Syndemics and the biosocial conception of health

Singer, Merrill; Bulled, Nicola; Ostrach, Bayla; Mendenhall, Emily

doi:10.1016/s0140-6736(17)30003-x

Cited by 1,036 publications

(898 citation statements)

References 56 publications

Supporting

Mentioning

806

Contrasting

Unclassified

Order By: Relevance

“…[9,10,14,18–21] In MSM, this clustering of poor mental, sexual and general health and behaviours leads to an increased risk of adverse sexual health outcomes, [22] suggesting that understanding such mechanisms requires a syndemic approach. [23]…”

Section: Introductionmentioning

confidence: 99%

Illicit drug use and its association with key sexual risk behaviours and outcomes: Findings from Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

et al. 2017

View full text Add to dashboard Cite

ObjectivesWe explore the hypothesis that using illicit drugs other than, or in addition to, cannabis is associated with sexual risk behaviour and sexual health outcomes in the British population.MethodsWe analysed data, separately by gender, reported by sexually-active participants (those reporting > = 1 partners/past year) aged 16–44 years (3,395 men, 4,980 women) in Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a probability survey undertaken 2010–12 involving computer-assisted personal-interview and computer-assisted self-interview. Analyses accounted for the stratification, clustering and weighting of the data. Multivariable logistic regression was used to calculate adjusted odds ratios.ResultsUse of illicit drugs other than, or in addition to, cannabis in the past year was reported by 11.5% (95%CI:10.4%-12.8%) of men and 5.5% (4.8%-6.3%) of women. Use of these types of drugs was more common among those <35 years, those who reported poor general and/or sexual health behaviours, e.g. binge drinking > = weekly (age-adjusted ORs, aAORs, 10.91 (6.27–18.97) men; 9.95 (6.11–16.19) women); having > = 2 condomless partners in the past year (aAOR:5.50 (3.61–8.39) men; 5.24 (3.07–8.94) women). Participants reporting illicit drug use were more likely (than those who did not) to report sexual health clinic attendance (ORs after adjusting for age, sexual identity and partner numbers: 1.79 (1.28–2.51) men; 1.99 (1.34–2.95) women), chlamydia testing (1.42 (1.06–1.92) men; 1.94 (1.40–2.70) women), unplanned pregnancy (2.93 (1.39–6.17) women), and among men only, sexually transmitted infection diagnoses (3.10 (1.63–5.89)).ConclusionsIn Britain, those reporting recent illicit drug use were more likely to report other markers of poor general and sexual health. They were also more likely to attend sexual health clinics so these should be considered appropriate settings to implement holistic interventions to maximise health gain.

show abstract

Section: Introductionmentioning

confidence: 99%

Illicit drug use and its association with key sexual risk behaviours and outcomes: Findings from Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

et al. 2017

View full text Add to dashboard Cite

show abstract

“…17 Where complex systems approaches have been used in public health research, policy, and practice they have tended to focus on describing or modelling systems. Although this focus is important, and echoes responses to other multifactorial, context-driven problems, 18 researchers now need to build on these foundations to investigate potential effects of interventions on systems (for an example, see panel). The development of robust tools, by use of a broad, multidisciplinary suite of methods for both intervention research and evidence synthesis, is needed to support effective policy responses.…”

mentioning

confidence: 99%

The need for a complex systems model of evidence for public health

et al. 2017

View full text Add to dashboard Cite

Despite major investment in both research and policy, many pressing contemporary public health challenges remain. To date, the evidence underpinning responses to these challenges has largely been generated by tools and methods that were developed to answer questions about the effectiveness of clinical interventions, and as such are grounded in linear models of cause and effect. Identification, implementation, and evaluation of effective responses to major public health challenges require a wider set of approaches 1,2 and a focus on complex systems. 3,4 A complex systems model of public health conceptualises poor health and health inequalities as outcomes of a multitude of interdependent elements within a connected whole. These elements affect each other in sometimes subtle ways, with changes potentially reverberating throughout the system. 5 A complex systems approach uses a broad spectrum of methods to design, implement, and evaluate interventions for changing these systems to improve public health.Complex systems are defined by several properties, including emergence, feedback, and adaptation. 3 Emergence describes the properties of a complex system that cannot be directly predicted from the elements within it and are more than just the sum of its parts. For example, the changing distribution of obesity across the population can be conceptualised as an emergent property of the food, employment, transport, economic, and other systems that shape the energy intake and expenditure of individuals. Feedback describes the situation in which a change reinforces or balances further change. For example, if a smoking ban in public places reduces the visibility and convenience of smoking, and this makes it less appealing, fewer young people might then start smoking, further reducing its visibility, and so on in a reinforcing loop. Adaptation refers to adjustments in behaviour in response to interventions, such as a tobacco company lowering the price of cigarettes in response to a public smoking ban.Rhetoric urging complex systems approaches to public health is only rarely operationalised in ways that generate relevant evidence or effective policies. 1,6 Public health problems that emerge as a property of a complex system cannot necessarily be solved with a simple, single intervention, but the interacting factors within the system can potentially be reshaped to generate a more desirable set of outcomes. 7,8 Achievement of meaningful impacts on complex multicausal problems, like obesity, requires more than single interventions, such as traffic light food labelling or exercise on prescription, many of which require high levels of individual agency, have low reach and impact, and tend to widen health inequalities. 9-11 Shifts within multiple elements across the many systems that influence obesity are required, some of which might only have small effects on individuals but can drive large changes when aggregated at population level. 12 Although randomised controlled trials of individual-level interventions are relatively strai...

show abstract

“…This “scarcity mindset” is a serious risk factor for a lower health status (Fell & Hewstone, 2015). The interaction between the emergence of diseases and challenging environmental circumstances may even result in what has recently been called a “syndemic” (from “synergistic” and “epidemic”) (Singer, Bulled, Ostrach, & Mendenhall, 2017). The accumulation of physical, mental and social problems resulting in such syndemics exacerbates the poverty cycle, and intergenerational transfer is likely to occur, as children grow up with a scarcity mindset (Tiemeijer, 2016; Wagmiller & Adelman, 2009).…”

Section: Discussionmentioning

confidence: 99%

Shining light inside the tunnel: using photovoice as a strategy to define the needs for health promotion among families of low socioeconomic status

Prevo

Stessen

Kremers

et al. 2018

International Journal of Qualitative Studies on Health and Well

View full text Add to dashboard Cite

Purpose: This study aimed to identify opportunities to improve the current health and social situation of low socioeconomic status (SES) families and to gain a better understanding of the main needs regarding health promotion. Low-SES families were approached to participate in a photovoice study. Method: The study took place in the municipality of Vaals, which is located in the southernmost part of the Netherlands. A diverse group of ten people from eight different families took about 150 photographs within their community on topics they considered important for their health and quality of life. This was followed by individual interviews and a focus group interview. Results: Four main needs were identified: meeting each other, helping each other, feeling safe and being mobile. The photographs showed that health-related themes had low priority for these families. Conclusion: The low-SES families focused on upstream factors relating to independence, self-resilience and a sense of belonging, to help them cope with their current situation. This study represents a first step towards the development of a community approach to health promotion in low-SES families.

show abstract

Syndemics and the biosocial conception of health

Cited by 1,036 publications

References 56 publications

Illicit drug use and its association with key sexual risk behaviours and outcomes: Findings from Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Illicit drug use and its association with key sexual risk behaviours and outcomes: Findings from Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

The need for a complex systems model of evidence for public health

Shining light inside the tunnel: using photovoice as a strategy to define the needs for health promotion among families of low socioeconomic status

Contact Info

Product

Resources

About