An editorial in The Lancet: Syndemics: health in context. Excerpt:
Syndemics, as a new Series published in today's Lancet details, is a conceptual framework for understanding diseases or health conditions that arise in populations and that are exacerbated by the social, economic, environmental, and political milieu in which a population is immersed.
A syndemic, or synergistic epidemic, is more than a convenient portmanteau or a synonym for comorbidity. The hallmark of a syndemic is the presence of two or more disease states that adversely interact with each other, negatively affecting the mutual course of each disease trajectory, enhancing vulnerability, and which are made more deleterious by experienced inequities.
Perhaps the most unique feature of the syndemic approach to understanding various disease states and the way in which they cluster is the emphasis on the situation and circumstances in which individuals live. In other words, syndemics fundamentally rely on context.
When introduced in the 1990s by medical anthropologist Merrill Singer, the notion of a syndemic was used to describe the interactions among substance abuse, violence, and AIDS (SAVA), that had become a full-blown health crisis in Hartford, CT, USA. While investigating HIV prevention in drug users, researchers took notice of the constellation of elements that impinged on risk, structural factors such as lack of housing and poverty, and social aspects such as stigma and lack of support systems—all reinforcing the disease burden.
The observation that these factors did not merely exist in parallel, but were intertwined and cumulative, offered a branch point for clinical medicine and public health interventions. These fields have made appreciable strides in recognising that interventions for combating and treating disease must take a more multifactorial tack, nevertheless there exists a great need and opportunity to more widely apply the principles of the syndemic approach.
In the years since SAVA was identified, there have been other syndemics described that include HIV/AIDS as a component, such as the HIV–malnutrition–food insecurity syndemic in sub-Saharan Africa. Alternatively, other existing and emerging syndemics centre on non-communicable diseases (NCDs) such as VIDDA (violence, immigration, depression, type 2 diabetes, and abuse) in women who have emigrated to the USA from Mexico.
