DOCSLIB.ORG

JAOA 1811 Clearfield0365 719..729

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
JAOA 1811 Clearfield0365 719..729 REVIEW Cardiovascular Disease as a Result of the Interactions Between Obesity, Climate Change, and Inflammation: The COCCI Syndemic Michael Clearfield, DO; Glenn Davis, MS; Jennifer Weis, DO; Gregory Gayer, PhD; Jay H. Shubrook, DO From the Touro University Obesity and climate change conspire to create an environment in which sub- College of Osteopathic clinical vascular inflammation leads to progressive atherosclerosis, which Medicine-CA in Vallejo. Drs Clearfield and Shubrook are contributes to the number 1 cause of global mortality: cardiovascular investigators in the National disease. The syndemic model requires 2 or more diseases or contributors to Institutes of Health fi Cardiovascular Inflammation disease (such as obesity and climate change) clustering within a speci c Trial. population in addition to the associated societal and social factors, ultimately Disclaimer: Jay H. Shubrook, creating an environment supportive of a greater adverse interaction. This an associate editor of The article explores the syndemic of obesity and climate change as a driver for Journal of the American cardiovascular disease. Osteopathic Association,was not involved in the editorial J Am Osteopath Assoc. 2018;118(11):719-729 review or decision to publish doi:10.7556/jaoa.2018.157 this article. Keywords: cardiovascular disease, climate change, inflammation, obesity Financial Disclosures: None reported. Support: None reported. Address correspondence to umerous breakthroughs in medicine and technology over the past half century Jay H. Shubrook, DO, Touro have addressed risk factors for and management of cardiovascular disease University College of (CVD); yet, despite these successes, CVD remains the number 1 cause of mor- Osteopathic Medicine-CA, N 1 1310 Club Dr, Mare Island, tality in both men and women. The evidence base for treating patients with major CVD Vallejo, CA 94592-1187. risk factors, such as hyperlipidemia, hypertension, and cigarette smoking, have resulted 2-5 Email: [email protected] in both robust improvements and national guidelines. Therapeutic and preventive inter- ventions have continued to improve cardiovascular (CV) outcomes, such that the most Submitted fi December 19, 2017; recent lipid-lowering trials have demonstrated continued bene ts from lowering low- accepted density lipoprotein cholesterol (LDL-C) to levels far below the targets elicited from January 17, 2018. current guidelines.6-10 However, even with the significant benefits associated with aggressive LDL-C lowering, there remains a considerable residual risk in both primary and secondary CV risk populations (Figure 1). Historical Perspective on CVD Cardiovascular disease steadily increased through the first half of the 20th century, peaking around 1968, when the annual growth flattened.11,12 Since that time, CVD mortality rates have decreased from 507/100,000 to 254/100,000—a 50% decrease; yet, given the growth of the population and especially people aged 65 years or older, CVD remains the number 1 cause of mortality.11 Had the trend from 1900 to 1968 continued, it is estimated that an additional 1 million CVD deaths likely would have occurred in 2014.12 The Journal of the American Osteopathic Association November 2018 | Vol 118 | No. 11 719 REVIEW 35 30 25 20 15 CV Event Rate, % 10 Placebo Treatment 5 0 IMPROVE IT FOURIER REVEAL JUPITER HOPE-3 Secondary Primary Achieved LDL: 53 mg/dL 30 mg/dL 38 mg/dL 55 mg/dL 88 mg/dL Figure 1. Residual cardiovascular (CV) risks in lipid-lowering trials persist despite low-density lipoprotein (LDL) lowering to levels below those generally recommended. Although beneficial, significant residual CV risk remains after therapy. Patients at primary risk have never had a CV event; patients at secondary risk have a CV event in their history. Abbreviations: FOURIER, Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk; HOPE-3, Heart Outcomes Prevention Evaluation–3; IMPROVE IT, Improved Reduction of Outcomes: Vytorin Efficacy International Trial; JUPITER, Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin; REVEAL, Randomized Evaluation of the Effects of Anacetrapib Through Lipid-Modification. CV Risk Factors factors: total blood cholesterol greater than or equal to Starting in the 1950s and then escalating into the 1960s 240 mg/dL, hypertension, BMI