinese population while excluding the Malay and Indian racial groups, a pattern which reflects Singapore’s long standing geopolitical stance in the Asian region. In the final chapter, I take a leaf out of Annemarie Mol’s page and ‘multiply’ diabetes, homing in on how people do diabetes at the everyday practices while situating them within the broader discourse of racialized diabetes in Singapore. I discuss three distinct cases based on a combination of in-depth interviews and observations, highlighting the different ways of doing diabetes that center around daily routines, management of the body, dealing with shame, and finally the weaving of religious beliefs and practices into diabetes. The inclusion of these cases is meant as a preview for a future ethnography of racialized diabetes I aim to carry out as part of my book project.