Health inequalities and social determinants of health: The role of syndemics in rheumatic disease.

May 01, 2023

Experts: Gregory Winston Gilcrease,Savino Sciascia,Dario Padovan,Alessandro Sciullo,Michele Cioffi,Fulvio Ricceri,Massimo Radin,Karen Schreiber,Dina Husum,Dario Roccatello,Elena Nikiphorou

A syndemic is the co-existence of two or more health problems (including both social and biological features) that adversely influence each other with negative consequences on disease outcomes and perpetuation of inequalities. The syndemic approach can be applied to better understand the course of rheumatic musculoskeletal diseases (RMD) involving the study of adverse biological pathways and social determinants of health (SDH) all under the same framework. Identifying if a syndemic exists within RMDs may include investigating the synergic interactions between comorbidity (e.g., diabetes, obesity, chronic kidney diseases) and the concomitant of other adverse conditions (e.g., drug non-adherence, substance abuse), along with SDHs such as low household income, unemployment, low education, limited access to health care, as well as racial/ethnic discrimination. For decades, the understanding of RMDs progression has been based on causality, rather than investigating the kaleidoscopic web of connections that can potentially influence a disease course. The co-existence of health burdens in vulnerable populations, including those with RMD, specifically in certain socioeconomic groups, calls for new ways and strategies of thinking to improve our understanding of risk factors and co-morbidities to offer tailored interventions for clinical medicine and public health policy.
Copyright © 2023. Published by Elsevier B.V.

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ABOUT THE EXPERTS

Gregory Winston Gilcrease,Savino Sciascia,Dario Padovan,Alessandro Sciullo,Michele Cioffi,Fulvio Ricceri,Massimo Radin,Karen Schreiber,Dina Husum,Dario Roccatello,Elena Nikiphorou

Gregory Winston Gilcrease

UNESCO Chair, Department of Culture, Politics and Society, University of Turin, Italy; International Center for Sustainable Well-Being, A Project of the Center for Transformative Action, Ithaca, NY, United States of America; Rheumatology Department, King’s College Hospital, London, UK.

Savino Sciascia

Center of Research of Immunopathology and Rare Diseases – Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy.

Dario Padovan

UNESCO Chair, Department of Culture, Politics and Society, University of Turin, Italy.

Alessandro Sciullo

UNESCO Chair, Department of Culture, Politics and Society, University of Turin, Italy.

Michele Cioffi

Center of Research of Immunopathology and Rare Diseases – Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy.

Fulvio Ricceri

Center of Biostatistics, Epidemiology, and Public Health, Department of Clinical and Biological Sciences, University of Turin, Italy.

Massimo Radin

Center of Research of Immunopathology and Rare Diseases – Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy.

Karen Schreiber

Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Denmark; Institute for Regional Health Research, Southern Danish University, Odense, Denmark; Thrombosis and Haemophilia, Guy’s King’s College and Saint Thomas’ Hospitals, London, UK. Electronic address: kschreiber@danskgigthospital.dk.

Dina Husum

Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Denmark; Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark.

Dario Roccatello

Center of Research of Immunopathology and Rare Diseases – Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy.

Elena Nikiphorou

Department of Cardiology, Hospital of Southern Jutland, Aabenraa, Denmark; Centre for Rheumatic Diseases, King’s College London, London, UK.