This dissertation examines the lived experience of people with diabetes in Kumasi, Ghana, and places their stories and health outcomes within the greater structural and social climate, both within West Africa and globally. It utilizes chronicity theory, which considers structural forces such as poverty and gender inequality as chronic and comorbid conditions, in that they are unending and worsening and exacerbate the illness itself. The first chapter examines how diabetic patients grapple with the weight of expectations placed on them through the diabetes self-management model while living in a context of income insecurity and gender inequality, and how they utilize personal responsibility discourse to demand increased resources from the government. The second chapter investigates how diabetes impacts patients' ability to fulfill gendered expectations in the areas of sexuality and physical work, and the resulting distress and worsened economic states that arise. The third chapter analyzes diabetes management outcome biomarkers at the intersections of multiple disadvantaged identities in order to better understand how the economic and gendered realities of diabetes self-management evaluated in the previous chapters may be reflected in tendencies in measurable health outcomes at the group level. Findings from these studies have implications for policy and clinical practice and contribute to the anthropological literature on chronic illness, economic precarity, and gender.
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