Syndemic Prevention Network: Overview -- Uses

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Syndemics Overview - When Is It Appropriate or Inappropriate to Use a Syndemic Orientation?

The medical model of disease specialization, once praised for its utility and versatility, is proving inadequate for confronting such contemporary public health challenges as eliminating health disparities. Although conventional prevention programs have had strong effects, for the most part the categorical approach has failed to assure the conditions for overall community health, and it has done little to spread successes equitably among subgroups in society.

From the perspective of community leaders, it is no longer acceptable to concentrate on preventing some diseases while allowing others to go unchecked, especially when many of the most burdensome problems have common causes. Instead, more and more initiatives aim to reduce the overall burden of disease in the community. They seek new approaches for organizing resources and framing problems in ways that will address connections among all those issues that threaten health and wellbeing (Institute of Medicine, 1996).

Unfortunately, comprehensive community initiatives generally encounter barriers and receive limited institutional support because they run counter to the assumptions of prevailing scientific frameworks (see Schorr, 1997). A profound tension now exists between the desire to engage in comprehensive health improvement initiatives and the need to present scientific evidence of effects based on categorical models of disease (Figure 3). A syndemic orientation offers the possibility to cut through this bind. It could, in fact, open the way to establishing new theories of change, new alliances among interest groups, new funding policies, new insight about the root causes of health and social problems, and new levels of achievement in improving population health.

Figure 3: Balancing Values

The core functions and values of public health provide a practical mandate for adopting a syndemic orientation. The mission of public health is to "fulfill society's interest in assuring the conditions in which people can be healthy" (Institute of Medicine, 1988), which entails organized, interdisciplinary efforts that identify and reduce the physical, mental, and environmental health concerns of communities. The mission to assure the conditions for health also carries the responsibility for declaring what those conditions are, measuring them, and ensuring that they are available to all.

Specifically, public health organizations are guided by three core functions, ten essential services, and five operating principles (Table 1; see also DHHS, 1999; Koplan J, 1999). These tenets emanate from a holistic view of community health, one that accepts the need to continuously improve health and protect communities against all threats to their well-being. Certain health problems (e.g., outbreaks of disease) can be controlled effectively using categorical (bounded) interventions. A syndemic orientation, however, is more likely to be effective as an operational strategy for fulfilling public health’s core responsibilities, which require ecological (unbounded) solutions (Green LW, Kreuter MK, et. al. 1999).

Table 1: Core Public Health Functions, Essential Services, and Operating Principles

Core Functions

Assessment – assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities
Policy Development – formulating public policies, in collaboration with community and government leaders, designed to solve identified local and national health problems and priorities
Assurance – assuring that all populations have access to appropriate and cost-effective care, including health promotion and disease prevention services, and evaluation of the effectiveness of that care

Essential Services

Monitor health status to identify community health problems.
Diagnose and investigate health problems and health hazards in the community.
Inform, educate, and empower people about health issues.
Mobilize community partnerships to identify and solve health problems.
Develop policies and plans that support individual and community health efforts.
Enforce laws and regulations that protect health and ensure safety.
Link people to needed personal health services and assure the provision of health care when otherwise unavailable.
Assure a competent public health and personal health care workforce.
Evaluate effectiveness, accessibility, and quality of personal and population-based health service.
Research for new insights and innovative solutions to health problems.

Operating Principles

Use science as a basis for decision making and public health action.
Expand the quest for social equity through public health action.
Make efforts outcome oriented.
Be accountable.
Perform enthusiastically and effectively as service agencies.

References

Department of Health and Human Services. Public health in America. Department of Health and Human Services: Washington DC. 1999. Accessed on October 2, 2001.
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Green LW, Kreuter MK, Lezin NA, Young L. Health promotion planning: an educational and ecological approach. Mountain View, CA: Mayfield Publishing Company. 1999.

Institute of Medicine, Committee for the Study of the Future of Public Health, Division of Health Care Services. The Future of Public Health. Washington, DC: National Academy Press, 1988.
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Institute of Medicine, Healthy Communities: New Partnerships for the Future of Public Health. Washington, DC: National Academy Press, 1996.

Koplan JP. CDC sets millennium priorities. US Medicine 1999;4-7.

Schorr LB. Common purpose: strengthening families and neighborhoods to rebuild America. New York, NY: Doubleday, Anchor Books, 1997.

Page last reviewed: January 30, 2008
Page last modified: January 30, 2008