A Critical Perspective on Syndemic Theory and Social Justice

Syndemic theory proposes that social phenomena play critical roles in the production and spreading of epidemics and that a syndemic is the result of multiple, adversely interacting epidemics. As currently framed, only the co-occurrence of multiple biological epidemics constitutes a syndemic – social phenomena are treated as risk factors but not epidemics in their own right. I argue that social phenomena such as direct violence (e.g. interpersonal violence, genocide, ethnic cleansing, colonialism, and imperialism) and structural violence (e.g. poverty, racism, historical trauma, and political disenfranchisement) are widespread and adversely affect health in many Indigenous communities, thus meeting the definition of an epidemic. As such, I propose that syndemic theory must be reconceptualized to consider biological and social epidemics, with both types framed as treatable and preventable. Wider acceptance of this frame across disciplines facilitates creation of a collective action frame, which in turn allows us to demand accountability from policymakers – and to demand justice.

Syndemics: A Cross-Disciplinary Approach to Complex Epidemic Events Like COVID-19

In this review, we trace the origins and dissemination of syndemics, a concept developed within critical medical anthropology that rapidly diffused to other fields. The goal is to provide a review of the literature, with a focus on key debates. After a brief discussion of the nature and significance of syndemic theory and its applications, we trace the history and development of the syndemic framework within anthropology and the contributions of anthropologists who use it. We also look beyond anthropology to the adoption and use of syndemics in other health-related disciplines, including biomedicine, nursing, public health, and psychology, and discuss controversies in syndemics, particularly the perception that existing syndemics research focuses on methodologies at the individual level rather than at the population level and fails to provide evidence of synergistic interactions. Finally, we discuss emerging syndemics research on COVID-19 and provide an overview of the application of syndemics research.

COVID-19, food insecurity, and diet-related diseases: Can syndemic theory inform effective responses? A case study

New York City was hit hard by the COVID-19 pandemic. Although the immediate health burden was devastating, we posit that its long-term impact will be even greater, because the rapid spread of COVID-19 both depended on and exacerbated other deep-seated inequities related to food and broader living conditions. Using the Bronx as a case study, we explore the intersection of the pandemic with two other persistent problems: food insecurity and diet-related diseases, a constellation we label the COVID-Food Syndemic. Syndemic theory focuses on the common causes and biological and social interactions between two or more health problems. We hypothesize that with its focus on the common social causes of ill health, this approach can inform and strengthen the synergies between community-based, activist-driven solutions and municipal government responses, thus reducing the burden of ill health in the Bronx. We suggest that combining these two approaches can more fully mobilize the social changes that are needed in the food system and beyond to interrupt the fundamental drivers of this syndemic and capitalize on the respective strengths of government, civil society, and activists.

How Community and Individual Risk Factors Mutually Impact Youth’s Perceived Safety: A Syndemic Analysis Using Structural Equation Modeling

The purpose of this study was to evaluate the mutual impact of community and individual factors on youth’s perceptions of community safety, using structural equation modeling (SEM) conceptualized by syndemic theory. This study used survey data collected from a county wide sample of middle and high school students (N=25,147) in West Central Florida in 2015. The outcome variable was youth’s perceptions of community safety. Predictors were latent individual and community factors constructed from 14 observed variables including gun accessibility, substance use, depressive symptoms, and multiple neighborhood disadvantage questions. Three structural equation models were conceptualized based on syndemic theory and analyzed in Mplus 8 using weighted least squares (WLS) estimation. Each model’s goodness of fit was assessed. Approximately seven percent of youth reported feeling unsafe in their community. After model modifications, the final model showed a good fit of the data and adhered to the theoretical assumption. In the final SEM model, an individual latent factor was implied by individual predictors measuring gun accessibility without adult’s permission (β=0.70), sadness and hopelessness (β=0.52), alcohol use (β=0.79), marijuana use (β=0.94), and illegal drug use (β=0.77). Meanwhile, a community latent factor was indicated by multiple community problems including public drinking (β=0.88), drug addiction (β=0.96), drug selling (β=0.97), lack of money (β=0.83), gang activities (β=0.90), litter and trash (β=0.79), graffiti (β=0.91), deserted houses (β=0.86), and shootings (β=0.93). A second-order syndemic factor that represented the individual and community factors showed a very strong negative association with youth’s safe perception (β=-0.98). This study indicates that individual risk factors and disadvantaged community conditions interacted with each other and mutually affected youth’s perceptions of community safety. To reduce these co-occurring effects and improve safe perceptions among youth, researchers and practitioners should develop and implement comprehensive strategies targeting both individual and community factors.

Global research on syndemics: A meta-knowledge analysis (2001-2020)

Syndemics or synergies of cooccurring epidemics are widely studies across health and social sciences in recent years. We conducted a meta-knowledge analysis of articles published between 2001 to 2020 in this growing field of academic scholarship. We found a total of 830 articles authored by 3025 authors, mostly from high-income countries. Publications on syndemics are gradually increasing since 2003, with rapid development in 2013. Each article was cited more than 15 times on average, whereas most (n = 604) articles were original studies. Syndemics research focused on several areas, including HIV/AIDS, substance abuse, mental health, gender minority stressors, racism, violence, chronic physical and mental disorders, food insecurity, social determinants of health, and COVID-19. Moreover, biopsychosocial interactions between multiple health problems were studied across medical, anthropological, public health, and other disciplines of science. The limited yet rapidly evolving literature on syndemics informs transdisciplinary interests to understand complex coexisting health challenges in the context of systematic exclusion and structural violence in vulnerable populations. The findings also suggest applications of syndemic theory to evaluate clinical and public health problems, examine the socioecological dynamics of factors influencing health and wellbeing, and use the insights to alleviate health inequities in the intersections of synergistic epidemics and persistent contextual challenges for population health.

Mapping the current knowledge in syndemic research applied to men who have sex with men: a scoping review protocol

IntroductionMen who have sex with men (MSM) are disproportionally affected by a number of health conditions that are associated with violence, stigma, discrimination, poverty, unemployment or poor healthcare access. In recent years, syndemic theory provided a framework to explore the interactions of these health disparities on the biological and social levels. Research in this field has been increasing for the past 10 years, but methodologies have evolved and sometimes differed from the original concept. The aim of this paper is to provide an overview of the existing literature on syndemic theory applied to MSM in order to identify knowledge gaps, inform future investigations and expand our understanding of the complex interactions between avoidable health conditions in a vulnerable population.Methods and analysisThe proposed scoping review will follow the methodological framework developed by Arksey and O’Malley with subsequent enhancements by Levac et al, Colquhoun et al and Peters et al as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review. A systematic search of MEDLINE, PsycInfo, Scopus, Cochrane Central Register of Controlled Trials and ProQuest Sociological Abstracts will be conducted. Reference lists of the included studies will be hand-searched for additional studies. Screening and data charting will be achieved using DistillerSR. Data collating, summarising and reporting will be performed using R and RStudio. Tabular and graphical summaries will be presented, alongside an evidence map and a descriptive overview of the main results.Ethics and disseminationThis scoping review does not require ethical approval. Data and code will be made accessible after manuscript submission. Final results will be disseminated through publication in a peer-reviewed journal and collaboration with grassroots Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual (LGBTQIA+) organisations.RegistrationThis protocol was registered on manuscript submission on the Open Science Framework at the following address: https://osf.io/jwxtd; DOI: 10.17605/OSF.IO/JWXTD.