|
|
|
Syndemics Overview - What Principles Characterize a Syndemic Orientation?A syndemic orientation is primarily distinguished from other perspectives by its explicit emphasis on examining connections between health-related problems. With this concern, it offers a broader framework for understanding how multiple health problems interact in particular settings. A syndemic orientation elevates public health inquiry beyond its many individual categories to examine directly the conditions that create and sustain overall population health. The idea of preventing syndemics builds upon proven principles of epidemiology, which have been applied largely to the first tier of a highly complex world. The transforming effect of increasing scale is captured by the Sufi saying "You think that if you understand one, you understand two-because one and one are two. But you must also understand 'and'." Similarly, the notion of a syndemic shows that at a population level there is more to public health work than the study of isolated health problems. It reminds us that we do not yet know precisely what happens when two (or more) epidemics interact, nor how powerful interventions can be if they are planned to disrupt those forces that hold multiple diseases together. Acknowledging the distinction between a single epidemic and the phenomenon of syndemics expands the science, practice, and policy aspects of public health work. Traditionally, research protocols, prevention programs, policy interventions, and other aspects of public health practice have focused on one disease or risk factor at a time, leaving other health problems to be addressed by parallel enterprises. This categorical (i.e., single issue) approach is often used even though there is a high probability that several of the conditions that threaten a given population's health will have common social, environmental, behavioral, or biological determinants. Under a syndemic orientation, such forces would be addressed in an integrated, networked fashion. The Encyclopedia of Public Health contains an entry that describes the unique conceptual plane inherent in a syndemic orientation. Writing about syndemics within the broader realm of anthropology and public health, Kate MacQueen observes that
Whereas the usual public health approach begins by defining the disease in question, a syndemic orientation first defines the people in question. With this frame of reference, it goes on to identify links among the entire set of issues that create excess burden of disease among the group's members. In practice, a syndemic orientation follows a specific line of questioning:
These are provocative questions because diseases in human populations do not occur randomly. In virtually all societies, the heaviest burden of disease falls upon those who are socially marginalized, disenfranchised, or oppressed. With few exceptions, even emerging diseases that first strike members of the majority eventually gravitate to take hold among minorities. This dynamic concentrates disease among disadvantaged groups, who then become even more vulnerable as health threats reinforce one another in a vicious cycle. The clustering of health-related problems can occur for many reasons. For instance, "separate" health concerns are actually linked if they
[Note: This is a preliminary list of potential epidemic ties. Research is underway to explore and define a complete typology of the ways that health-related problems could be linked.] When several health problems concentrate by person, place, or time, the real forces that connect them are often unrecognized or minimized due to the categorical nature of most epidemiological analyses (notable exceptions can be found in social epidemiology; see Krieger N, 2001a, 2001b). The problem, however, is not inherent in the science of epidemiology. On the contrary, epidemiologists are trained to see diseases emerging from interactions of an agent, host, and environment (e.g., CDC 2001). This same typology (or one similar) could perhaps be used on a higher level of analysis to investigate connections between different diseases, but such questions are not commonly asked. A syndemic orientation, by definition, prompts extensive inquiry into the conditions that create and sustain health, questioning how and why those conditions might differ among groups. For these reasons a syndemic orientation provides a more precise scientific framework for understanding and preventing the conditions that perpetuate health inequities. Next: When Is It Appropriate or Inappropriate to Use a Syndemic Orientation? >> References CDC.
Introduction to Epidemiology. Centers for Disease Control and
Prevention: Atlanta, GA. 2001. Accessed on October 2, 2001. Krieger N. A
glossary for social epidemiology. Journal of Epidemiology and
Community Health 2001;55:693-700. Krieger N. Theories
for social epidemiology in the 21st century: an ecosocial
perspective. International Journal of Epidemiology 2001;30:668-77. MacQueen KM. Anthropology and public health. In Breslow L, Green LW, Keck W, Last J, McGinnis M. (Eds.). Encyclopedia of Public Health. New York: Macmillan, 2002.
Content source: Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion |
|
||||||||||||
|