The syndemics model of health focuses on the biosocial complex, which consists of interacting, co-present, or sequential diseases and the social and environmental factors that promote and enhance the negative effects of disease interaction. This emergent approach to health conception and clinical practice reconfigures conventional historical understanding of diseases as distinct entities in nature, separate from other diseases and independent of the social contexts in which they are found. Rather, all of these factors tend to interact synergistically in various and consequential ways, having a substantial impact on the health of individuals and whole populations. Specifically, a syndemics approach examines why certain diseases cluster (ie, multiple diseases affecting individuals and groups); the pathways through which they interact biologically in individuals and within populations, and thereby multiply their overall disease burden, and the ways in which social environments, especially conditions of social inequality and injustice, contribute to disease clustering and interaction as well as to vulnerability. In this Series, the contributions of the syndemics approach for understanding both interacting chronic diseases in social context, and the implications of a syndemics orientation to the issue of health rights, are examined.
Format: Journal
Syndemics and Public Health
The world of public health has undergone dramatic changes since the emergence of AIDS in the early 1980s. The appearance and global spread in recent years of wave after wave of new and renewed infectious diseases and their entwinement with each other and with the social conditions and biopsychological consequences of disparity, discrimination, and structural violence has produced a new significant threat to public health internationally. The term syndemic has been introduced recently by medical anthropologists to label the synergistic interaction of two or more coexistent diseases and resultant excess burden of disease. This article provides the fullest examination of this new concept to date, including a review of relevant new literature and recent research finds concerning coinfection and synergistic interaction of diseases and social conditions at the biological and population levels.
Reinventing Medical Anthropology
Responding to the narrow focus, medicalization, and inattention to political-economy within conventional medical anthropology, a growing number of researchers are participating in a significant restructuring of the subdiscipline. The paper examines several shortcomings of contemporary medical anthropology and, building on the work of the emergent critical trend, identifies key areas of theory and practice for furthering the critical realignment of medical anthropology.
Why India cannot plan its cities
Roy’s research troubles the easy binary between ‘formal’ and ‘informal’ that is often taken for granted within public health policy. Rather than take ‘informal’ and ‘formal’ as distinct and intrinsic categories, Roy shows how they enable one another. Informality, then, is better understood as a relation of power. The power and politics of the state – or an NGO or UN agency for example – is not contained to ‘formal’ channels, instead the ability of the ‘formal’ sphere to engage as it chooses often mobilizes informal processes and practices (Roy 2009:84), such as creative solutions to health, access to water or access to medicines. As Sarah Pinto has shown, many so-called informal health providers are indeed enabled because of lack of state resources to serve rural and marginal communities, and via a lack of denunciation of their activities. The ‘informal’ props up the ‘formal’, and is intrinsic to how the formal operates. Roy urges us to consider how the formal/informal binary obscures the modes and methods of informality as central to how the ‘formal’ operates.
Doctors, Borders, and Life in Crisis
The politics of life and death is explored from the perspective of Doctors Without Borders (Médecins sans frontières [MSF]), an activist nongovernmental organization explicitly founded to respond to health crises on a global scale. Following the work of Michel Foucault and Giorgio Agamben, I underline key intersections between MSF’s operations that express concern for human life in the midst of humanitarian disaster and the group’s self‐proclaimed ethic of engaged refusal. Adopting the analytic frame of biopolitics, I suggest that the actual practice of medical humanitarian organizations in crisis settings presents a fragmentary and uncertain form of such power, extended beyond stable sovereignty and deployed within a restricted temporal horizon.
