In Other Words

A Contextualized Dictionary to Problematize Otherness

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syndemic
[sindemia]

by Paola Giorgis
This word has been published: 2022-04-14 15:58:50

Abstract:

Questa voce si occupa del termine 'sindemia' definito come "l'insieme di problemi di salute, ambientali, sociali ed economici prodotti dall'interazione sinergica di due o più malattie (...) e caratterizzata da pesanti ripercussioni, in particolare sulla fascia di popolazione svantaggiata" (www.treccani.it).

This entry analyzes the term 'syndemic', defined as the interdependence of health issues with social, environmental, and economic problems that particularly affect less advantaged social groups.

Etymology:

syndemic: from the Greek 'σύν' (together with) and 'δῆμος' (people). In the 1990s, the medical anthropologist Merril Singer defined syndemic as the interaction of health conditions and social, environmental, and economic factors: «Syndemics are the concentration and deleterious interaction of two or more diseases or other health conditions in a population, especially as a consequence of social inequity and the unjust exercise of power». 

Therefore, a syndemics does not only refer to the co-presence of two or more diseases, but rather foregrounds how health is determined by structural issues of social injustice.

Problematization:

'Syndemic' refers to the notion of interdependence of health issues with environmental, social and economic factors that impact in particular less advantaged social groups. While the term 'pandemic' (from the Greek: 'all the people') defines a general condition of health problems that apparently affect every individual in the same way, the term 'syndemic' points out that individuals are differently affected depending on their access not only to health care, but also on their social and economic status, as well as on their access to cultural and material resources.

In  2017, the prestigiuos medical journal The Lancet published a dedicated series of articles on sydemic, arguing that a syndemic can only be treated through a syndemic approach to the study and treatment of health issues capable of integrating social and health care, in order to reshape health care systems to contrast social differences and inequalities. 

Referring specifically to the Covid-19 pandemic, in 2020 Richard Horton takes up again the notion of syndemic in his article for The Lancet 'Covid-19 is not a pandemic', sustaining that "COVID-19 is not a pandemic. It is a syndemic (...). A syndemic is not merely a comorbidity [the co-presence of two or more diseases]. Syndemics are characterised by biological and social interactions between conditions and states, interactions that increase a person’s susceptibility to harm or worsen their health outcomes. In the case of COVID-19, attacking NCDs [non communicable diseases] will be a prerequisite for successful containment».

Subversion:

As seen above, Covid-19 has been a health and social crisis, showing the interdependence and intersectionality of different medical and socio-economical factors (e.g., lack of access to proper healthcare, unhealthy housing conditions, etc.) that cannot be addressed separately. Indeed, the concept of syndemic can be connected to that of intersectionality as the co-occurrence of factors such as ethnicity, socio-economic status, gender that determine the reproduction of inequalities and discrimination (Szasz, 2020) - a glocal example is the disproportionate death rate among ethnic minorities and the poor.

Medical and political discussion thus converged in the analysis of the different impact that Covid-19 had on different demographics of population, as shown in some examples in the list below.

  • August, 2020: the different impact of Covid-19 has also manifested in gender issues. In an article for The Lancet, Sophie Cousin discusses the devasting effects of the virus on the physical and mental health of vulnerable women and girls in terms of reduce or lack to acces to care services, increase of gender based violence, and unintended pregnancies.
  • September, 2020: in a talk from the podcast series 10 Minutes Talk held by the British Academy, Fiona Williams sustains the same argument, affirming that much of the hidden unequal effects of Covid-19 were mostly experienced by women - who, besides losing jobs, had to provide the caregiving services for children and the elderly - and by young men in low paid jobs. The intersection of socio-economic status, racism, ethnicity, gender, age went together with low paid, unsecure employment, poor quality housing, and overcrowded spaces, so that, for example, in the deprived areas of the UK deaths for Covid were seven times higher for men in lower pay.
  • October, 2020: in an article published by SI COBAS (an independent militant Italian trade union), it is highlighted how using the term 'syndemic' instead of 'pandemic' helps to focus on the social origins and consequences of Covid-19. The most vulnerable citizens have been the poor, the elderly, the ethnic minorities, the underpaid workers. Therefore, what is needed is not a biomedical solution, but rather an integrated and radical approach capable of understanding and tackling what lies behind the crisis, that is the neo-liberal state, its disastrous privatisation of public health care and the exploitation of low paid workers. Indeed, during the pandemic the key workers were not only doctors and nurses, but also the workers with less social protection and labour rights, such as the fruit pickers and the workers in the supermarkets.
  • February, 2021: in a meeting of the Italian magazine Internazionale, held in Ferrara, the presentation of the volume Disuguali (Unequals) became the occasion to dfiscuss how Covid-19 has mainly been a social crisis, increasing inequalities generated by the economic and financial system. The author of the book, the Italian economist Stefano Zamagni, sustained that inequalities are functional to capitalism since they keep down the cost of labour, and that contrasting inequalities is not only a pressing ethical issue but also an urgent concern since it  puts democracies at risk.
  • July 2021: a more radical perspective was the one that emerged in the Sherwood Festival held by Radio Sherwoord. Founded in 1976, Radio Sherwood is a militant radical Italian independent radio station. The discussion engaged several groups of Ecologia politica [Political Ecology] that puts in dialogue a critical academic approach with grass-root collectives engaged in environmental issues. What emerged from the discussion was that environmental, social, and health issues are strictly related as elements of a systemic origin caused by neo-liberal agendas. Environmental, social, and health crises are the direct by-products of the capitalist system that they greatly contribute to serve, providing capitalism with opportunities to reinforce structural inequalities and dynamics of domination.
  • November 2021: in an article on The Guardian, the philosopher Kwame Anthony Appiah discussed the true cost of Covid in the global South, sustaining that "much of the world is facing devastating second-order coronavirus effects", such as an increase of deaths for malaria, HIV, TB, and that Covid-19 "isn't simply a story about disease - it's about poverty, hunger, truncated education and stunted lives". To him, local and global dimensions should be adressed in a way that local circles of reciprocal care should be integrated with global ones.

