SİNDEMİLER YA DA SİNERJİK EPİDEMİLER: TOPLUM SAĞLIĞININ ÇAĞDAŞ TEHDİTLERİ

Özet Eski Yunanca’da iki veya daha fazla etkenin bir araya gelerek toplamlarından daha büyük bir etkiye neden olmaları anlamına gelen “synergos” ile halk anlamına gelen “demos” sözcüklerinin bileşiminden oluşan Sindemi sözcüğü iki veya daha fazla hastalık ya da sağlıkla ilgili sorun epidemisinin, karşılıklı etki ve etkileşimlerini arttıran sosyal-çevresel koşullar kapsamında bir araya gelmesini ve hastalık yükü artışını ifade etmektedir. Pek çok hastalığın ve sağlık sorununun sosyal belirleyicilerinin olduğu, ekonomik ve/ya kültürel değişkenlerle yakından ilişkili olduğu konusundaki bilgilerin geçmişi oldukça eski olmakla birlikte Sindemi kavramı ile gündeme gelen yenilik sosyal koşulların, hastalık epidemileri ile etkileşime girerek toplumsal hastalık yükünü beklenenin üzerinde arttırıyor olmasıdır. Klasik epidemilerden, pandemiden ve komorbiditeden farklı olan bu birlikteliğin neden olduğu sorunları çözmek için aralarındaki ilişki dinamiğini açıklığa kavuşturmak gerekmektedir. Ne var ki çeşitli sindemilerin oluşumunda psikososyal etkenler ve yapısal özellikler arasındaki etkileşim konusunda pek çok algoritmalar, nedensellik modelleri geliştirme çalışmaları bulunsa da bu etkileşimler henüz tam olarak formüle edilebilmiş değildir. İlk olarak AIDS hastalarında tanımlanan ve uzun süre HIV/AIDS risk gruplarında çalışma konusu olan sindemik ilişkilerin geçen kısa sure içerisinde bulaşıcı olan ve olmayan pek çok sorun için söz konusu olabileceği anlaşılmıştır. Bulaşıcı hastalıklardan AIDS’e ek olarak Tüberküloz, bulaşıcı olmayan hastalıklardan ise diyabet, depresyon ve obezite öne çıkan hastalıklardır. Ancak, ani bebek ölümü (SUID/SID), çocuklardaki anemi ve gelişme geriliği gibi sorunların da sindemik özellikler taşıdığına ilişkin çalışmalar bulunmaktadır. Son yirmi yılda yapılan araştırma ve yayınlar çok sayıda sindeminin varlığını ve yayılmakta olduğunu göstermektedir. Sindemilerin özelliği gereği sindemik hastalıkların tek tek tedavisi yerine bir bütün olarak, holistik bakım anlayışı ile tedavi edilmeleri önemlidir. Bu anlamda hastalıkların sosyal bileşenlerini de dikkate alan sindemik bakım anlayışının geliştirilmesi, yaygınlaştırılması, tıp eğitiminde sosyal bilimlere daha fazla yer verilmesi gerekmektedir.

Anahtar Kelimeler:

Sindemi, sinerjik epidemi, toplum sağlığı

SYNDEMICS as MODERN THREAD for PUBLIC HEALTH

Syndemics is a word derived from ancient Greek words “synergos” meaning “working together” and “demos” meaning “people”. It has been used to express the aggregation of two or more disease clusters or epidemics in a population within social and environmental context and explain the unexpected increases in burden of diseases. Our knowledge about social, cultural and economic determinants of health and diseases is not new and has an old history. The thing which is new regarding syndemics is the interaction of social conditions with epidemics which exacerbate the prognosis and burden of disease more than expected. The Dynamics of this occurrence is different than epidemics, pandemics and comorbidity and needs to be clarified. However, despite the presence of several efforts to explain the role of psychosocial and structural variables on such interactions, there is no satisfactory formulation regarding the causality of syndemics. First syndemics was defined among AIDS patients and high risk groups of HIV/AIDS infections. Within a short time it was understood that syndemic interactions could occur between several communicable or non-communicable diseases and health problems. Tuberculosis among communicable diseases, and depression, diabetes and obesity among noncommunicable diseases are well known examples. There are studies and publications regarding the syndemic characteristics of sudden infant deaths (SID/SUID), anemia and childhood developmental problems. Results of the studies published in recent two decades indicate the existence of several syndemics which are significant threats to public health. “Syndemic care”, a holistic medicine approach instead of single disease oriented therapies is needed for overhelming these problems. Such an approach emphasize the necessity and importance of social sciences during the medical education.

Keywords:

Syndemics, thread, public health,

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