greater than or equal to was a concern over the steep rise in CV events and mor- 30, hemoglobin A1c greater than or equal to 6.5%, and tality in the United States. To that end, several public current smoker. These risk factors accounted for health initiatives contributed to the plateauing of CV approximately half of the deaths due to CV events in mortality, such as the Surgeon General’s 1964 report 2009-2010.16 Smoking and Health,13 the 1977 Report of the Joint After adjusting for the Behavioral Risk Factor National Committee on Detection, Evaluation, and Surveillance System CV risk factor cut-points, there Treatment of High Blood Pressure,14 and the 1988 remains considerable residual risk. Recent trials17-19 National Cholesterol Education Program Adult suggest that if more robust cut-points were implemen- Treatment Panel report,15 all of which recommended ted for these 5 CV risk factors, the residual risk would more aggressive approaches to CV risk factors. As a still persist, albeit further reduced. component of these guidelines, the traditional risk Other CV and metabolic risk factors include high factors of age, gender, total cholesterol and high- serum glucose, high triglyceride, and low HDL-C density lipoprotein cholesterol (HDL-C) levels, systolic levels. Individually, these risk factors have not demon- blood pressure, smoking history, and diabetes were strated similar significant CVD risk reductions as incorporated into the Framingham Risk Score and later found with LDL-C reduction, blood pressure lowering, in the Global Risk Assessment for Primary Prevention and cigarette smoking cessation and, therefore, have not to predict CV risk.2,15 Starting in 1984, the self- promulgated similar guidelines indicating therapeutic reported risk factor status from the Behavioral Risk targets for the management and/or prevention of Factor Surveillance System incorporated 5 CV risk CVD.20-22 720 The Journal of the American Osteopathic Association November 2018 | Vol 118 | No. 11 REVIEW Residual CV Risk and Table. Metabolic Syndrome Waist Circumference Criteria for Metabolic Syndrome27 In the Third Report of National Cholesterol Education Program Adult Treatment Panel III,23 the diagnostic cri- Waist fi teria for metabolic syndrome were de ned as the presence Criteria Circumference of at least 3 of the following 5 risk factors: abdominal ATP III, AHA, ACC obesity, elevated triglyceride level, decreased HDL-C Men ≥102 cm (40 in) level, elevated blood pressure, and elevated fasting Women ≥88 cm (35 in) glucose level. When the metabolic panel of glucose, tri- IDF (European, US, Canada, glycerides, and HDL-C are evaluated collectively for Middle Eastern, Sub-Saharan metabolic syndrome, the residual risk for CVD is African) 24 increased independent of body mass index (BMI). This Men ≥94 cm (37 in) increase in CVD risk with metabolic syndrome may Women ≥80 cm (31 in) fi explain, in part, the signi cant residual risk that remains, IDF (South Asian, Japanese, as shown in Figure 1, when traditional risk factors for Chinese, Ethnic South and Central Americans) CVD are improved.25,26 Additionally, when more than 3 ≥ of the metabolic syndrome risk factors are combined, Men 90 cm (35 in) there is a continuous trend of increasing CVD risk.25 Women ≥80 cm (31 in) Other risk factors, including insulin resistance, proin- Abbreviations: ACC, American College of Cardiology; AHA, flammatory state, and pro-thrombotic state, were also American Heart Association; ATP III, Adult Treatment Panel III; IDF, International Diabetes Federation. noted in the definition of metabolic syndrome but were not included in the diagnostic criteria because these risk factors could not be easily identified by routine clin- insulin sensitivity, absent of diabetes, dyslipidemia, or ical evaluation.23 However, these additional metabolic hypertension, and designated as metabolically healthy risk factors are most notably associated with obesity.23 obese (MHO).29-31 The definition of MHO varies somewhat, with the most common being overweight or obese without the presence of metabolic syndrome.31 Residual CV Risk and Obesity Using that definition, the prevalence of MHO generally The Canadian guidelines for the diagnosis and manage- ranges from 20% to 30% of the obese/overweight ment of dyslipidemia and the prevention of CVD, as population.24,29,31 well as those from the American College of Clinical Compared with