Outbreaks in the age of syndemics: New insights for improving Indigenous health

Abstract

Conventional approaches for the prevention and control of communicable diseases within Indigenous contexts may benefit from new insights arising from the growing interest in syndemics. Syndemics is a term used to describe a conceptual framework for understanding diseases or health conditions, and how these are exacerbated by the social, economic, environmental and political milieu in which a population is immersed. The use of conventional approaches for outbreak prevention and control remains the bedrock of intervention in the field of communicable diseases; yet on their own, these strategies are not always successful, especially within contexts of marginalization and disadvantage. A broader approach is needed; one that examines the systemic factors involved, understands how various policies and systems support or hinder effective responses and identifies the structural changes needed to create more supportive environments and increase the resilience of the population. In an Indigenous context, whether the focus is on hepatitis C, tuberculosis, HIV or water-borne diseases, it is important to recognize that a) social determinants contribute to the emergence and persistence of outbreaks, b) conventional approaches to communicable disease control are necessary but not sufficient, and c) using a "syndemics lens" can leverage action at multiple levels to tackle the root causes of poor health and inform more effective strategies for improving Indigenous health and reducing health inequities.

A community-wide acute diarrheal disease outbreak associated with drinking contaminated water from shallow bore-wells in a tribal village, India, 2017

“…This vulnerable tribal population continues to be at higher risk for ADD outbreaks with 27% not having access to safe drinking water and 75% of households not having toilets [15]. They need special assistance schemes from the government to enable them overcome poor accessibility to WASH facilities and secure healthy living [16].…”

Social and structural barriers and facilitators to HIV healthcare and harm reduction services for people experiencing syndemics in Manitoba: study protocol

“…This syndemic theory is particularly valuable in the context of communicable diseases and seldom-heard and marginalised peoples’ health, as it brings interacting diseases and inequalities together, and it emphasises the political, social, historical and economic factors that have negatively affected their health outcomes 34 36 Figure 1. summarises our approach for this study.…”

An Update on the Ocular Surface Bacterial Microbiota in Small Animals

“…As a result of a legacy of colonialism and the associated intergenerational trauma (TRC, 2015), Indigenous people in Canada experience a number of structural inequities that put them at higher risk of acquiring infections relative to the rest of the population (Andermann, 2017). TB (PHAC, 2017a), pneumococcal disease (Kovesi, 2012;Das & Kovesi, 2015;Marrie et al, 2017), and gastrointestinal infections (Bradford et al, 2016) disproportionately impact Indigenous people in Canada.…”