Interpersonal Violence Syndemics and Co-Occurring Epidemics Preventing Violence in the Context of Opioid Misuse, Suicide, Social Disparities, and HIV: Proceedings of a Workshop—in Brief (2019) / Chapter Skim
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Interpersonal Violence Syndemics and Co-Occurring Epidemics: Preventing Violence in the Context of Opioid Misuse, Suicide, Social Disparities, and HIV: Proceedings of a Workshop - in Brief
Interpersonal Violence Syndemics and Co-Occurring Epidemics: Preventing Violence in the Context of Opioid Misuse, Suicide, Social Disparities, and HIV: Proceedings of a Workshop - in Brief
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When viewing these biosocial and disease–disease interactions holistically, it becomes evident that violence, with its impact on the immune and other bodily systems, can manifest as an underlying driver of multiple health conditions. And so, the syndemics model provides a lens for examining how deleterious health effects result from the interaction of human biology with epidemic interpersonal and self-directed violence.
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As mentioned, the syndemics model describes co-occurring epidemics that have a multiplicative effect on bodily systems through the adverse interactions of two or more diseases or health conditions, whose interactions with social conditions exacerbate both the prognosis and the burden of disease. According to Bulled, the syndemic model has been widely adopted but often incompletely applied.
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ACEs and Childhood Trauma, Adult Violence and Victimization, and Health Outcomes from a Global Perspective Shannon Foley Martinez, Free Radicals Project, recounted her transition from trauma -- including rape during her teens -- to rage, as a member of a group of violent white supremacists. She escaped the ensuing cycle of violence and self-hatred with the support of a trusted adult.
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She described a modeling study comparing two types of interventions intended to reduce PTSD in such communities: those that reduce violence versus those that address poverty through income supplementation. According to the model, reducing violence completely proved far less effective than a modest income supplementation scheme (of comparable cost to violence prevention)
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CURRENT AND FUTURE PUBLIC HEALTH APPROACHES In his keynote on the workshop's second day, John Auerbach, Trust for America's Health, used the example of Billy, an uninsured man receiving medical treatment for a back injury -- but who is also at risk for multiple diseases of despair and for HIV -- to illustrate how traditional practices of medicine and public health fail to address syndemic risk factors. Billy's history, which would not be captured in a standard medical exam, reveals multiple social issues (poverty, job loss, lack of educational opportunities, disconnectedness, racism)
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Rita Nieves, Boston Public Health Commission, described its response to the opioid epidemic in an area within the city where OUDand co-occurring epidemics of homelessness, HIV, other infectious diseases, and mental illness are concentrated. The commission houses diverse services in one building located in this neighborhood, and in recent years has adopted policies that take a syndemic approach to addressing multiple health needs and reducing isolation.
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When viewed through a syndemic lens, violence and co-occurring epidemics are rooted in exacerbating social conditions that need to be identified and targeted in order for true prevention to occur, she concluded. Collectively, Amaro and Kar described several major and recurring themes in the workshop presentations and discussions: • The phenomenon of epidemics of despair; • The importance of connectedness to health not only of individuals, but communities and populations; • The need to recognize the specific community and geographic contexts in which syndemics occur; • The limitations of condition-specific interventions and, by contrast, opportunities presented by midstream and upstream strategies, including legal regulatory changes, building multisector collaborations, income supple mentation and housing support, changing social and gender norms, and the social structures they impose; • The importance of terminology in framing and addressing issues ranging from defining "syndemic," to stigma perpetuating terms for people who use violence ("perpetrators")
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PLANNING COMMITTEE FOR INTERPERSONAL VIOLENCE SYNDEMICS AND CO-OCCURRING EPIDEMICS: PREVENTING VIOLENCE IN THE CONTEXT OF OPIOID MISUSE, SUICIDE, SOCIAL DISPARITIES, AND HIV: A WORKSHOP* Hortensia Amaro (Co-Chair)
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