metabolically healthy normal-weight Endocrinologists for management of dyslipidemia and people, metabolically healthy overweight and MHO prevention of CVD, have used the International people tend to progressively increase CV risk as their Diabetes Foundation (IDF) definition for metabolic weight increases when followed up for more than syndrome.27,28 In the IDF model, central obesity (waist 10 years.24,29 This finding suggests that an increase in circumference, 31 inches in women and 35-37 inches in residual CV risk may occur as weight increases in men, depending on ethnicity) is an essential criterion people who are MHO such that about half will transition and requires the addition of 2 of the other metabolic from metabolically healthy to unhealthy over the next risk
Load more

Recommended publications
  • From the COCCI Syndemic to the COVID-19 Pandemic
    Scholars Insight Publishers Journal of Epidemiology and Global Health Research Research Article Open Access From the COCCI Syndemic to the COVID-19 Pandemic: A Cautionary Tale Interaction of Metabolic Syndrome, Obesity, Particulate Matter (PM), SARS-CoV-2 and the inflammatory response Clearfield M*, Gayer G, Wagner A, Stevenson T, Shubrook J and Gugliucci A Touro University College of Osteopathic Medicine, California, USA Corresponding Author: Dr. Clearfield M, Touro University Abstract College of Osteopathic Medicine, California, USA. A narrative review of the literature was conducted to determine E-mail id: [email protected] associations between cardiovascular (CV) risk factors associated with the COCCI syndemic (Cardiovascular disease as a result of the Received Date: March 15, 2021; interactions between obesity, climate change and inflammation) and Accepted Date: May 19, 2021; COVID-19. Published Date: May 21, 2021; The COCCI syndemic consists of two health conditions Publisher: Scholars Insight Online Publishers (dysmetabolic obesity and air pollution) that interact via biologic Citation: Clearfield M*, Gayer G, Wagner A, Stevenson T, pathways admixed with social, economic and ecologic drivers Shubrook J and Gugliucci A “From the COCCI Syndemic to augmenting adverse clinical outcomes in excess of either of these the COVID-19 Pandemic: A Cautionary Tale Interaction of health conditions individually. Metabolic Syndrome, Obesity, Particulate Matter (PM), SARS- The comorbidities noted with COVID-19 are in large part aligned CoV-2 and the inflammatory response”. J Epidemiol Glob Health with those traditional risk factors associated with CVD. In addition, Res. 2021; 1:102 when the traditional CV comorbidities are combined with the Copyright: ©2021 Clearfield M.
    [Show full text]
  • The Syndemic of COVID-19 and Gender-Based
    Commentary BMJ Glob Health: first published as 10.1136/bmjgh-2020-004194 on 18 November 2020. Downloaded from The syndemic of COVID-19 and gender- based violence in humanitarian settings: leveraging lessons from Ebola in the Democratic Republic of Congo 1 1 1 2 Lindsay Stark , Melissa Meinhart, Luissa Vahedi, Simone E Carter , Elisabeth Roesch,3 Isabel Scott Moncrieff,3 Philomene Mwanze Palaku,4 Flore Rossi,4 Catherine Poulton3 To cite: Stark L, Meinhart M, As the gendered dimensions of COVID-19 Summary box Vahedi L, et al. The are increasingly recognised, efforts to situate syndemic of COVID-19 and gender- based violence gender- based violence (GBV) within the ► Efforts to situate gender- based violence (GBV) within in humanitarian settings: pandemic remain inadequate. It is critical to the COVID-19 pandemic remain inadequate. Based leveraging lessons from Ebola first acknowledge that the drivers and impacts on the knowledge that the public health crises of vi- in the Democratic Republic of COVID-19 and GBV do not occur in isola- olence and infectious disease are intersecting, we of Congo. BMJ Global Health tion; rather, they present as a syndemic—each use a syndemic perspective to examine their shared 2020;5:e004194. doi:10.1136/ influence in humanitarian settings. bmjgh-2020-004194 is made more destructive by the presence of the other.1 Thus, it is not the infection of ► When the humanitarian community exclusively pri- oritises the lives saved from infectious diseases, Handling editor Seye Abimbola COVID-19 that increases the risk of GBV but rather the gender- insensitive systems and such as Ebola and COVID-19, the lives impacted by interrelated factors, such as GBV, can be overlooked.
