Over the weekend, a new buzzword entered the mainstream lexicon when the British medical journal The Lancet released a major report on “The Global Syndemic of Obesity, Undernutrition, and Climate Change.” The word that got tongues wagging is “syndemic,” which, in this context, refers to multiple interrelated epidemics happening at the same time.
William Dietz, co-chair of the Lancet Commission on Obesity that produced the report and director of George Washington University's Global Center for Prevention and Wellness, tells Rebecca Ellis at NPR that he had never heard of the term either, but that his team chanced upon on it. The concept exactly encapsulated what they were trying to communicate—that the epidemics of obesity, malnutrition and climate change are not happening in isolation, but are thoroughly intertwined and need to be addressed together, not as isolated problems.
The term “syndemic” isn’t brand new. It was coined by medical anthropologist Merrill Singer of the University of Connecticut in the mid-1990s to describe the way epidemics can overlap with one another and social and cultural problems; she wrote a 2009 textbook on syndemics. For instance, HIV and tuberculosis often form a syndemic. There is a biological element in which HIV weakens the immune system, making people more susceptible to a tuberculosis infection. But there’s also a social or community health element in which close quarters, poor health care and unsanitary conditions allow tuberculosis to thrive. The effects of these two epidemics are amplified in vulnerable groups, like refugees, migrants and those living in poverty to form a syndemic.
In 2017, The Lancet published a series of papers outlining how to think of disease clusters as syndemics and provide care that covers all of the overlapping problems, but the Lancet Commission seems to have ignored the strictly technical definition of the word.
Merrill tells Ellis at NPR that the Commission has twisted his definition of syndemic, since his meaning specifically refers to disease interacting with the human body. The problems outlined in the new report aren’t the types of diseases covered by syndemics, and climate change isn’t really an epidemic at all he contends. “It really isn’t comparable to a syndemic if you adhere to a strict definition guideline,” Merrill says.
Even though his technical term has been hijacked, he still supports what it’s being used for—addressing three overlapping problems as one unit. As Yasmin Tayag at Inverse writes, “[d]efining the 'Global Syndemic,'…isn’t just about semantics. It’s about reframing the three pandemics as a single super-problem so that we can start thinking about how to kill three birds with one stone.”
The report contends that all three problems are powered by our modern food systems and exacerbated by the actions of large, multi-national food companies that have prioritized profits over human health and global sustainability. Agriculture and food production contribute about 20 percent of global greenhouse gase emissions and by some measures constitute up to one third. It’s also led to a seeming paradox of rising obesity, which has tripled to about 13 percent of the global adult population since 1975, and rising undernutrition, which can occur in both overweight and underweight people.
“Until now, undernutrition and obesity have been seen as polar opposites of either too few or too many calories,” co-commissioner Boyd Swinburn of the University of Auckland tells Tayag. “In reality, they are both driven by the same unhealthy, inequitable food systems, underpinned by the same political economy that is single-focused on economic growth, and ignores the negative health and equity outcomes.”
The report suggests a global public health treaty to regulate food companies the same way many nations have dealt with tobacco companies. It also suggests limiting their influence on governments to prevent problems. Just this month, a study revealed how Coca-Cola exerted influence over China's policymaking on its obesity crisis. Other suggestions include a tax on red meat, an end to the $5 trillion in subsidies given to food and fossil fuel companies around the world and a $1 billion fund to support policy initiatives to combat the Global Syndemic.
William Dietz tells Ellis at NPR that’s its difficult to say when, or even if, the recommendations will be acted upon. But at least it has helped jumpstart the conversation about the syndemic, which is important, no matter what words are used to describe it.