“Just One Thing after Another”: Recursive Cascades and Chronic Conditions

Abstract

Chronic conditions and their resultant difficulties in daily living frequently occur with other health problems, sometimes due to interactions or complications at a biological level, or as a result of common pathogens or risk factors. On other occasions, they develop independently. Drawing on research conducted with Australian women that began in the mid-2000s and is still ongoing, we highlight how chronic structural factors shape the risk factors of "chronic" conditions, influencing health seeking, continuity of care, and health outcomes. Institutional, economic, and other circumstantial factors pertain and impact health trajectories as much in highly industrialized as in resource poor settings. In illustrating how poverty and social exclusion create the preconditions of multiple chronic health problems, and how chronic health problems increase such disadvantages for individuals and their households, we introduce the idea of "recursive cascades" to capture the often inevitable trajectory of increasing ill health and growing empoverishment.

Chronic Living in a Communicable World

“…In the midst of a global pandemic that has half of the world's population in some kind of lockdown and breaking news covering rising infection and death rates by the hour, we are for a time distracted from the fact that, apart from COVID-19, every single day, molecular and cellular disturbances within individual bodies cascade into new medical conditions affecting millions of people throughout the world (Manderson and Warren 2016;Mendenhall 2012;Nichter 2016). Organs fail, immune systems weaken, metabolisms falter, cells degenerate, and genes mutate.…”

“…Such therapeutic pluralism notwithstanding, there is nothing inherently chronic about conditions like type 1 diabetes, cancer, HIV, congenital heart defects or kidney disease; rather these medical conditions are made chronic given access to lifesaving and prolonging treatment as well as adequate care and support (Kierans 2020). Moreover, as people grow older, the cascading of multiple medical conditions can complicate treatment and its coordination, with possible compromises as treatment costs accrue (Manderson and Warren 2016).…”

Living with HIV in regional Queensland: social ties, care and support in managing a long-term complex chronic illness

“…adaptive capacity was also observed in women living with complex chronic illnesses and receiving welfare in Australia [228]. Describing the experiences of these women, Manderson and Warren (2016) proposed it was an intersection of social and biological disease factors which not only predisposed them to health-harming exposures but also further impeded on women's ability to manage their poor health [228].…”

“…Describing the experiences of these women, Manderson and Warren (2016) proposed it was an intersection of social and biological disease factors which not only predisposed them to health-harming exposures but also further impeded on women's ability to manage their poor health [228]. To describe that Manderson and Warren (2016) argue they were experiencing syndemic suffering [210].…”

“…To describe that Manderson and Warren (2016) argue they were experiencing syndemic suffering [210]. It contributed to a systematic erosion of resources (including social networks) available to them, and cascaded into the chronicity of their poor health [228].…”