    [Show full text]
  • Research Comparing the Risk Identification and Management Behaviors Between Oral Health Providers for Patients with Diabetes
    Research Comparing the Risk Identification and Management Behaviors between Oral Health Providers for Patients with Diabetes Mitzi G. Efurd, RDH, MS; Kimberly Krust Bray, RDH, MS; Tanya Villalpando Mitchell RDH, MS; Karen Williams RDH, PhD Introduction Abstract According to the most recent data Purpose: Evidence supporting the link between periodontal from the Centers for Disease Con- disease and systemic disease continues to grow. To date, little trol and Prevention, it is estimated is known about how dental professionals incorporate this infor- that 23.6 million Americans, or over mation into managing diabetic patients. This study examines 7.8% of the adult population, are af- the risk identification and practice behaviors regarding diabetic fected by diabetes.1 Over the past patients among dentists, hygienists and specialists. 35 years, diabetes prevalence has Methods: Responses were received from 383 currently practic- increased 3–fold.2 In 2007, 1.6 mil- ing oral health professionals in Arkansas. The electronic survey lion new cases of diabetes were di- consisted of 35 open and closed–ended or Likert–type items. agnosed in people aged 20 and old- Principal components factor analysis using varimax rotation was e r. 1 While this increase in diagnosed used to explore underlying dimensions of the questionnaire in cases of diabetes is alarming, the order to provide a more parsimonious view of the outcomes. estimated 5.7 million undiagnosed Logistic models were fitted to determine best practice outcome cases is an additional cause for con- as a function of knowledge and professional and social norms. cern.1 With the increase of diabetes, Results: Neither knowledge about diabetes (p<0.285) nor dental practitioners will be treating provider type (p<0.186) was a predictor of practice behavior.
    [Show full text]
  • International Centre for Oral-Systemic Health (ICOSH) Gerald Niznick College of Dentistry Rady Faculty of Heath Sciences University of Manitoba
    International Centre for Oral-Systemic Health (ICOSH) Gerald Niznick College of Dentistry Rady Faculty of Heath Sciences University of Manitoba Summary Status Report - March 1, 2020 Centre Launch: The International Centre for Oral-Systemic Health (ICOSH) was launched as an Academic Centre through the Office of the Provost in January of 2008 with Dr. Anthony M. Iacopino, Dean of the Gerald Niznick College of Dentistry, serving as the Founding Executive Director. Dr. Iacopino had been recently recruited from the United States and brought a singular expertise as an internationally recognized leader in Oral-Systemic Science to the University. In addition to hundreds of publications and presentations within the field, he served as associate editor for “Grand Rounds in Oral- Systemic Medicine”, a unique interprofessional journal dedicated to communicating new scientific information and technical advances to health professionals and the public. He had also been engaged as a highly regarded consultant and key opinion leader for many years on related topics for the dental industry, universities, governments and healthcare systems. ICOSH was conceived as an Academic Centre because although it would engage in various types of basic, clinical and applied research, the major emphasis would be on developing and implementing resources for interprofessional education and practice as well as advocacy for public policy making oral health a key component of the primary healthcare system. This positioned ICOSH to pursue a mission primarily associated with addressing the knowledge gap that exists between dentistry and other health professions by increasing awareness of the links between oral and systemic health through health professions curriculum reform, continuing education, public policy, and related research.
    [Show full text]
  • Improving the Prevention and Management of Multimorbidity in Sub-Saharan Africa
    Improving the prevention and management of multimorbidity in sub-Saharan Africa Workshop report 5–6 September 2019 Johannesburg, South Africa The Academy of Science of South Africa (ASSAf) was inaugurated in May 1996. It was formed in response to the need for an Academy of Science consonant with the dawn of democracy in South Africa: activist in its mission of using science and scholarship for the benefit of society, with a mandate encompassing all scholarly disciplines that use an open-minded and evidence-based approach to build knowledge. ASSAf thus adopted in its name the term ‘science’ in the singular as reflecting a common way of enquiring rather than an aggregation of different disciplines. Its Members are elected on the basis of a combination of two principal criteria, academic excellence and significant contributions to society. The Parliament of South Africa passed the Academy of Science of South Africa Act (No 67 of 2001), which came into force on 15 May 2002. This made ASSAf the only academy of science in South Africa officially recognised by government and representing the country in the international community of science academies and elsewhere. The Academy of Medical Sciences is the independent body in the UK representing the diversity of medical science. Our mission is to promote medical science and its translation into benefits for society. The Academy’s elected Fellows are the United Kingdom’s leading medical scientists from hospitals, academia, industry and the public service. We work with them to promote excellence, influence policy to improve health and wealth, nurture the next generation of medical researchers, link academia, industry and the NHS, seize international opportunities and encourage dialogue about the medical sciences.
