Non-covid Patients during the Period of Pandemic in Serbia

The paper considers a problem at the intersection of sociology, anthropology, law and multidisciplinary public health research - health care accessibility during a sudden social crisis. The authors test the theoretical assumptions on the example of the covid-19 pandemic in Serbia, trying to understand the specific position of non-covid patients suffering from chronic non-communicable diseases and their perceptions regarding health care accessibility during the period of the pandemic. The empirical data on which the analysis was performed was collected with the help of focus group interviews. The sample consisted of interviewees - representatives of the association of patients suffering from chronic non-communicable diseases that burden the population of Serbia the most, who live on the territory of the Republic of Serbia without Kosovo and Metohija. The analysis shows that access to health care during the pandemic was limited and that the protocols that the state and the health care system were setting up in the process did not take into account the specific needs of this socially vulnerable group of patients. This, due to the impossibility for them to go through certain diagnostic procedures in time, receive adequate therapy and/or rehabilitation, in a large number of cases resulted in the deterioration of the clinical picture of the chronic disease from which they suffer. The paper presents theoretical and practical conclusions, which aim to show how important it is to incorporate theoretical and empirical insights from the social sciences and humanities in the conceptualization and future implementation of public health protocols for future social crises in order to reduce their potential syndemic effect.

Towards a sociology of spatial event

The concept of "event” is used in some fields of research in urban, regional and environmental sociology, but has not so far received a univocal definition and consistent developments. However, it is at the centre of numerous debates in contemporary philosophy, as well as in other fields of knowledge. This article examines some aspects of this reflection, trying to draw from them indications for a more solid foundation of the idea of the spatial event, considered as an unforeseen and contingent phenomenon, which refers not only to the effects of social interactions, but involves at the same time a multiplicity of non-human elements endowed with specific agency, be they natural or technological entities. This task also requires defining the relationship between the event and the situation from which it originates, as well as the ways in which it can bring about a radical transformation of this situation. Based on these considerations, the article concludes by posing the question of the Covid 19 syndemics as a catastrophic event, which nevertheless has the potential to transform the situation at various spatial levels. Copyright © FrancoAngeli.

Localized Syndemic Assemblages: COVID-19, Substance Use Disorder, and Overdose Risk in Small-Town America

Pandemics do not exist in isolation and COVID-19 is no exception. We argue that existing health crises, notably substance use disorder (SUD), developed syndemic relationships with COVID-19 that produced compounding deleterious effects. Combining Merrill Singer's theory of syndemics and assemblage theory, we analyze the combinatory impact of overdose and COVID-19 within a localized context. We focus on Sandusky, Ohio, where we combine police reports, in-depth interviews with area residents, and ethnographic data to compare conditions before and after the emergence of COVID-19. We find dramatic shifts in relevant local contexts due to COVID-19, inhibiting existing systems of law and public policy aimed at overdose prevention and SUD treatment. Further, our findings provide evidence of complications in the COVID-19 response originating from the overdose epidemic.

From pandemic to syndemic : the importance of context

The concept of "syndemics" is getting more and more popularity in scientific journals, especially since the end of the first decade of the current century. It relates to the dynamic interaction of synchronous or sequential diseases (whether communicable or not, also including mental diseases), with social and environmental factors, resulting at the end in a worse global outcome. The rise of publications in peer reviewed journals is exponential, especially in the last ten years. Born after another - forgotten - epidemy, the one related to HIV (AIDS), this concept is more than ever cited within the frame of the still ongoing COVID-19 pandemics. We will highlight this concept through a couple of selected examples related to infectious diseases. The recognition of an extensive intertwining allows to change in depth the way we approach health care efficiency, both at an individual as well as a societal level.;Le concept de «syndémie» - l'interaction entre maladies co-existantes ou séquentielles (transmissibles, non transmissibles, et maladies mentales), avec des phénomènes sociaux et environnementaux qui amplifient les effets négatifs de cette interaction - fait de plus en plus le sujet de publications dans des journaux internationaux, particulièrement ces dernières années. La croissance d'articles est effectivement exponentielle en particulier depuis la fin de la première décade du 21ème siècle. Né dans les suites d'une autre épidémie - celle du SIDA (taxée d'ailleurs de pandémie oubliée) - ce terme est devenu de plus en plus populaire. Il l'est encore plus aujourd'hui, depuis l'avènement de la crise sanitaire liée à une autre pandémie, celle de la COVID-19. Les liens et interactions multiples entre maladies et facteurs «externes» seront illustrés à l'aide de quelques exemples relatifs aux maladies infectieuses. Le fait même de reconnaître un tel entrelacement permet d'évoquer une approche différente afin d'améliorer l'efficience de la prise en charge de la santé d'une population et d'un individu.