Biocapital
Biocapital is a major theoretical contribution to science studies and political economy. Grounding his analysis in a multi-sited ethnography of genomic research and drug development marketplaces in the United States and India, Kaushik Sunder Rajan argues that contemporary biotechnologies such as genomics can only be understood in relation to the economic markets within which they emerge. Sunder Rajan conducted fieldwork in biotechnology labs and in small start-up companies in the United States (mostly in the San Francisco Bay area) and India (mainly in New Delhi, Hyderabad, and Bombay) over a five-year period spanning 1999 to 2004. He draws on his research with scientists, entrepreneurs, venture capitalists, and policymakers to compare drug development in the two countries, examining the practices and goals of research, the financing mechanisms, the relevant government regulations, and the hype and marketing surrounding promising new technologies. In the process, he illuminates the global flow of ideas, information, capital, and people connected to biotech initiatives.Sunder Rajan’s ethnography informs his theoretically sophisticated inquiry into how the contemporary world is shaped by the marriage of biotechnology and market forces, by what he calls technoscientific capitalism. Bringing Marxian theories of value into conversation with Foucaultian notions of biopolitics, he traces how the life sciences came to be significant producers of both economic and epistemic value in the late twentieth century and early twenty-first.
Rethinking Antibiotic Research and Development
Policy leaders and public health experts may be overlooking effective ways to stimulate innovative antibiotic research and development. I analyzed archival resources concerning the US government’s efforts to produce penicillin during World War II, which demonstrate how much science policy can differ from present approaches. By contrast to current attempts to invigorate commercial participation in antibiotic development, the effort to develop the first commercially produced antibiotic did not rely on economic enticements or the further privatization of scientific resources. Rather, this extremely successful scientific and, ultimately, commercial endeavor was rooted in government stewardship, intraindustry cooperation, and the open exchange of scientific information. For policymakers facing the problem of stimulating antibiotic research and development, the origins of the antibiotic era offer a template for effective policy solutions that concentrate primarily on scientific rather than commercial goals.
Making time for soil
The dominant drive for understanding soil has been to pace its fertility with human demand. Today, warnings about soil’s exhaustion and endangered ecology raise concerns marked by fears of gloomy environmental futures, prompting scientists and soil practitioners urgently to develop better ways of taking care of soils. Yet the pace required by ecological soil care could be at odds with the predominant temporal orientation of technoscientific intervention, which is driven by an inherently progressivist, productionist and restless mode of futurity. Through a conceptual and historical approach to the soil sciences and other domains of soil knowledge, this article looks for soil ontologies and relations to soil care that are obscured by the predominant timescape. Contemporary discussions of the future of the soil sciences expose tensions between ‘progress as usual’ – by intensifying productivity – and the need to protect the pace of soil renewal. The intimate relation of soil science with productionism is being interrogated, as ecology attempts to engage with soil as a living community rather than a receptacle for crops. In this context, and beyond science, the ‘foodweb’ model of soil ecology has become a figure of alternative human–soil relations that involve environmental practitioners in the soil community. Reading these ways of making time for soil as a form of ‘care time’ helps to reveal a diversity of more-than-human interdependent temporalities, disrupting the anthropocentric appeal of predominant timescales of technoscientific futurity and their reductive notion of innovation.
Nothing Comes Without Its World
What is the significance of caring for thinking and knowing? Thinking and knowing are essentially relational processes. Grounded on a relational conception of ontology the essay argues that ‘thinking with care’ is a vital requisite of collective thinking in interdependent worlds, but also one that necessitates a thick vision of caring. A speculative exploration of forms of thinking with care unfolds through a rereading of Donna Haraway’s work, specifically of its take on feminist discussions on the situated character of knowledge. The notion of thinking with care is articulated through a series of concrete moves: thinking-with, dissenting-within and thinking-for. While weaving Haraway’s thinking and writing practices with the trope of care offers a particular understanding of this author’s knowledge politics, the task of caring also appears in a different light.
History Teaches Us That Confronting Antibiotic Resistance Requires Stronger Global Collective Action
Antibiotic development and usage, and antibiotic resistance in particular, are today considered global concerns, simultaneously mandating local and global perspectives and actions. Yet such global considerations have not always been part of antibiotic policy formation, and those who attempt to formulate a globally coordinated response to antibiotic resistance will need to confront a history of heterogeneous, often uncoordinated, and at times conflicting reform efforts, whose legacies remain apparent today. Historical analysis permits us to highlight such entrenched trends and processes, helping to frame contemporary efforts to improve access, conservation and innovation.