However, the global south is not a geographical index but rather a socio-political one since the global south lives within the global north - in deprived areas, in low paid jobs, in the exploitation of the workers, in the (re)production of inequalities, in ethnic and gender discriminations.

 

Artists have responded in many ways to Covid-19. From graffiti and street art to dedicated art exhibitions, art works were often meant to inspire resilience or celebrate the work of doctors and nurses, often referring to specific cultural references. However, the artists have often used their art and projects to expose critically and visually the concept of 'syndemic' as linked to issues of inequalities and invisibilities.

Here below are some of their works and projects.

https://thisisafrica.me/politics-and-society/cartoon-hogging-the-shots/

Inequalities in the Covid-19 impacts are also due to other issues, such as the unequal distribution of the vaccines. In an article published on This is Africa (March, 17, 2021), it is reminded that "in an unequal world, it is deeply concerning, but not surprising that vaccines are rolled out in an unequal way" with richer countries buying the majority of vaccines to speed up the vaccination process at the expenses of poorer countries who cannot afford the costs nor, due to patent rights, are granted the possibility of vaccines locally produced and allocated. 

 

The work of art on the left was donated by Franco Rivolli Art to the Bergamo hospital, a city in the north of Italy that had been violently struck during the first wave of Covid-19. The image became an emblem of the dedication and care of doctors and nurses.

It shows a nurse who is taking care of Italy, hugging and protecting the 'Italian boot'. The writing says 'A Tutti voi... Grazie!' (To All of you... Thanks!)

While in 2020 doctors and nurses were praised and celebrated as the new heroes, in 2021 they were often targets of verbal - and sometimes even physical - violence.  To some, they became the representatives of the general feeling of impotence and frustration for a pandemic that continued to hit the country in several waves, while conspiracy theories and anti-vax movements saw them either colluting or maliciously linked to the Big Pharma and to authoriarian systems of mass control.

 

                (Franco Rivolli Art)

Nisha Jha, Incarnation of God as a Corona Warrior, 2020. Ink and acrylic on paper. 

Graphic Arts Collection GAX 2021

The work of art on the right is by Nisha Jha, a Mithila painter [Mithila is a region of India and Nepal]. 

Her decision to avoid the male-female form of Shiva and Parvati, allows for a feminist interpretation of the painting. "Parvati is no ordinary goddess but a form of Shakti, the supreme female force in the universe. Here we see a contemporary expression of the goddess in the form of a doctor battling covid-19 and cleansing the world of an epidemic". (from: graphicarts.princeton.edu)

 

 

A comprehensive project is that created by Sria Chatterjee, a art historian and environmental humanities scholar. She has founded the digital project Visualizing the Virus (https://visualisingthevirus.com) that aims to help visualize and understand the Coronavirus pandemic from a variety of perspectives, particularly focusing on the inequalities that the pandemic makes visible. 

We read from their website: "We are not only interested in the ways in which scientists, artists and people in their everyday lives have made the virus visible; but also in processes, historical and contemporary, that the viruses make visible – inequalities, be it of access to resources and healthcare, vaccine imperialism, xenophobia, gender inequalities, and so on." The project includes several themed sessions and several works of art by artists and communities from all over the world to show how, in Sria's words "artists and communities move between the microscopic and mythical to find ways to understand and live with the virus. The same examples [examples from art works from different local communities] also expose connections between visual experiences of the virus and longer histories of colonialism, racism, and the circulation of propaganda". 

The overall purpose of project Visualising the Virus is to connect the invisibility of the virus with other invisibilities that historically, racially and politically have marked and still mark the lived experience of the majority of the world's population.

 

Discussion:

  • As seen above, the term 'syndemic' redifines the Covid-19 pandemic from a multilayered perspective that foregrounds issues of inequalities and invisibilities that affect particular individuals or groups. Can you think of any examples of how such inequalities and invisibilities manifested - or were concealed - in your country?
  • The Greek prefix 'syn-' (with, together with, in accordance with) occurs in many words that are connected to the idea of co-occurence. Can you find out some of these words and explain them in relation and/or in contrast with the term 'syndemic'?

References/Further Readings:

How to cite this entry:

Giorgis, P. (2022). Syndemic [sindemia]. In Other Words. A Contextualized Dictionary to Problematize Otherness. Published: 14 April 2022. [https://www.iowdictionary.org/wordC19/it/syndemic, accessed: 25 April 2024]