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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).
Next: What are the advantages and limitations of a syndemic orientation? >> 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. 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. 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 Content source: Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion |
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