Proposing a New Conceptual Syndemic Framework for COVID-19 Vaccine Hesitancy: A Narrative Review.

BACKGROUND: Discussions regarding syndemics have dominated research in recent years. Vaccine hesitancy has also been propelled to the forefront. In this narrative review, we aim to frame a novel syndemic framework to understand the interaction between vaccine hesitancy, COVID-19, and negative health outcomes. METHODS: A non-systematic electronic search was conducted in PubMed and Google Scholar. Search criteria were limited to articles published between November 2019 and June 2022. Articles related to the COVID-19 syndemic and vaccine hesitancy were included. RESULTS: Our review revealed that the adherence to COVID-19 regulations-although they were effective in preventing COVID-19 transmission, cases, and deaths-created a dynamically unstable 'vicious cycle' between undesirable health, economic, and social outcomes. The "accumulation" of complex stressors decreased individuals' cognitive flexibility and hindered them from making decisions and getting vaccinated. Furthermore, it increased individuals' risk of acquiring COVID-19, losing their employment, increasing poverty, and decreasing healthcare utilization. We illustrated how the amalgamation of sociodemographic and contextual factors associated with COVID-19 might impact people's vaccine decisions, making them more hesitant toward COVID-19 vaccination. Failing to receive vaccinations increases the chances of COVID-19 transmission, hospitalization, and other negative health outcomes. CONCLUSIONS: Understanding the interaction between these factors is essential to provide policymakers with inspiration to set appropriate interventions for promoting COVID-19 vaccination acceptance to decrease the overall burden of pandemics.

Localized Syndemic Assemblages: COVID-19, Substance Use Disorder, and Overdose Risk in Small-Town America

Pandemics do not exist in isolation and COVID-19 is no exception. We argue that existing health crises, notably substance use disorder (SUD), developed syndemic relationships with COVID-19 that produced compounding deleterious effects. Combining Merrill Singer's theory of syndemics and assemblage theory, we analyze the combinatory impact of overdose and COVID-19 within a localized context. We focus on Sandusky, Ohio, where we combine police reports, in-depth interviews with area residents, and ethnographic data to compare conditions before and after the emergence of COVID-19. We find dramatic shifts in relevant local contexts due to COVID-19, inhibiting existing systems of law and public policy aimed at overdose prevention and SUD treatment. Further, our findings provide evidence of complications in the COVID-19 response originating from the overdose epidemic.

COVID-19 and Social Justice: A syndemic approach to vaccine hesitancy

The effects of COVID-19 pandemic depend on socio-cultural determinants that shield some individuals or groups from the most severe effects or make others more vulnerable to suffering harms to their health, social position, or economic stability. The case of vaccination is symptomatic of how specific groups suffer a higher degree of vulnerability due to socioeconomic inequalities and cultural determinants. Consequently, vaccine hesitancy among these groups might deepen the vulnerabilities, which is why it is necessary to design strategies that, while confronting vaccine hesitancy, do not ignore those structural inequalities which could continue feeding skepticism and resistance to vaccination, if unattended. In this work we claim that public health policies focused on promoting vaccination may benefit from a syndemic approach that considers the synergies between diseases and socioeconomic and cultural determinants. This implies introducing social justice issues into the planning of public health strategies. By critically analyzing the work of bioethicist Norman Daniels —who goes over the moral importance of public health from an interpretation of John Rawls' theory of justice— we explore the criticism to justice as fairness made by the communitarian and the politics of difference standpoints (specifically, I. M. Young), to show that a syndemic approach to public health is essential to achieve complete vaccination: the design of strategies will have to consider the specific contexts of vaccine hesitant groups, to achieve efficiency vaccinating in the short, medium and long term. Copyright (c) 2022 José Ramón Orrantia Cavazos.

Mental Health Inequities Amid the COVID-19 Pandemic: Findings From Three Rounds of a Cross-Sectional Monitoring Survey of Canadian Adults.

Objectives: Adverse mental health impacts of the COVID-19 pandemic are well documented; however, there remains limited data detailing trends in mental health at different points in time and across population sub-groups most impacted. This paper draws on data from three rounds of a nationally representative cross-sectional monitoring survey to characterize the mental health impacts of COVID-19 on adults living in Canada (N = 9,061). Methods: Descriptive statistics were used to examine the mental health impacts of the pandemic using a range of self-reported measures. Multivariate logistic regression models were then used to quantify the independent risks of experiencing adverse mental health outcomes for priority population sub-groups, adjusting for age, gender, and survey round. Results: Data illustrate significant disparities in the mental health consequences of the pandemic, with inequitable impacts for sub-groups who experience structural vulnerability related to pre-existing mental health conditions, disability, LGBTQ2+ identity, and Indigenous identity. Conclusion: There is immediate need for population-based approaches to support mental health in Canada and globally. Approaches should attend to the root causes of mental health inequities through promotion and prevention, in addition to treatment.

