Communities with Multiple Afflictions: A System Dynamics Approach to the Study and Prevention of Syndemics

People living in poverty in America are often afflicted by multiple health-related problems. The term " syndemic " was coined by the medical anthropologist Merrill Singer (1994, 1996) to describe what he saw as mutually reinforcing epidemics of substance abuse, violence, and AIDS that disproportionately impact the inner city poor. Other researchers have noted that the intertwined health problems of the urban poor are all strongly affected by an array of economic and social factors characterizing their neighborhoods, " including high rates of unemployment, poverty, homelessness and residential overcrowding, substandard nutrition, infrastructural deterioration and loss of quality housing stock, forced geographic mobility, family breakup and disruption of social support networks, youth gang formation, and health care inequality " There is growing acknowledgement in the field of public health that effective responses to the health problems of the urban poor require comprehensive, system-wide interventions. Community leaders have long argued that it does not make sense to concentrate on preventing some afflictions while allowing others to go unchecked, especially when the afflictions are mutually reinforcing. New approaches have been described for organizing resources and framing problems in ways that will address connections among all those issues that threaten community health and well-being (Institute of Medicine 1996). However, the desire to engage in comprehensive health planning stands in contrast to what most public health agencies are