    [Show full text]
  • HIV in the Migrant and Seasonal Farmworker Population: Oral Conditions As Early Indicators of Infection
    EARN This course was written for dentists, 3 CE dental hygienists, CREDITS and dental assistants. © Joe Sohm | Dreamstime.com HIV in the migrant and seasonal farmworker population: Oral conditions as early indicators of infection A peer-reviewed article written by Sherri M. Lukes, MS, RDH, FAADH PUBLICATION DATE: JULY 2021 EXPIRATION DATE: JUNE 2024 SUPPLEMENT TO ENDEAVOR PUBLICATIONS EARN 3 CE This continuing education (CE) activity was developed by Endeavor CREDITS Business Media with no commercial support. This course was written for dentists, dental hygienists, and dental assistants, from novice to skilled. Educational methods: This course is a self-instructional journal and web activity. Provider disclosure: Endeavor Business Media neither has a leadership position nor a commercial interest in any products or services discussed or shared in this educational activity. No manufacturer or third party had any input in the development of the course content. Requirements for successful completion: To obtain three (3) CE credits for this educational activity, you must pay the required fee, review the material, complete the course evaluation, and obtain HIV in the migrant and an exam score of 70% or higher. CE planner disclosure: Laura Winfield, Endeavor Business Media dental group CE coordinator, neither has a leadership nor seasonal farmworker commercial interest with the products or services discussed in this educational activity. Ms. Winfield can be reached at lwinfield@ endeavorb2b.com. population: Oral conditions as Educational disclaimer: Completing a single continuing education course does not provide enough information to result in the participant being an expert in the field related to the course early indicators of infection topic.
    [Show full text]
  • Oregon's Syndemic
    Oregon’s Syndemic: Substance Use, Overdose, STIs, associated conditions and IDU-related infections Framework and Response Models Oregon HIV, Hepatitis and Opioid Prevention and Engagement (OR-HOPE) Study • Aim 1: Conduct community assessments in two high-risk rural Oregon counties to inform development of a community-based program to increase HIV/HCV testing among PWUDs and linkage to accessible treatment services. • Aim 2: Develop and evaluate feasibility of a rural community-based service plan comprising (1) Peer Care Coordinators for HIV/HCV testing and linkage to HIV, HCV, and OUD services and (2) telehealth support of rural primary care providers for office-based treatment of HIV, HCV, and OUD. Oregon HIV, Hepatitis and Opioid Prevention and Engagement (OR-HOPE) Study • Aim 3: Refine and evaluate the impact of rural PCCs and telehealth provider support on rural PWID’s HIV testing rates, engagement in appropriate HIV, HCV, and OUD treatment. ▪ Peer care coordinator intervention to enroll 800 PWID in 8 rural counties ▪ Use State Medicaid and epi data used to assess HIV/HCV testing & treatment and OUD treatment, compared with matched controls What is a Syndemic? A • Population-level cluster of health conditions or issues C • Syndemic ≠ co-morbidity B • Each condition or issue has its own epidemiologic trajectory B • Conditions or Issues interact at the level of • Cause A • Consequence, or C • Needed response • The burden from the interaction is greater than the sum A B C Syndemic Approaches and Responses • Align with Health Equity and Social Determinants of Health More information on SDOH Neighborhood and Built Environment Economic Health and Stability Health Care Social Determinants of Health Social and Education Community Context Source: Beyond Health Care: The role of SDH in Promoting Health and Health Equity • Recognize the realities that social inequalities, environments and political climates affect people’s vulnerability to and capacity for effectively dealing with health conditions and issues.
