Syndemics

This blog is dedicated to promoting the study and discussion of syndemics. There term "syndemics" was coined to support a new perspective on health and disease. The traditional biomedical approach to disease is characterized by an effort to treat labeled health conditions liked diabetes or AIDS as if they were distinct entities in nature, separate from other diseases, and independent of the social contexts in which they are found. Historically, this approach proved to be very useful in focusing medical attention on the immediate causes and expressions of disease and it contributed to the emergence of modern biomedical treatments, some of which have been enormously successful. As the compendium of health knowledge has advanced, however, it has become increasingly clear that diseases do not necessarily exist in isolation from other diseases and other health conditions, rather interactions among diseases are of considerable importance to disease course and consequence, and that the social conditions of disease sufferers are absolutely critical to understanding health at the individual and population levels. Rather than existing as discrete conditions, multiple life-threatening diseases often are concentrated in particular populations. In a word, diseases, tend to cluster.

Beyond disease clustering, there is growing evidence of important interactions among comorbid diseases. One such interaction has been found, for example, between type 2 diabetes mellitus and various infections, such as hepatitis C viral infection in women. The worldwide prevalence of type 2 diabetes has been increasing and now impacts the lives of millions of women around the globe. Various factors are recognized as contributing to the onset of type 2 diabetes, including obesity and aging. The role of infection, however, is only beginning to be recognized. Already it is clear that risk for serious infections of various kinds increases significantly with poor diabetes control, but appreciation of more complex relationships between infection and type 2 diabetes is now emerging as well (Soule et al. 2005, Visnegarwala 2005). The NHANES III found that type 2 diabetes increases among people who have been infected with the hepatitis C virus. (O’Connor et al. 2004). Similarly, several health reports note that diabetes is present in as many as 37% of those who are critically ill with severe acute respiratory syndrome (SARS) (Booth et al. 2003, Fowler et al. 2003). These examples suggest the importance of dynamic diabetes/infection linkages. It is disease interactions of this sort that are a central element in syndemics. Syndemic theory seeks to draw attention to and provide a framework for the analysis of these interactions.

Various syndemics (although not always labeled as such) have been described in the literature already, including the SAVA syndemic (substance abuse, violence and AIDS) (Singer 1996, 2006), the hookworm, malaria and HIV/AIDS syndemic (Hotez 2003), the Chagas disease, rheumatic heart disease and congestive heart failure syndemic (Cubillos-Garzon et al. 2004), the asthma and infectious disease syndemic (Johnson and Martin 2005), the malnutrition and depression syndemic (Heflin, Siefert and Williams 2005), and the mental health and HIV/AIDS syndemic (Stall et al. 2003). Additionally, several syndemics have been identified that involve sexually transmitted diseases (Chesson et al. 2005, Craib et al. 1995, Otten et al. 1994). Here too, researchers report interactions between comorbid STDs and other diseases (Nusbaum et al. 2004).

Beyond disease clustering and interaction, the term syndemic also points to the importance of social conditions in disease concentrations, interactions and consequences. In syndemics, the interaction of diseases or other health problems (e.g., malnutrition) commonly arises because of adverse social conditions (e.g., poverty, stigmatization, oppressive social relationships) that put socially devalued groups at heightened risk. As Farmer (1999) argues with reference to TB, it is impossible to understand its persistence in poor countries as well as its recent resurgence among the poor in industrialized countries without assessing how social forces, such as political violence and racism, come to be embodied and expressed as individual pathology.

The purpose of syndemic theory is to facilite reconception and the way that we look at, think about, and respond to disease. In nature a parallel phenomenon to syndemics is seen in the case of lichens. Lichens are not a kind of species or other higher or lower level taxa as we usually use those terms, rather they are symbiotic partnerships between a fungus and either algae or cyanobacteria. As Chadwick (2003:119) comments, “I think of lichens as kind of a doorway between organisms [or individual species] and ecosystems. Look out one direction, and you see individual things; look the other way, you see processes, relationships—things together. This is the new level in understanding biology.”

As Chadwick notes (1992/93:1), “If we continue to focus chiefly on species -- even though we embrace all shapes and sizes of them -- rather than on connections, our view of nature will remain incomplete. So will our efforts at protection.”