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Encyclopedia of Evaluation

Sandra Mathison

Pub. date: 2005 | DOI:

Print ISBN: 9780761926092 | Online ISBN: 9781412950558

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Encyclopedia Entry


Bobby Milstein

Anthropologist Merrill Singer coined the term syndemic in the early 1990s to describe the mutually reinforcing nature of health crises, such as substance abuse, violence, and AIDS, that take hold in communities with harsh and inequitable living conditions. Observers throughout history have recognized that different disease processes interact, but Singer's innovation was to interpret those connections as evidence of a higher order phenomenon, which he named a “syndemic.” A generic definition “is two or more afflictions, interacting synergistically, contributing to excess burden of disease in a population.” Since the 1970s, health planners have understood that effective responses to the intertwined afflictions within communities require systemwide interventions. However, the desire to achieve systemic change stands in opposition to what most public health agencies are prepared to do. Ingrained in financial structures, problem-solving frameworks, statistical models, and the criteria for professional prestige is the idea, inherited from medical science, that each affliction ...

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