    [Show full text]
  • Understanding the Impact of a Syndemic on the Use of Pre- Exposure Prophylaxis in a Community-Based Sample of Behaviorally Prep-Eligible BMSM in the United States
    HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author AIDS Care Manuscript Author . Author manuscript; Manuscript Author available in PMC 2021 May 01. Published in final edited form as: AIDS Care. 2020 May ; 32(5): 551–556. doi:10.1080/09540121.2019.1659921. Understanding the impact of a syndemic on the use of pre- exposure prophylaxis in a community-based sample of Behaviorally PrEP-eligible BMSM in the United States Cristian J. Chandler1,2,*, Leigh A. Bukowski1,2, Derrick D. Matthews1,3,**, Mary E. Hawk1,2, Nina Markovic1,4, Ronald D. Stall1,2, James E. Egan1,2 1Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261 2Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261 3Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, USA 15261 4Dental Public Health, School of Dental Medicine, University of Pittsburgh, 3501 Terrace St, Pittsburgh, PA 15213 *Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322; Yale University Center for Interdisciplinary Research on AIDS, 130 College Street, Suite 200, New Haven, CT 06510 **Department of Human Behavior, Gillings School of Global Public Health, University of North Carolina, 361 Rousenau Hall, Chapel Hill, NC 27599 Abstract HIV Pre-Exposure Prophylaxis (PrEP) has shown great promise in reducing HIV transmission among affected populations; however, PrEP uptake among Black men who have sex with men (BMSM) has stalled.
    [Show full text]
  • And Middle-Income Countries
    PERSPECTIVE published: 25 September 2020 doi: 10.3389/fpubh.2020.00508 A Syndemic Perspective on the Management of Non-communicable Diseases Amid the COVID-19 Pandemic in Low- and Middle-Income Countries Uday Narayan Yadav 1,2*, Binod Rayamajhee 3,4, Sabuj Kanti Mistry 1,5, Shradha S. Parsekar 6 and Shyam Kumar Mishra 3,7 1 Centre for Primary Health Care and Equity, University of New South Wales (UNSW), Sydney, NSW, Australia, 2 Forum for Health Research and Development, Dharan, Nepal, 3 School of Optometry and Vision Science, Faculty of Science, University of New South Wales, Sydney, NSW, Australia, 4 Department of Infectious Diseases and Immunology, Kathmandu Research Institute for Biological Sciences (KRIBS), Lalitpur, Nepal, 5 James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh, 6 Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India, 7 Department of Microbiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal Edited by: Joanna Lai, UNICEF United Nations International The global coronavirus disease (COVID-19) pandemic has greatly affected the lives of Children’s Emergency Fund, people living with non-communicable diseases (PLWNCDs). The health of PLWNCDs United States worsens when synergistic epidemics or “syndemics” occur due to the interaction Reviewed by: between socioecological and biological factors, resulting in adverse outcomes. These Anu Mary Oommen, Christian Medical College and interactions can affect the physical, emotional, and social well-being of PLWNCDs. In this Hospital, India paper, we discuss the effects of the COVID-19 syndemic on PLWNCDs, particularly how it Rosemary Mamka Anyona, UNICEF United Nations International has exposed them to NCD risk factors and disrupted essential public health services.
    [Show full text]
  • An Emerging Syndemic of Smoking and Cardiopulmonary Diseases in People Living with HIV in Africa
    International Journal of Environmental Research and Public Health Commentary An Emerging Syndemic of Smoking and Cardiopulmonary Diseases in People Living with HIV in Africa Emmanuel Peprah 1,* , Mari Armstrong-Hough 1, Stephanie H. Cook 1 , Barbara Mukasa 2, Jacquelyn Y. Taylor 3 , Huichun Xu 4 , Linda Chang 5, Joyce Gyamfi 1, Nessa Ryan 1, Temitope Ojo 1 , Anya Snyder 1, Juliet Iwelunmor 6, Oliver Ezechi 7, Conrad Iyegbe 8, Paul O’Reilly 8 and Andre Pascal Kengne 8,9 1 School of Global Public Health, New York University, New York, NY 10012, USA; [email protected] (M.A.-H.); [email protected] (S.H.C.); [email protected] (J.G.); [email protected] (N.R.); [email protected] (T.O.); [email protected] (A.S.) 2 Mildmay Uganda, Kampala, Uganda; [email protected] 3 School of Nursing, Columbia University, New York, NY 10032, USA; [email protected] 4 Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; [email protected] 5 Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; [email protected] 6 College for Public Health and Social Justice, Saint Louis University, St. Louis, MO 63103, USA; [email protected] 7 Nigerian Institute of Medical Research, Lagos, Nigeria; [email protected] 8 Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USA; [email protected] (C.I.); [email protected] (P.O.); [email protected] (A.P.K.) Citation: Peprah, E.; Armstrong- 9 South African Medical Research Council, Cape Town, South Africa Hough, M.; Cook, S.H.; Mukasa, B.; * Correspondence: [email protected] Taylor, J.Y.; Xu, H.; Chang, L.; Gyamfi, J.; Ryan, N.; Ojo, T.; et al.