Addressing the Syndemics of HIV, Mental Health, and COVID-19 Using the Health and Human Rights Framework among Youth Living with HIV, in Uganda: an Interpretive Phenomenological Study.

Stigma and discrimination negatively impact the prevention, treatment, and care of HIV. The COVID-19 pandemic increased this complexity and created a cluster of synergistic health contexts, wherein the physiological aspects of HIV and the social and environmental conditions increased the vulnerability in health outcomes for youth living with HIV (YPLHIV) in Kampala, Uganda. We used interpretive phenomenological analysis (IPA) and the syndemics framework to understand the lived experiences of YPLHIV. From December 2020 to May 2021, six qualitative focus groups were held with 31 youth living with HIV to understand the lived experiences of YPLHIV. The guided questions used were audio-recorded, transcribed verbatim, and coded for thematic analysis. Findings highlight the complexity of intersecting stigma of HIV and COVID-19 that have worsened antiretroviral treatment adherence and mental health issues due to lack of access to critical needs such as fears of food insecurity, health-related worries, the fear of perishing due to COVID-19, and human rights concerns related to gender and sexual identity. The study recommends addressing human rights-related concerns in addition to health-related concerns to comprehensively mitigate the syndemics of HIV and COVID-19 for YPLHIV in Uganda.

Covid-19 and disaster capitalism: “Passando a boiada” in the Brazilian meat processing chain

The article discusses the social impacts of the COVID-19 pandemic on the meat processing industry in southern Brazil. Based on the notion of disaster capitalism, we examine how political and corporate agents have taken advantage of the health catastrophe to create a privileged space for simplifications and deregulation in this sector. According to our reasoning, they accelerate precarious work in the meat industry and amplify the harmful effects of agribusiness on local ecologies and global ecosystems. In light of this, we also emphasize the analytical potential that results from the intersection between the categories of syndemics and structural violence to displace the traditional analyses of risk groups and behaviors in highlighting environments and their agents. © 2022, Brazilian Anthropology Association. All rights reserved.

Paleosyndemics: A Bioarchaeological and Biosocial Approach to Study Infectious Diseases in the Past

Skeletons drawn from archaeological contexts provide a fund of data for assessing disease in general and timing of epidemics in particular in past societies. The bioarchaeological record presents an especially important perspective on timing of some of the world's most catastrophic diseases, such as leprosy, tuberculosis, plague (Black Death), and treponematosis. Application of new developments in paleogenomics and paleogenetics presents new opportunities to document ancient pathogens' DNA (for example, Black Death), track their history, and assess their beginning and end points. Paleopathological documentation of disease terminus is complex, in part owing to circumstances where past communities experienced overlapping epidemics, such as leprosy and plague. For most settings, these syndemics-whereby there is an interaction between two or more epidemic diseases-both exacerbate and enhance the burden of morbidity in a community or region. Fundamental to understanding the severity and duration of epidemics is the consideration of multiple factors that simultaneously influence the severity and duration of the specific infectious diseases in a community or region, including poor oral health, under-nutrition, iron deficiency anemia, and elevated parasite load. In our view, comprehending the beginning, the middle, and the end of epidemics requires understanding the wider context of syndemics, the multiple challenging circumstances that undermine health and community stability, and how biosocial factors differentially affect the immune competence of individuals. This article provides several examples of the application of bioarchaeology and syndemics theory in achieving an understanding of how epidemics end. Pathogens continue to circulate, even after what appears to be the end. In effect, then, there is no "end," just evolution of opportunistic pathogens and our ability (or not) to mitigate them.

Leveraging anthropological expertise to respond to the COVID-19 global mental health syndemic.

This commentary asks anthropologists to work within communities to actively address the global mental health impact of COVID-19 and contribute to the pandemic response. Multiple social and physical losses, worsened by numerous factors, have produced syndemic traumatic stress and suffering across populations, highlighting persistent inequalities further amplified by the effects of COVID-19. Specifically, anthropologists can work to contribute to the development of mental health programs; confront the racialization of COVID-19 alongside marginalized communities; support real-time policy making with community responses; and innovate transparent collaborative research methods through open science. This pandemic can serve as an opportunity to prioritize research endeavors, public service, and teaching to better align with societal needs while providing new opportunities for synergy and collaborations between anthropologists in and outside the academy. Anthropologists collaborating directly with mental health clinicians and the public can contribute to knowledge specifically through direct program development and implementation of interventions designed to improve mental well-being. Innovating to find impactful solutions in response to the unprecedented mental health challenges exacerbated by the COVID-19 pandemic has the potential to promote more equitable recovery around the world.

