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Introduction to Syndemics: A Critical Systems Approach to Public and Community Health

ISBN: 978-0-470-47203-3
304 pages
July 2009, ©2009, Jossey-Bass
Introduction to Syndemics: A Critical Systems Approach to Public and Community Health (0470472030) cover image
This book explains the growing field of syndemic theory and research, a framework for the analysis and prevention of disease interactions that addresses underlying social and environmental causes. This perspective complements single-issue prevention strategies, which can be effective for discrete problems, but often are mismatched to the goal of protecting the public's health in its widest sense.

"Merrill Singer has astutely described why health problems should not be seen in isolation, but rather in the context of other diseases and the social and economic inequities that fuel them. An important read for public health and social scientists."
Michael H. Merson, director, Duke Global Health Institute

"Not only does this book provide a persuasive theoretical biosocial model of syndemics, but it also illustrates the model with a wide variety of fascinating historical and contemporary examples."
Peter J. Brown, professor of Anthropology and Global Health and director, Center for Health, Culture, and Society, Emory University

"The concept of syndemics is Singer's most important contribution to critical medical anthropology as it interfaces with an ecosocial approach to epidemiology."
Mark Nichter, Regents Professor, Department of Anthropology, University of Arizona

"Merrill Singer offers the public the most comprehensive work ever written on this key area of research and policy making."
Francisco I. Bastos, chairman of the graduate studies on epidemiology, Fundacao Oswaldo Cruz

"Exquisitely describes how this new approach is a critical tool that brings together veterinary, medical, and social sciences to solve emerging infectious and non-infectious diseases of today's world."
Bonnie Buntain, MS, DVM, diplomate, American College of Veterinary Preventive Medicine

"For too long the great integrative perspectives on modern biomedicine and public health disease ecology and social medicine-have remained more or less separate. In this innovative and provocative book, Merrill Singer develops a valuable synthesis that will reshape the way we think about health and disease."
Warwick H. Anderson, MD, PhD, professorial research fellow, Department of History and Centre for Values, Ethics, and the Law in Medicine, University of Sidney

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Preface.

The Author.

Acknowledgments.

PART ONE INTRODUCING KEY CONCEPTS IN SYNDEMICS.

1 LEARNING FROM LICHEN: RECONCEPTUALIZING HEALTH AND DISEASE.

On Not Planting Cut Flowers: The Weight of History.

Germ Theory and the Biomedical Conception of Disease.

Revolutions in Biomedical Realities.

Problems with Postulates.

Confronting Comorbidity.

Toward Syndemic Reconceptualization.

Local Knowledge.

Connections: Human and Nonhuman.

Summary.

Key Terms.

Questions for Discussion.

PART TWO SYNDEMIC CASES.

2 TRUCKING BETWEEN THE BAILIWICKS: MULTIDISCIPLINARITY, SAVA, AND SYNERGIES IN HEALTH.

Why Multidisciplinarity.

The Term Syndemic.

The SAVA Syndemic.

SAVA Among Victims of Domestic Violence.

SAVA Among MSM.

SAVA Among Street Drug Users.

SAVA Among Commercial Sex Workers.

SAVA and Public Health.

Summary.

Key Terms.

Questions for Discussion.

3 EXEMPLARS: SYNDEMIC CASE STUDIES.

Syllables in the Biological Message.

Varieties of Microlevel Disease Interaction.

Syndemic Diversity.

Renocardiac Syndemic.

SARS–Chronic Disease Syndemic.

Asthma-Infl uenza Syndemic.

Diabulimia Syndemic.

Summary.

Key Terms.

Questions for Discussion.

4 HIV/AIDS AND OTHER INFECTIONS: IMMUNE IMPARITY AND SYNDEMOGENESIS.

Assessing the HIV/AIDS Syndemics.

Opportunistic Infections and HIV/AIDS.

Sexually Transmitted Disease Syndemics.

Hepatitis and HIV/AIDS Syndemic.

Tuberculosis and HIV/AIDS Syndemic

Malaria and HIV/AIDS Syndemic

VL and HIV/AIDS Syndemic.

Helminths and HIV/AIDS Syndemic.

Summary.

Key Terms.

Questions for Discussion.

5 BEYOND CONTAGION: HIV/AIDS AND NONINFECTIOUS DISEASE SYNDEMOGENESIS.

An Aging Epidemic.

Infectious and Chronic Disease Connections.

Kidney Disease and HIV.

Food Insuffi ciency and HIV.

Cardiovascular Diseases and HIV/AIDS.

Emotional and Cognitive Health and HIV/AIDS.

Countersyndemics.

Summary.

Key Terms.

Questions for Discussion.

PART THREE SOCIETY, HISTORY, AND THE ENVIRONMENT.

6 INEQUITY AS A COFACTOR: THE SYNDEMIC IMPACT OF SOCIAL DISPARITIES.

Disease in the Time of Disparity.

The Making Social of Disease.

Biologizing Experience.

Supersyndemics.

Health and Human Rights.

Summary.

Key Terms.

Questions for Discussion.

7 SYNDEMICS AND THE WORLDS THEY MADE.

Before Now.

Irish Famine Syndemic of 1741.

Gibraltar Cholera Syndemic of 1865.

Massachusetts Scarlet Fever Syndemic of the 1800s.

Global Influenza Syndemic of 1918.

Syndemics Among Native Americans on the American Frontier.

Syndemics of the Mormon Migration.

Syndemics of War.

Summary.

Key Terms.

Questions for Discussion.

8 A WORLD OUT OF BALANCE: EMERGENT AND REEMERGENT ECOSYNDEMICS.

Emergent Syndemics of a Troubled World.

From Emergent Infection to Emergent Syndemic.

Reemergent Diseases and Emergent Syndemics.

Superinfection: Intragenus Syndemics.

Iatrogenic Syndemics.

Unintended Countersyndemics.

Ecosyndemics and the Anthropocene.

Summary.

Key Terms.

Questions for Discussion.

PART FOUR APPLICATIONS OF THE SYNDEMIC PERSPECTIVE.

9 PRACTICAL UTILITY: MOBILIZING THE SYNDEMIC MODEL IN THE PROMOTION OF HEALTH AND TREATMENT OF DISEASE.

Why Study Syndemics?

Public Health and Syndemic Prevention.

Medical Treatment of Syndemics.

Modeling Syndemics.

Future Syndemics.

Summary.

Key Terms.

Questions for Discussion.

GLOSSARY.

REFERENCES.

INDEX.

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Merrill Singer, a cultural and medical anthropologist who earned his PhD degree from the University of Utah, holds a dual appointment as senior research scientist at the Center for Health, Intervention, and Prevention and professor of anthropology at the University of Connecticut. Additionally, he is affi liated with the Center for Interdisciplinary Research on AIDS (CIRA) at Yale University. He has authored, coauthored, or edited twenty books and over two hundred articles and book chapters on health and social issues. Active in the building of social science of health theory, the development of methods in qualitative health research, and the use of research in the development of community - based health promotion and intervention, he has been the recipient of the Rudolph Virchow Award from the Critical Anthropology of Health Caucus of the Society for Medical Anthropology, the George Foster Practicing Medical Anthropology Award from the Society for Medical Anthropology, the AIDS and Anthropology Prize Paper award from the AIDS and Anthropology Research Group, and the Prize for Distinguished Achievement in the Critical Study of North America from the Society for the Anthropology of North America. Since 1984 he has been the principal investigator on a continuous series of basic and applied federally funded health studies, and he has carried out health research in the United States, Brazil, China, and Haiti.
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