    [Show full text]
  • The Syndemic of Racism and COVID-19 and Its Implications for Medical Education Joshua Freeman, MD
    COMMENTARY Something Old, Something New: The Syndemic of Racism and COVID-19 and Its Implications for Medical Education Joshua Freeman, MD (Fam Med. 2020;52(9):623-5.) doi: 10.22454/FamMed.2020.140670 wo seismic issues, racism and COVID-19, African Americans, have far higher rates of have engaged the United States in the most chronic diseases, which makes them more last several months, acting together to vulnerable both to becoming infected and for T 1— create what is known as a syndemic a set of worse outcomes when infected. Even before linked health problems that interact synergis- COVID, African Americans had mortality rates tically to contribute to excess burden of dis- much higher than those of Whites, particularly ease in a population—that seriously impacts for the most common chronic diseases: diabe- the health of all of us. Racism is old; it has tes, cancer, heart disease, and stroke.5,6 always been a defining characteristic of our People of color are not more vulnerable, and country. Triggered by episodes of police kill- do not have more chronic disease as a result ing of people of color, particularly the murder of genetics or biology.7 The genetic variation of George Floyd, we have seen extraordinari- among people of the same race is at least 10 ly broad discussion about it. The Black Lives times that between races.8,9 The true causes Matter movement reminds us of the history of of population health disparity are collectively racism in the United States, from slavery, to known as the social determinants of health lynchings and Jim Crow segregation, to mass (SDH): factors such as adequate housing, food, incarceration (the “New Jim Crow”2), and the income, and education, to provide the basis inequity that begins at birth for every Black for a reasonably healthy life.
    [Show full text]
  • Introducing Key Concepts in Syndemics
    PART 1 INTRODUCING KEY CONCEPTS IN SYNDEMICS Chapter One , “ Learning from Lichen: Reconceptualizing Health and Disease, ” which makes up Part OneCOPYRIGHTED of this book, introduces the readerMATERIAL to the concept of syndemics and to the biosocial syndemic perspective on human health. Examining the syndemic perspective in a historical context, it describes the developing recognition that health and illness are shaped by multiple and complex factors, and it shows how the identifi - cation and study of syndemics has grown out of these far - reaching shifts in the ways that we conceptualize disease. 1 cc01.indd01.indd 1 44/15/09/15/09 110:23:130:23:13 AAMM cc01.indd01.indd 2 44/15/09/15/09 110:23:140:23:14 AAMM CHAPTER 1 LEARNING FROM LICHEN Reconceptualizing Health and Disease After studying this chapter, you should be able to ■ Locate the syndemic perspective within the evolutionary history of the scientifi c understanding of disease, including dilemmas encountered in meeting Robert Koch ’ s criteria when attempting to determine the cause of an infectious disease. ■ Understand the syndemic approach as one that supersedes two limitations of conventional biomedical approaches to disease— reductionism and mind - body dualism. ■ Recognize the fundamental importance of biosocial interconnections and relation- ships in syndemics theory. ■ Explain why syndemics were often not recognized in the past. ■ Explain how the consideration of social factors, such as social disparity, differen- tiates syndemic processes from the biomedical conception of comorbidity and also differentiates syndemics among humans from synergistic disease inter-actions among animals. 3 cc01.indd01.indd 3 44/15/09/15/09 110:23:140:23:14 AAMM 4 Introduction to Syndemics ON NOT PLANTING CUT FLOWERS: THE WEIGHT OF HISTORY It was just a few decades ago, in the 1970s, that medical anthropology, the source dis- cipline for the syndemics concept, was a new fi eld.
    [Show full text]