Pandemics, past, and present: The role of biological anthropology in interdisciplinary pandemic studies

Biological anthropologists are ideally suited for the study of pandemics given their strengths in human biology, health, culture, and behavior, yet pandemics have historically not been a major focus of research. The COVID-19 pandemic has reinforced the need to understand pandemic causes and unequal consequences at multiple levels. Insights from past pandemics can strengthen the knowledge base and inform the study of current and future pandemics through an anthropological lens. In this paper, we discuss the distinctive social and epidemiological features of pandemics, as well as the ways in which biological anthropologists have previously studied infectious diseases, epidemics, and pandemics. We then review interdisciplinary research on three pandemics-1918 influenza, 2009 influenza, and COVID-19-focusing on persistent social inequalities in morbidity and mortality related to sex and gender;race, ethnicity, and Indigeneity;and pre-existing health and disability. Following this review of the current state of pandemic research on these topics, we conclude with a discussion of ways biological anthropologists can contribute to this field moving forward. Biological anthropologists can add rich historical and cross-cultural depth to the study of pandemics, provide insights into the biosocial complexities of pandemics using the theory of syndemics, investigate the social and health impacts of stress and stigma, and address important methodological and ethical issues. As COVID-19 is unlikely to be the last global pandemic, stronger involvement of biological anthropology in pandemic studies and public health policy and research is vital.

Conservation biology meets medical science

that syndemics are a new path to global health research. Many medical researchers have since picked up on the topic, leading to the suggestion that the ongoing Covid-19 crisis is a syndemic and not a pandemic (Horton 2020). In a syndemic, the Covid-19 virus is not the primary cause of the current pandemic, but only a trigger due to the globally deteriorating human health (Horton 2020). Kenyon (Kenyon 2020) added that the syndemic approach needs to include an ecological dimension, while Mendenhall (Mendenhall 2020) stated that the context matters. None of the colleagues was wrong. However, it shows how little researchers from different disciplines interact and exchange on concepts. Syndemics is already well captured in the more medical-orientated OneHealth concept (Gibbs 2014), as well as in the more ecologically-orientated EcoHealth concept (Rapport 2007). All of these concepts and terms have in common to state that human health is inextricably linked to the environmental health and health-determining factors in the highly complex socio-ecological system. The complexity of this socio-ecological system, in which human health is embedded, is the underlying factor for the emergence of these slightly differently centred concepts, while the aim of all of these are the same: understanding the underlying causes for the increasing frequency of epidemics or panattributed to climate change, biodiversity loss, habitat degradation and an increasing rate of wildlife-human contacts, but that all of these are caused by synergies between

Photojournalism and Covid-19: representation and invisibility during the first confinement in Spain

The State of Alarm period declared by the Spanish Government due to the coronavirus crisis has had an exhaustive media coverage. However, it is observed how the visual story / narrative that has been published in the newspapers goes beyond the health field, focusing mainly on aspects of a social, political or economic nature. The types of images with the greatest presence in the representation of the harshest weeks of the pandemic determine the type of coverage, causing some relevant aspects to be minimized or invisibilized, and conditions the impact and the understanding of the severity of the disease in the society, in a particularly difficult and decisive moment such as the confinement of citizens. In the same way, the published images will have a later impact as a document by becoming part of the historical memory in the future. This article focuses on the analysis of the images published during the State of Alarm in three of the most relevant and broader scope national newspapers (El país, La vanguardia and El mundo), which is complemented by semi-directed interviews with several photojournalists who have covered Covid-19 during its first stage. The cataloging of the photographs in various categories is intended to observe the type of story that has been made visible of the Covid-19 (assessing the way in which this pandemic is being shown as an epidemic or syndemic), as well as to detect some of the most present and/or recurring visual representations and identify which are the most prominent absences.

Service Ecosystem Health: A Transformative Approach to Elevating Service Science

Events in the year 2020 threw human service systems into chaotic states, threatening peoples' lives and livelihoods. Before 2020, there were many profound challenges to human life that had been well documented by efforts such as the United Nations Sustainable Development Goals. The COVID-19 pandemic seems to be a "last straw" crisis that has destabilized modern human civilization. This article diagnoses various crises of human service systems (e.g., COVID-19, inequality, and climate change) and proposes the metaphor of service ecosystem health for reimagining service science in a postpandemic world. Service ecosystem health is defined as the interdependent state of private, public, and planetary well-being necessary for sustaining life. This article reimagines service science, broadens transformative service research, builds the service ecosystem health metaphor, outlines the Goldilocks Civilization thought experiment, and explores designing for a Goldilocks civilization. Because service is for humans, the ultimate objective is to elevate service science to uplift human well-being.

