A syndemic born of war: Combining intersectionality and structural violence to explore the biosocial interactions of neglected tropical diseases, disability and mental distress in Liberia.

Autor:	Dean L; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom., Theobald S; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom., Nallo G; University of Liberia Pacific Institute for Research and Evaluation, Monrovia, Monsterrado, Liberia., Bettee A; Neglected Tropical Disease Programme, Ministry of Health, Government of Liberia, Monrovia, Monsterrado, Liberia., Kollie K; Neglected Tropical Disease Programme, Ministry of Health, Government of Liberia, Monrovia, Monsterrado, Liberia., Tolhurst R; Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
Jazyk:	angličtina
Zdroj:	PLOS global public health [PLOS Glob Public Health] 2022 Jun 29; Vol. 2 (6), pp. e0000551. Date of Electronic Publication: 2022 Jun 29 (Print Publication: 2022).
DOI:	10.1371/journal.pgph.0000551
Abstrakt:	The intersections between NTDs, disability, and mental ill-health are increasingly recognised globally. Chronic morbidity resultant from many NTDs, particularly those affecting the skin-including lymphatic filariasis (LF), leprosy, Buruli ulcer (BU) and onchocerciasis-is well known and largely documented from a medicalised perspective. However less is known about the complex biosocial interaction shaping interconnected morbidities. We apply syndemic theory to explain the biosocial relationship between NTDs and mental distress in the context of structural violence in Liberia. By advancing syndemic theory to include intersectional thought, it is apparent that structural violence becomes embodied in different ways through interacting multi-level (macro, meso and micro) processes. Through the use of in-depth qualitative methods, we explore the syndemic interaction of NTDs and mental distress from the vantage point of the most vulnerable and suggest that: 1) the post-conflict environment in Liberia predisposes people to the chronic effects of NTDs as well as other 'generalised stressors' as a consequence of ongoing structural violence; 2) people affected by NTDs are additionally exposed to stigma and discrimination that cause additional stressors and synergistically produce negative health outcomes in relation to NTDs and mental distress; and 3) the impact and experience of consequential syndemic suffering is shaped by intersecting axes of inequity such as gender and generation which are themselves created by unequal power distribution across multiple systems levels. Bringing together health systems discourse, which is focused on service integration and centred around disease control, with syndemic discourse that considers the biosocial context of disease interaction offers new approaches. We suggest that taking a syndemic-informed approach to care in the development of people-centred health systems is key to alleviating the burden of syndemic suffering associated with NTDs and mental distress currently experienced by vulnerable populations in resource-limited settings. Competing Interests: The authors have declared that no competing interests exist. (Copyright: © 2022 Dean et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze:	MEDLINE
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