The Lancet
Volume 389, Issue 10072, 2017, Pages 951-963
Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations (Review)
Mendenhall E.* ,
Kohrt B.A. ,
Norris S.A. ,
Ndetei D. ,
Prabhakaran D.
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a
School of Foreign Service, Georgetown University, Washington, DC, United States
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b
Department of Psychiatry, Duke Global Health Institute, Duke University, Durham, NC, United States
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c
MRC Developmental Pathways for Health Research Unit, Faculty of Health, University of the Witwatersrand, Johannesburg, South Africa
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d
Department of Psychiatry, University of Nairobi, Nairobi, Kenya, Africa Mental Health Foundation, Nairobi, Kenya
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e
Public Health Foundation of India, Centre for Chronic Disease Control, New Delhi, India, London School of Hygiene & Tropical Medicine, London, United Kingdom
Abstract
The co-occurrence of health burdens in transitioning populations, particularly in specific socioeconomic and cultural contexts, calls for conceptual frameworks to improve understanding of risk factors, so as to better design and implement prevention and intervention programmes to address comorbidities. The concept of a syndemic, developed by medical anthropologists, provides such a framework for preventing and treating comorbidities. The term syndemic refers to synergistic health problems that affect the health of a population within the context of persistent social and economic inequalities. Until now, syndemic theory has been applied to comorbid health problems in poor immigrant communities in high-income countries with limited translation, and in low-income or middle-income countries. In this Series paper, we examine the application of syndemic theory to comorbidities and multimorbidities in low-income and middle-income countries. We employ diabetes as an exemplar and discuss its comorbidity with HIV in Kenya, tuberculosis in India, and depression in South Africa. Using a model of syndemics that addresses transactional pathophysiology, socioeconomic conditions, health system structures, and cultural context, we illustrate the different syndemics across these countries and the potential benefit of syndemic care to patients. We conclude with recommendations for research and systems of care to address syndemics in low-income and middle-income country settings. © 2017 Elsevier Ltd
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Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85014484389&doi=10.1016%2fS0140-6736%2817%2930402-6&partnerID=40&md5=dfdc696287d5298f9d00e118ecdd86b8
DOI: 10.1016/S0140-6736(17)30402-6
ISSN: 01406736
Cited by: 70
Original Language: English