Are There Global Syndemics?

In this article, we address the nature of syndemics and whether, as some have asserted, these epidemiological phenomena are global configurations. Our argument that syndemics are not global rests on recognition that they are composed of social/environment contexts, disease clusters, demographics, and biologies that vary across locations. These points are illustrated with the cases of syndemics involving COVID-19, diabetes mellitus, and HIV/AIDS. We draw on theoretical discourse from epidemiology, biology, and anthropology to present what we believe is a more accurate framework for thinking about syndemics with shared elements.

Applied Medical Anthropology and Structurally Informed Emergency Care in the Evolving Context COVID-19

This article describes the integration of medical anthropologists as direct members of health care teams within a large, urban teaching hospital as a means to address the role of structural inequality in unequal health care delivery within the context of COVID-19. The pandemic starkly underlined the role structural forces such as food insecurity, housing instability, and unequal access to health insurance play among vulnerable populations that seek health care, particularly within the emergency department (ED). There is a critical need to recognize the reality that disease acquisition is a cultural process. This is a significant limitation of the biomedical model, which often considers disease as a separate entity from the social contexts in which disease is found. Further, a focus on patient-centered care can open the door for critical, clinically applied, medical anthropologists to team with physicians, merging ethnographic methods with health data and the socially constructed realities of patients' lived experience to build new pathways of care. These pathways may better prepare physicians and health care systems to respond to novel threats like COVID-19, which are rooted in pathophysiological origins but have outcome distributions driven by cultural and structural determinants. To this end, we propose a reconfiguration of dominant biomedical ideologies around disease acquisition and spread by examining our work since 2018, which sees anthropologists embedded both locally and systematically in the creation of anthropologically informed treatment pathways for socially complex disease states like HIV, Hepatitis C, and Opioid Use Disorder (Henderson 2018). Understanding how these socially complex diseases concentrate and interact in populations is a potential opportunity to model solutions for other widespread and complex health care crises, including COVID-19.

On the syndemic nature of crises: A Freeman perspective.

In this paper we draw a parallel between the insights developed within the framework of the current COVID-19 health crisis and the views and insights developed with respect to the long term environmental crisis, the implications for science, technology and innovation (STI) policy, Christopher Freeman analyzed already in the early 90's. With at the time of writing, the COVID-19 pandemic entering in many countries a third wave with a very differentiated implementation path of vaccination across rich and poor countries, drawing such a parallel remains of course a relatively speculative exercise. Nevertheless, based on the available evidence of the first wave of the pandemic, we feel confident that some lessons from the current health crisis and its parallels with the long-term environmental crisis can be drawn. The COVID-19 pandemic has also been described as a " syndemic ": a term popular in medical anthropology which marries the concept of 'synergy' with 'epidemic' and provides conceptually an interesting background for these posthumous Freeman reflections on crises. The COVID-19 crisis affects citizens in very different and disproportionate ways. It results not only in rising structural inequalities among social groups and classes, but also among generations. In the paper, we focus on the growing inequality within two particular groups: youngsters and the impact of COVID-19 on learning and the organization of education; and as mirror picture, the elderly many of whom witnessed despite strict confinement in long-term care facilities, high mortality following the COVID-19 outbreak. From a Freeman perspective, these inequality consequences of the current COVID-19 health crisis call for new social STI policies: for a new "corona version" of inclusion versus exclusion.

This Is America: Systemic Racism and Health Inequities Amidst the COVID-19 Pandemic.

The Coronavirus 2019 (COVID-19) continues to devastate the world and the United States remains number one of reported COVID-19 cases and deaths. Research demonstrates that Blacks and Hispanics in the United States are disproportionately impacted by COVID-19, especially among highly marginalized people at the intersection of immigration and incarceration. Social distancing is a privilege and contact tracing is a deterrent for historically oppressed populations. Public health professionals have attempted a multicausal approach to prevent the spread of infectious diseases, but they have been unsuccessful in addressing the biological-social impact of highly vulnerable populations. An emphasis is placed on syndemics and social determinants of health to address health inequities associated with COVID-19 due to systemic racism. Implications for social work will reinforce the profession's obligation to address public emergencies through social and political action. Recommendations will be made for social workers to support local, state, and federal level responses of COVID-19.