Syndemic effects in complex humanitarian emergencies: A framework for understanding political violence and improving multi-morbidity health outcomes

Abstract

A hallmark of complex humanitarian emergencies is the collective exposure, often over extended periods of time, to political violence in the forms of war, terrorism, political intimidation, repression, unlawful detention, and forced displacement. Populations in complex humanitarian emergencies have higher risks of multiple co-morbidities: mental disorders, infectious diseases, malnutrition, and chronic non-communicable physical diseases. However, there is wide variation in the health impacts of both across and within humanitarian emergencies. Syndemic theory is an approach to conceptualizing multiple morbidities and social determinants to understand differential patterns of multimorbidity, elucidate underlying mechanisms, and better design interventions. Syndemic theory, if applied to complex humanitarian emergencies, has the potential to uncover origins of localized patterns of multi-morbidity resulting from political violence and historical inequities. In this paper, we present two case studies based on mixed-methods research to illustrate how syndemic models can be applied in complex humanitarian emergencies. First, in a Nepal case study, we explore different patterns of posttraumatic stress disorder (PTSD) and depression co-morbidity among female former child soldiers returning home after war. Despite comparable exposure to war-related traumas, girl soldiers in high-caste Hindu communities had 63% co-morbidity of PTSD and depression, whereas girl soldiers in communities with mixed castes and religions, had 8% PTSD prevalence, but no cases of PTSD and depression co-morbidity. In the second case study, we explore the high rates of type 2 diabetes during a spike in political violence and population displacement. Despite low rates of obesity and other common risk factors, Somalis in Ethiopia experienced rising cases of and poor outcomes from type-2 diabetes. Political violence shapes healthcare resources, diets, and potentially, this epidemiological anomaly. Based on these case studies we propose a humanitarian syndemic research agenda for observational and intervention studies, with the central focus being that public health efforts need to target violence prevention at family, community, national, and global levels.

COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health

“…160 In Latin America and Africa, governmental cash transfer programmes have doc umented positive mental health benefits, which could be more impactful than ever during the economic contraction caused by Syndemic theory postulates that specific localised sociocultural, economic, and political conditions contribute to patterns of multimorbidity, and that settings without the same contextual features will not share these multimorbidity patterns. [150][151][152] Syndemic theory goes beyond comorbidity to recognise the clustering of health burdens in a specific population that biologically interact to worsen health, and the shared sociostructural forces that exacerbate the biological disease interaction. 150,153 Therefore, diseases become concentrated in specific geographical or temporal contexts where people are exposed to harmful social conditions, interacting at individual and population levels to worsen health.…”

Collaboration With People With Lived Experience of Mental Illness to Reduce Stigma and Improve Primary Care Services

“…Caste and ethnicity were recorded for this study because the social categorizations have been associated with stigmatization and discrimination, mental illness risk factors, and differential treatment within the health system. 39 , 40 , 41 , 42 , 43 , 44 , 45 …”

Sindemia, infodemia, pandemia de COVID-19: Hacia una pandemiología de enfermedades emergentes

“…Posteriormente, se utilizó el enfoque sindémico para explicar las complejas interrelaciones entre la comorbilidad de la depresión con la diabetes y la interacción entre inmigración y violencia en Chicago, EEUU (13) . Recientemente, la teoría de la sindemia se ha presentado como una fuente de soluciones innovadoras para hacer frente a emergencias humanitarias complejas, evitando la interacción de resultados negativos en los indicadores relevantes de protección y promoción de la salud en crisis sanitarias (14) .…”