Syndemic contexts: findings from a review of research on non-communicable diseases and interviews with experts

Abstract

Background: Syndemics are characterized by the clustering of two or more health conditions, their adverse interaction, and contextual factors that create the conditions for clustering and/or interaction that worsens health outcomes. Studying syndemics entails drawing on diverse disciplines, including epidemiology and anthropology. This often means collaboration between researchers with different scholarly backgrounds, who share and -ideally -integrate their findings. Objective: This article examines how context within syndemics has been defined and studied. Methods: A literature review of empirical studies focusing on syndemics involving noncommunicable diseases (NCDs) and mental health conditions was conducted and the full text of 13 articles was analyzed. The review was followed-up with semi-structured interviews with 11 expert researchers working in the field. Results: The review and interviews highlighted a relatively consistent definition of syndemics. The reviewed studies of NCD-related syndemics tended to focus on micro-level context, suggesting a need to analyze further underlying structural factors. In their syndemics research, respondents described working with other disciplines and, although there were some challenges, welcomed greater disciplinary diversity. Methodological gaps, including a lack of mixed methods and longitudinal studies, were identified, for which further interdisciplinary collaborations would be beneficial. Conclusions: NCD-related syndemics research would benefit from further analysis of structural factors and the interconnections between syndemic components across multiple levels, together with more ambitious research designs integrating quantitative and qualitative methods. Research on the COVID-19 pandemic can benefit from a syndemics approach, particularly to understand vulnerability and the unequal impacts of this public health crisis.

Strengthening public mental health during and after the acute phase of the COVID-19 pandemic

“…Syndemic research approaches will help our understanding of the unequal impacts of the pandemic, for instance, on people who are homeless, migrants and displaced and refugee populations, individuals with disabilities, and people with pre-existing mental or substance use disorders, particularly the social, economic, and political contexts, and inform necessary interventions for these populations. 13 Multisectoral and multidisciplinary research approaches that incorporate partnership within the health sector and collaboration with key government agencies are essential for the expansion of mental health services at community levels and the promotion of social reconnections and rehabilitation for people with mental disorders. Strategies to prevent maltreatment, violence, and injuries tested in multidisciplinary studies are necessary for the development of effective response plans to safeguard human rights in subgroups such as older adults, children, populations with learning and intellectual disabilities, and people with severe mental disorders in public health emergencies.…”

Assuring Healthy Populations During the COVID-19 Pandemic: Recognizing Women's Contributions in Addressing Syndemic Interactions

“…The synergistic interactions among disease and the contextual social environment (i.e., SDoH) in which they occur can result in a syndemic. More specifically, a syndemic is described by the coming together of two or more health conditions (e.g., chronic illness and infectious disease) and their adverse interactions with each other and the SDoH that can provide the milieu for enhancing vulnerabilities, magnifying inequities, and worsening health outcomes for marginalized populations ( 14 – 16 ). A syndemic framework examines disease interactions and the contributions of structural, social, economic, and environmental factors that synergistically interact to contribute to adverse health outcomes for individuals and whole populations ( 16 , 17 ).…”

Noncommunicable diseases, climate change and iniquities: What COVID‐19 has taught us about syndemic

“…Thus, research on the COVID‐19 pandemic can benefit from a syndemic approach, which is particularly useful to understand vulnerability and the unequal impacts of this public health crisis. 90 …”

“…Thus, research on the COVID-19 pandemic can benefit from a syndemic approach, which is particularly useful to understand vulnerability and the unequal impacts of this public health crisis. 90 Judging COVID-19 as a syndemic requires a syndemic approach not only to provide an appropriate response to the pandemic but also to limit the risk of further pandemics. In fact, we must consider that NCD as obesity, hypertension, cardiovascular diseases, chronic respiratory diseases and cancer have been spreading across poorer and most vulnerable countries.…”

“…The events related to the syndemic will greatly exacerbate the prognosis and burden of disease. Thus, research on the COVID‐19 pandemic can benefit from a syndemic approach, which is particularly useful to understand vulnerability and the unequal impacts of this public health crisis 90 …”