Epidemics, pandemics, syndemics, and intersectionality

Over the millennia of human existence, epidemics and pandemics have shaped the history of all cultures. An epidemic is the spread of a contagious illness that affects a large number of people in a community, region, or defined population. A pandemic is an epidemic occurring worldwide, crossing boundaries, and affecting a large number of people. We are now in the grasp of a pandemic caused by a hitherto unknown virus. Like other pandemics, this one has a staggering death toll, has impacted everyone’s life, has threatened the collapse of health care systems, and has brought about economic and political instability in various countries. 

Current public health strategies focus simultaneously on two major programs to fight the pandemic. The first is to identify the hostile agent causing the contagious sickness and develop a vaccine to immunize the population. While waiting for the vaccine, the second program is to “flatten the curve” that represents the rise in the number of sick individuals in order to prevent acute health care facilities from being overwhelmed. This is attempted with measures that include physical distancing and enforced quarantines, along with case-tracing techniques. 

While we hope and wait for the appropriate vaccine to materialize, there are two ideas on academic backburners to be considered and acted upon to prevent future epidemics and pandemics, or at least to alleviate the side effects of their management.  

The idea of syndemics (or synergistic epidemics) recognizes that epidemics and pandemics occur in the context of preexisting social and health conditions. In the 1990s, Merrill Singer (an American medical anthropologist) and colleagues proposed that some epidemics or pandemics would not occur or could not get a deep hold on a population if the public’s social and biological vulnerabilities to infections were reduced, if not eliminated. 

Experience with the current pandemic reveals that those who suffer from, for example, cardiovascular and chronic respiratory diseases, cancer, diabetes, and other chronic disorders, including even obesity, are extremely vulnerable to infection. Vulnerable populations also include people living in disadvantaged communities, those suffering from economic distress, as well as older persons (many of whom live in care home facilities). Attention should be focused on a population’s social and medical conditions, which may provide the fuel for the spread of infectious diseases.

The theory of intersectionality was coined in 1989 by Kimberlé Crenshaw to help explain the oppression of Black women in the US. Her analysis was expanded over the years to indicate the interconnections between women’s issues related to race, gender, class, ability, nationality, citizenship, religion, and even body type. The intersectionist concept is not meant to consider either the medical or the general societal effects of epidemics or pandemics on women’s situations, but it may be a valuable tool to understand and correct for the negative effects of social isolation during a pandemic on women’s lives.

We are in the middle of a pandemic, and we are depending on a successful vaccination program to end the devastation. Epidemics and pandemics will likely continue to emerge. It is time to begin to plan ahead.   
—George Szasz, CM, MD

Suggested reading
Cousins S. Covid-19 has “devastating” effect on women and girls. Lancet 2020;396(10247):301-302.
Editorial. Syndemics: Health in context. Lancet 2017;389(10072):881. 
Horton R. Offline: COVID-19 is not a pandemic. Lancet 2020;396(10255):874. 
Wikipedia. Intersectionality. Accessed 2 November 2020. https://en.wikipedia.org/wiki/Intersectionality.

This post has not been peer reviewed by the BCMJ Editorial Board.

Leave a Reply