Noncommunicable diseases, climate change and iniquities: What COVID-19 has taught us about syndemic

Agostino Di Ciaula, Marcin Krawczyk, Krzysztof J Filipiak, Andreas Geier, Leonilde Bonfrate, Piero Portincasa, Agostino Di Ciaula, Marcin Krawczyk, Krzysztof J Filipiak, Andreas Geier, Leonilde Bonfrate, Piero Portincasa

Abstract

Background: COVID-19 is generating clinical challenges, lifestyle changes, economic consequences. The pandemic imposes to familiarize with concepts as prevention, vulnerability and resilience.

Methods: We analysed and reviewed the most relevant papers in the MEDLINE database on syndemic, noncommunicable diseases, pandemic, climate changes, pollution, resilience, vulnerability, health costs, COVID-19.

Results: We discuss that comprehensive strategies must face multifactorial consequences since the pandemic becomes syndemic due to interactions with noncommunicable diseases, climate changes and iniquities. The lockdown experience, on the other hand, demonstrates that it is rapidly possible to reverse epidemiologic trends and to reduce pollution. The worst outcome is evident in eight highly industrialized nations, where 12% of the world population experienced about one-third of all COVID-19-deaths worldwide. Thus, a great economic power has not been fully protective, and a change of policy is obviously needed to avoid irreversible consequences.

Conclusions: We are accumulating unhealthy populations living in unhealthy environments and generating unhealthy offspring. The winning policy should tackle structural inequities through a syndemic approach, to protect vulnerable populations from present and future harms.

Keywords: COVID-19; SARS-CoV-2; climate changes; noncommunicable diseases; pandemic; pollution; resilience; syndemic; vulnerability.

Conflict of interest statement

None to declare.

© 2021 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Impact of pre‐existing social differences on the outcome of COVID‐19 pandemic. (A) In a given metropolis, the initial event of pandemic can hit two geographical areas, which segregate intrinsic social, economic, structural, health and medical differences. (B) COVID‐19 pandemic has the chance to hit each area in a totally different way and violence since the above‐mentioned differences are important predisposing; (C) the consequences of the pandemic will ultimately depend on the underlying capacity of resilience, which is weaker below ‘the line of poverty’. The ultimate outcome of the pandemic (bringing the concept of ‘syndemic’) will increase the burden of inequalities between the two social realities Source: Mumbai, India (2017), Extreme wealth and opulence exist side by side in India's financial capital, Mumbai. With permission from J. Miller, Unequal Scenes ‐ Mumbai.
FIGURE 2
FIGURE 2
Framework showing the intersection of human rights. The overarching right to well‐being comprises five rights, which contribute to the right to well‐being Adapted from Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, Brinsden H, Calvillo A, De Schutter O, Devarajan R. The global syndemic of obesity, undernutrition and climate change: The Lancet Commission report.
FIGURE 3
FIGURE 3
Factors contributing to the modulation of global syndemic. The factors group under three essential steps, which involve governance, systems, and outcomes Adapted from Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, Brinsden H, Calvillo A, De Schutter O, Devarajan R. The global syndemic of obesity, undernutrition, and climate change: the Lancet Commission report.

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