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1.    Post #1 Answer a question.
For better or worse, the word “syndemic” is careening into the lexicon of population health. Both the Lancet and the Interdisciplinary Association on Population Health Science are paying attention to it. Basically a “syndemic” is an epidemic with two or more diseases interacting synergistically. For this to happen an array of supporting factors have to be aligned in the biosocial environment and in physiology.
Read more about it at https://iaphs.org/syndemics-population-health-qa-anthropologist-emily-mendenhall/
Let’s discuss. Now that you have this concept, how does it help you think about the problems you face? Please post on one of the below in 100 words or less.
Examples of others answers:
1)    While two or more epidemic diseases interact synergistically, we have to carefully reallocate our recourses and health workers, and adjust the public health intervention accordingly. For example, if there are more than two diseases, we might have to make different prevention or action strategies for each stratum (A(-)B(-), A(+)B(-), A(-)B(+), A(+)B(+), etc.). Also, how this synergic effect interacts with the other common diseases should also be investigated, and consequently make the public health policy.
2)    Discussing (1) Now that you have this concept, how does it help you think about the problems you face?
It makes me think about how we can evaluate and potentially link existing projects that have similar underlying social determinants of health. As the article suggested if treating diabetes should be done in the context of improving housing and being mindful of TB/mental health illness, then we might want to look at projects that are aimed at addressing these issues in the same neighborhood and pooling resources together to see if the more holistic approach can result in better outcomes if those projects are done individually.
3)    The concept of a syndemic is essential in considering countermeasures against new coronas. First, dealing with non-infectious chronic diseases should be a prerequisite for the successful containment of COVID-19. In Japan, we often hear the terms “coronary depression,” “coronary fatness,” and “coronary poverty,” and also hear stories of elderly people whose legs, feet, and muscles around the mouth have deteriorated (frail) and whose dementia has worsened as they stay at home. By looking at infectious diseases as a syndromic, we can see that it’s important to maintain mental and physical health from a broad perspective and the health of society.
2.    Post #2 Answer a question.
Trust in your community and institutions is critical during the course of pandemics, such as the ongoing COVID19 pandemic. Looking ahead, what strategies can be used to enhance trust in institutions in the context in which you live. Your response should be 100 words or less.
Examples of others answers:
1)    Looking ahead, we can use several strategies to enhance trust in institutions. For one, we need to make sure institutions are transparent and open to engagement from citizens. For example, specific budgets need to be shared with communities and an open dialogue needs to be created. Community members should have a role in how an institution operates in said community, whether it is policing or environmental protocol. All conversations should have all stakeholders at the table, not just those making the executive decisions. Furthermore, we should expect institutions to have members of the community working for them. It is wrong that a police force can be made up of people who do not even live in the city or community that they are policing. Keeping an open dialogue, maintaining transparency, and allowing representation from the community are all key strategies to build trust.
2)    All strategies will need to be longer term as trust is not developed overnight. In fact, most people will have an initial skepticism. To counter that, the institution will likely need backing from a larger one that has gained trust in the community, for instance, a world renowned research institution. The members in the institution should also be people who are transparent and a clean reputation, and more importantly sing the same song. Thirdly, being accredited subject-matter experts will provide the credibility to lead people to a specific objective.
3)    Information directed to the public should be truthful, essential, easy to understand, verified and ready to be subject to fact-checking, publicly accessible in form of data sheets and graphs; adopted classifications or criteria should be clearly stated to avoid speculations; persons who are responsible to communicate data should be experts in the field, able to explain significance of public health (especially restrictive) measures to the public and address their concerns; significant voluntary or involuntary data omissions, overt conflicts of interests in the leadership or group members will fuel speculations, conspiracy theories and undermine public trust, therefore should be avoided.
4)    Building trust in institutions (especially government institutions) is challenging, but there are helpful strategies. I agree with Matthew’s point around participatory budgeting – the more you can engage constituents in decision-making processes, the more mutual trust you build. Being accountable to constituents and other stakeholders is also important; institutions will never be able to satisfy every stakeholder, but they should at least explain how and why they made certain decisions. Hiring local stakeholders is also useful; if people know someone who works at the Public Health Commission, for example, they’re probably more likely to trust the institution as a whole.

3.    Post #3 Answer a question.
Cardiovascular disease (CVD) is the leading cause of death among high-income countries and is projected to be the leading cause of death worldwide by 2030. Much like other CVDs, there are dramatic disparities in blood pressure control across income groups and across race and ethnicity. Different social determinants do not independently affecthypertension. Thus, researchers often use the systems thinking approach to identifyeffective prevention and treatment strategy forhypertension. We are presenting a Causal Loop Diagram (CLD) below which aims to understand the relationship between social determinants and hypertension. The diagram has some weaknesses. (HINT: you may want to look at lecture1 through lecture 5 before completing this post) see file CLD.pdf
Let’s discuss:
a. What doesnt make sense in this diagram?
b. What are the additionalvariables and relationships you want to include in this CLD?
c. What will be the challenges to make this CLD complete/perfect?
Remember: Each response should be 100 words or less.
Examples of others answers:
1)    a) I agree with my colleagues that there are aspects of this CLD that are hard to comprehend. For example, the polarity and the clockwise/counterclockwise symbols are not necessarily true or correct. When looking at the increased use of medication, the blood pressure should decrease, not increase. The inaccuracy of the polarity could be due to the poor labels, like diet.
b) Family medical history should be added to this CLD. Also, SES needs to be expanded upon as it affects access to treatment. 
c) Hypertension is multifaceted and individualized, which creates challenges knowing what factors to list out. Picking and choosing factors can be biased, but creating a complete CLD will be too complicated to comprehend. That said, for this to be effective, the diagram needs to be targeted for a specific demographic.
2)    a . Many polarities appear opposite of what I would expect. For example, an increase in use of medication would not result in an increase in blood pressure and if it for some reason did, this would be a reenforcing loop, not a balancing loop as indicated here. Also, since hypertension is elevated blood pressure, I think hypertension should be taken out of the CLD and just leave blood pressure in.
b .  Insurance coverage, access to transportation, safe/secure neighborhood, free time, access to fresh food
c . Challenges in making this CLD complete would be getting participatory consensus on the relationships and assumptions made here
3)    a. It doesn’t make sense that a poor diet would lead to decreased weight and blood sugar. I thought a poor diet would consist of unhealthy foods that would increase blood sugar.
b. This CLD should include other responsibilities in addition to a job, like parenting that can impact the amount of free time someone has to exercise. It could also include financial obligations that impact how many jobs someone has, how often they have to work, and the toll that takes on their mental and physical health.
c. A challenge could be stakeholder validation.
4)    A. I agree that a poor diet wouldn’t lead to decreased weight and blood sugar. I think that a poor diet would actually lead to an increase in weight, so this correlation does not make sense to me.
B. I think there are several other factors that need to be incorporated in this such as family medical history, insurance coverage, and the underlying factors that impact access to treatment such as location, availability of transportation, and access to quality healthcare.
C. I think that CVD develops due to varying reasons depending on the circumstance of each person, so it’s difficult to create this CLD comprehensive and perfect.


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