IN DEPTH: The Global "Syndemic"

Defining "syndemic"

This week, the Lancet Commission published a comprehensive report on the “Global Syndemic of Obesity, Undernutrition, and Climate Change.” Coined in the 1990s, the term “syndemic” refers to the co-occurrence of multiple epidemics that interact with one another and share common societal drivers. 

The original definition was intended to describe co-present or sequential diseases that specifically interact with the human body. Although climate change is not an epidemic, the Lancet Commission argues that the term should more broadly link the three largest threats to environmental and public health of the 21st century due to the common damage they cause and the behaviors of the corporations that profit from them.

In doing so, the authors hope to encourage the groups working on these separate problems to collaborate on a unified, sustainable solution. The authors note that there has been little progress in individual resolutions when the issues are addressed separately.

Linking climate change, obesity, and malnutrition

The report explains that global temperatures continue to rise and no country has yet to reverse the obesity epidemic affecting over two billion people worldwide. Simultaneously, two billion people experience micronutrient deficiencies and 815 million people suffer from chronic undernutrition. In 2014, the World Health Organization (WHO) predicted that climate change may lead to more than 250,000 deaths per year. Because of food shortages, this number may increase to 529,000 deaths by 2050. 

These public health threats are not independent of one another. Instead, they each impact each other or are the result of common systemic problems like agriculture, transportation, urban design, and land use. The authors present this example: climate change has led to extreme weather conditions, including drought. Drought results in food scarcity, driving up the prices of produce and other healthier food options.

Consumers who cannot afford these high prices opt for more affordable processed options, resulting in chronic malnutrition. Chronic malnutrition and obesity are risk factors for poor health and mortality.

Each problem, they argue, occurs because of misplaced economic interests, lack of public demand, and policy inertia. The report calls on international leaders to develop a holistic solution that redirects economic incentives and improves dysfunctional policies.

Framework for a unified resolution

The commission calls for an international treaty to fight diet-related public health issues, modeled after international efforts to regulate “Big Tobacco” in WHO’s Framework Convention on Tobacco Control. In rethinking food systems, governance, and business models, the health effects of “Big Food” could be reduced.

The nine broad recommendations include strengthening governance to mobilize local actions and pressure national action, strengthening civil society engagement and accountability systems for policy actions, and creating sustainable and health-promoting business models to shift business goals from gaining short-term profits to ones that benefit society and the environment. The report also recommends focusing research on the syndemic determinants that could provide the evidence for these collaborative, systemic actions.

More specifically, the authors call for investments in public transportation, which they hypothesize would make travel for work more convenient, providing more means to purchase healthier food options and simultaneously reducing greenhouse gas emissions. They want to redirect government subsidies to sustainable farming and strengthen laws that would increase food business transparency. They also propose that businesses invest in sustainable energy and invest in a Food Fund that aims to reduce undernutrition worldwide.

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The Lancet Commission Report
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