SeriesSyndemics and the biosocial conception of health
Section snippets
The nature of syndemics
Co-infection with multiple pathogens, as Laurent Hébert-Dufresnea and Benjamin Althousea1 have emphasised, can be a critical factor in disease course and outcome. Concurrent infection, as described for infectious agents such as HIV and Mycobacterium tuberculosis, for example, is associated with more rapid disease progression, worse symptoms, and higher pathogenic load than during a single infection with either agent.2, 3 In addition to HIV accelerating advancement from latent to active
Syndemics research
The first syndemic identified and described in the literature,13 and the one most heavily investigated, is known as SAVA (substance abuse, violence, and AIDS). This term describes three closely linked and interdependent conditions that coexist in the human body and social life of many individuals in low-income urban environments.13 Recognition of this syndemic emerged during a multiyear research programme on HIV risk prevention among drug users, in which researchers realised that the
Syndemic pathways
A core concern of syndemics research is the investigation of the specific pathways through which disease and other health conditions interact in the body and within populations to allow multiplication of adverse health effects. Domains of social–psychological, psychological–biological, and social–biological interaction are as fundamental to syndemics as biological interactions are. Syndemics are not characterised merely by co-occurring conditions, but rather exemplify the nature of the changes
Syndemics and mental health
No less than physical diseases, alterations of the emotions and of mental health, for example by trauma, stress, internalisation of social rejection, and the embodied experience of social stigma, can have a role in the onset and exacerbation of other diseases, including somatoform diseases. The internalisation of social contempt opprobrium through a stigmatised illness or disease-related, stigmatised identity can have both psychosocial and biological effects on disease–disease interaction and
Clinical issues
Awareness of syndemics raises important questions from a biomedical perspective. How do syndemic interactions complicate diagnosis? What is the best course of medical treatment for entwined syndemic diseases? How could clinicians address the social causes of syndemics? How can iatrogenic syndemics in biomedicine be avoided? Can counter-syndemics play an innovative part in new treatment options?
An important complication of syndemics is that they can alter landmark disease characteristics that
The social origins of syndemics
Broadening biomedical care to consider not only the biological but also the social components of disease is an inherent part of the syndemics perspective. Farmer and colleagues56, 57 at Partners in Health have shown that structural interventions within the biomedical setting can have a greater impact than conventional clinical interventions on disease control. Using their model in Haiti, Peru, Rwanda, Lesotho, Boston (MA, USA), and elsewhere, Partners in Health have: removed clinical and
Syndemics, multicausal models, and health policy
The syndemics orientation has the potential to affect health policy by drawing attention to how social, economic, and environmental factors affect the health of human beings, provided that these factors are not separated in analysis from disease emergence or comorbidity. Instead, the clustering of diseases and the vulnerability of populations to disease must be recognised to incorporate inherent social and environmental risk factors. Doing so becomes an ever more pressing issue as populations
Programmatic initiatives
Approaches to health promotion that are appropriate from a syndemics perspective have been implemented at the national level in various countries through progressive social policies aimed at poverty alleviation and inequality reductions. Such initiatives operate through multiple mechanisms, in line with the syndemic perspective: improving social conditions by decreasing poverty and barriers to health care; improving food access and education; and providing health-care access and biomedical
Conclusion
As emphasised by Littleton and Park,71 a syndemics approach to disease is valuable because of the degree to which disease comorbidity and noxious social conditions are concentrated together in populations. Syndemics underline the importance of the disease clustering within populations, the social, psychological, and biological reasons that diseases cluster, the ways comorbid diseases affect each other, how important these interactions can be to the health burden within the populations, the
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