Here's a new paper of mine that will be part of a special issue on #COVID19 in AJHB ( @HumBioAssoc). I try to articulate the value—and challenges—of applying the #syndemic framework to systemic racism, Covid-19, and chronic health inequities. 1/ https://onlinelibrary.wiley.com/doi/full/10.1002/ajhb.23482

I'm a little surprised I wrote this paper: Syndemics has always seemed like a useful heuristic, but as @drdrtsai, @mendenhall_em, @MerrillSinger11, and others have pointed out, most empirical work hasn't actually tested the central tenets of syndemic thinking. I was skeptical. 2/

But the scale and racialized suffering of Covid-19 has made the syndemic framework seem not only relevant but urgent. My thinking was profoundly shaped by many journalists and commentators who identified the relevant interactions even if they didn't name them as syndemic. 3/

In fact, this my first paper that began with a tweet—this one about @jeligon's piece in early March, which highlighted how poverty increased both exposure to SARS-CoV-2 and the risk of chronic conditions that could make infection with it more deadly. 4/ https://twitter.com/lancegravlee/status/1237815092550332416

In early April, a piece in @TheAtlantic by Vann Newkirk II pushed my thinking more by drawing attention to how the legacy of slavery, Jim Crow, and mass incarceration was shaping the path of the pandemic in the American South. 5/ https://twitter.com/lancegravlee/status/1245865417748275206

Around the same time, @nhannahjones tied together several threads of evidence that suggested a syndemic model (without naming it as such) of racial inequities and Covid-19. 6/ https://twitter.com/lancegravlee/status/1247244587422355456

Students in my #medanthro class also earned mention in the acknowledgments. As the pandemic pushed us online, we collaboratively revamped the syllabus to include a focus on #syndemics, and our Zoom-mediated discussions shaped my thinking. 7/ https://twitter.com/lancegravlee/status/1242559501858934786

In the paper I try to integrate these ideas into a syndemic model of systemic racism, cardiometabolic disease (especially diabetes and hypertension), and Covid-19. My hope is that the model can serve as a kind of roadmap for asking questions and interpreting data. 8/

The syndemic framework shares a lot in common with other models of population health, like those developed by @thePhDandMe and @D_R_Williams1 for Covid-19 inequities. What syndemic thinking adds is the focus on disease interactions across levels of analysis. 9/

Many challenges remain in testing and refining syndemic theory. (See especially @drdrtsai and colleagues' critique of conceptual and methodological limitations of existing work.) Covid-19 is a key test case both for basic research and for public health policy and practice. 10/

The whole special collection on Covid-19 (slated for the next issue of AJHB) will be open access, and several other commentaries are already on Early View, so check them out! /end https://onlinelibrary.wiley.com/toc/15206300/0/0