2017

Tsai, Alexander, Emily Mendenhall, James Trostle, and Ichiro Kawachi. 2017. “Co-occurring epidemics, syndemics, and population health.”  The Lancet, 978–82.

 

Mendenhall, Emily. 2017. “Syndemics: A New Path for Global Health Research.” The Lancet, 389: 391.

 

Mendenhall, Emily. 2017. “The Georgetown Conference on Global Mental Health: Transdisciplinary Perspectives.” Global Public Health, 13(9):1145-1151.

 

Mendenhall, Emily, Brandon Kohrt, Shane Norris, David Ndetei, and Dorairaj Prabhakaran. 2017. “Non-communicable Disease Syndemics: Poverty, Depression, and Diabetes among the Urban Poor.” The Lancet, 389: 952-963.

The co-occurrence of health burdens in transitioning populations, particularly in specific socioeconomic and cultural contexts, calls for conceptual frameworks to improve understanding of risk factors, so as to better design and implement prevention and intervention programmes to address comorbidities. The concept of a syndemic, developed by medical anthropologists, provides such a framework for preventing and treating comorbidities. The term syndemic refers to synergistic health problems that affect the health of a population within the context of persistent social and economic inequalities. Until now, syndemic theory has been applied to comorbid health problems in poor immigrant communities in high-income countries with limited translation, and in low-income or middle-income countries. In this Series paper, we examine the application of syndemic theory to comorbidities and multimorbidities in low-income and middle-income countries. We employ diabetes as an exemplar and discuss its comorbidity with HIV in Kenya, tuberculosis in India, and depression in South Africa. Using a model of syndemics that addresses transactional pathophysiology, socioeconomic conditions, health system structures, and cultural context, we illustrate the different syndemics across these countries and the potential benefit of syndemic care to patients. We conclude with recommendations for research and systems of care to address syndemics in low-income and middle-income country settings.

 

*McMurry, H. Stowe, Roopa Shivashankar, Emily Mendenhall, and Dorairaj Prabhakaran. 2017. “Today’s risk factors, tomorrow’s disease; overweight and obesity insights from India’s fourth National Family Health Survey.” Economic and Political Weekly (EPW).

India is in the midst of an epidemiological transition, whereby poverty-linked infectious, maternal and nutritional diseases exist in conjunction with non-communicable chronic illnesses. This transition is driven by rapid economic development within which people eat, move, work, and live differently than before. This analysis of the third and fourth rounds of the National Family Health Survey demonstrates that non-communicable diseases, and their risk factors are undergoing a reversal of the social gradient and are moving down the socio-economic ladder into lower-income populations.

 

Singer, Merrill, Bayla Ostrach, and Nicola Bulled, and Emily Mendenhall. 2017. “Syndemics and the Biosocial Conception of Health.” The Lancet, 941–50.

The syndemics model of health focuses on the biosocial complex, which consists of interacting, co-present, or sequential diseases and the social and environmental factors that promote and enhance the negative effects of disease interaction. This emergent approach to health conception and clinical practice reconfigures conventional historical understanding of diseases as distinct entities in nature, separate from other diseases and independent of the social contexts in which they are found. Rather, all of these factors tend to interact synergistically in various and consequential ways, having a substantial impact on the health of individuals and whole populations. Specifically, a syndemics approach examines why certain diseases cluster (ie, multiple diseases affecting individuals and groups); the pathways through which they interact biologically in individuals and within populations, and thereby multiply their overall disease burden, and the ways in which social environments, especially conditions of social inequality and injustice, contribute to disease clustering and interaction as well as to vulnerability. In this Series, the contributions of the syndemics approach for understanding both interacting chronic diseases in social context, and the implications of a syndemics orientation to the issue of health rights, are examined.