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By Annie Kenny, Postdoctoral fellow, Université Laval

We may be in self-isolation, but the COVID-19 pandemic is clearly not.

It isn’t isolated from other social, environmental and health crises — like ,  and the  — nor is it separate from other epidemics like , ,  and .

When two or more epidemics co-exist and compound one another to worsen health, they are , or “synergistic epidemics.”

What is a syndemic?

The concept of syndemics arose in the 1990s to describe how substance abuse, violence and AIDS (known as the ) overlapped and negatively reinforced health among inner-city populations in the United States.

The concept  to call attention to the way various diseases like , along with  cluster together, particularly in disadvantaged populations.

While the term syndemic has traditionally been used to describe disease clusters at the individual level, a  expanded on the concept to include climate change.

The commission called the clustering of climate change and malnutrition (including both obesity and undernutrition) the . This is because they share common underlying societal causes, such as , and affect people in all corners of the world.

A key feature of a syndemic is the way overlapping diseases and health conditions amplify one another biologically within the human body. For example, a disease can weaken the immune system and promote the progression of another disease.

 can complicate medical treatments, lead to higher health-care costs and worsen health outcomes. In the case of COVID-19, people with pre-existing and underlying conditions, including , , appear to be at higher risk for complications from the disease.

But diseases don’t just interact biologically, they also interact with . , ,  and , for example, are all powerful determinants of health.

Individuals with lower incomes and less education are  than more socially advantaged individuals. These same relationships play a part in other risk factors for COVID-19, like  and .

And it’s precisely these interactions — between both biological and social factors — that sets syndemics apart from other epidemic events.

COVID-19 and marginalized communities

The coronavirus has been particularly dangerous .

A major outbreak of COVID-19 in the Navajo Nation is one example. Many Navajo people have underlying health conditions and .

By regarding COVID-19 as a syndemic and taking biological and social interactions directly into account,  — in the United States, Canada and around the world.

Addressing a syndemic demands not only the management of each affliction, but efforts to address the underlying forces that unite them — social inequality chief among them.

In Canada, we have seen some semblance of this approach in COVID-19 emergency response strategies directed towards  and .

Yet these responses don’t go far enough. A basic income, not just expanded food charity, is needed to address food insecurity.

Without strong national frameworks to protect fundamental human rights (like  ), the ability of Canadians to meet their most basic needs, including health care, is vulnerable to the vagaries of government funding decisions and political will.

In 2018, for example, a pilot project in Ontario to .

‘Slow-motion disaster’

Most of the social and health issues now at the forefront of the COVID-19 pandemic were already major public health concerns prior to the outbreak of the pandemic.

But these issues were often long term in nature. For example, rates of non-communicable disease — those not transmissible directly from one person to another, like type 2 diabetes and cardiovascular disease — have been surging for decades into what the World Health Organization (WHO) has called a “.” Yet immediate emergencies are dealt with first, .

And as they tended to disproportionately impact socially, economically and politically marginalized groups, funding and responses have been inadequate. A lack of funding, for example, is responsible for the  on the eradication of .

Living conditions in Indigenous communities have long been inadequate, but the lack of  and a  persist.

So why are governments only responding now? Could these issues not have been responded to sooner? Far more money, in fact, is .

Leaving no one behind

The WHO suggests , from infectious disease outbreaks to extreme weather events and climate change. Epidemics, in fact, were only one of 13  by the WHO in January.

What the COVID-19 pandemic makes clear is that we need an “all people approach” that , wherein the social factors and health conditions that cluster around the most vulnerable are not ignored until they’re cast to the foreground of a global pandemic.

Thinking about COVID-19 through a syndemics lens helps bring attention to the fact that these crises haven’t waned, and they aren’t background noise.

Instead, they’re compounded to forge a challenging landscape within which the COVID-19 pandemic has now taken centre stage. The health and social issues that concentrate in disadvantaged populations, and/or that are chronic and long-term in nature, simply can’t wait any longer.