Syndemic

Time to radically rethink non-communicable diseases 

Published:May 11, 2019DOI:https://doi.org/10.1016/S0140-6736(19)31038-4

PlumX Met

    Richard Horton

That Commission defined a syndemic as a “synergy of epidemics”—components “co-occur in time and place, interact with each other to produce complex sequelae, and share common underlying societal drivers”
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Rachel ruefully noted, “the limitation of our own brains”: temporal discounting (lethal short-termism), non-linearity (tipping points that can precipitate extreme, rapid, and unpredictable change), and a strange phenomenon in which humans deploy psychological tricks to distance themselves from the risks around them. The result is that, “Almost everywhere in the world, we are doing a lousy job”. Although air pollution has now been added to the core risk factors driving NCDs, this welcome incremental addition is not enough. As Rachel's Taskforce showed, “NCDs are both cause and consequence of poverty”. The jeopardy presented by NCDs is amplified by poor education (SDG 4), gender inequalities (SDG 5), economic dysfunction (SDG 8), urban degradation (SDG 11), and unsustainable production and consumption (SDG 12). The unsolved paradox is that policies that would produce the greatest health impact receive the least attention. Why? Here is the alarming truth: our economies are incentivised to earn vast private wealth by increasing public risks for NCDs. Until that truth is accepted and addressed, NCDs will remain part of an unchecked planetary emergency.