In a major contribution to the study of diabetes, this book is the first to analyze the disease through a syndemic framework, offering a model study of chronic disease disparity among the poor in high income countries.

This book explains the growing field of syndemic theory and research, a framework for the analysis and prevention of disease interactions that addresses underlying social and environmental causes. This perspective complements single-issue prevention strategies, which can be effective for discrete problems, but often are mismatched to the goal of protecting the public's health in its widest sense. "Merrill Singer has astutely described why health problems should not be seen in isolation, but rather in the context of other diseases and the social and economic inequities that fuel them. An important read for public health and social scientists." —Michael H. Merson, director, Duke Global Health Institute "Not only does this book provide a persuasive theoretical biosocial model of syndemics, but it also illustrates the model with a wide variety of fascinating historical and contemporary examples." —Peter J. Brown, professor of Anthropology and Global Health and director, Center for Health, Culture, and Society, Emory University "The concept of syndemics is Singer's most important contribution to critical medical anthropology as it interfaces with an ecosocial approach to epidemiology." —Mark Nichter, Regents Professor, Department of Anthropology, University of Arizona "Merrill Singer offers the public the most comprehensive work ever written on this key area of research and policy making." —Francisco I. Bastos, chairman of the graduate studies on epidemiology, Fundacao Oswaldo Cruz "Exquisitely describes how this new approach is a critical tool that brings together veterinary, medical, and social sciences to solve emerging infectious and non-infectious diseases of today's world." —Bonnie Buntain, MS, DVM, diplomate, American College of Veterinary Preventive Medicine "For too long the great integrative perspectives on modern biomedicine and public health disease ecology and social medicine-have remained more or less separate. In this innovative and provocative book, Merrill Singer develops a valuable synthesis that will reshape the way we think about health and disease." —Warwick H. Anderson, MD, PhD, professorial research fellow, Department of History and Centre for Values, Ethics, and the Law in Medicine, University of Sidney

This research study illustrates the overarching syndemic theory, which was used to explain the interconnections of type 2 diabetes, clinical depression, and human suffering among low-income African American outpatients in the southern sector of Dallas TX, USA. The intersections of race, gender, and class were additional variables that were included in this research. Furthermore, this research indicated how poverty, social relationships and other conditions stressed individuals and populations, weakened their natural defenses and caused exposure to disease clusters. I have coined the term D2 S2 to deconstruct the social/syndemic interconnections that interface with diabetes, depression and human suffering. The first dimension in the D2 S2 Model is Diabetes - the chronic blood glucose dysregulating condition. The second dimension is Depression - the biochemical mood disorder, which is often chronic, internalized and untreated. The third and fourth dimensions are Syndemic Suffering - which entails adverse psychological and social conditions encompassing poverty, social relationships and other conditions. The discussion of these four dimensions in this research was illustrated by the personal narratives of six (6) African American outpatients, was shaped by and associated with social, political and economic inequalities, and was escalated by the chronic adversity of diabetes and depression. The D2 S2 Model was developed from the triangulation of the biological, psychosocial and survey data, as well as, through the critical examination of narratives. The narratives indicated that internalized stress and chronic hardships interacted with the self-management of type 2 diabetes and depression. Their narratives indicated that the most frequently occurring themes were physical health problems, mental health problems, occupational problems and economic problems. The research study findings established the value of using narratives in qualitative research and how this methodology provided a vast depth and breadth of knowledge from the information that was gathered. Other findings indicated that psychosocial distress, poverty, and unemployment were major contributing factors vis-à-vis type 2 diabetes, depression and syndemic suffering. The results indicated the benefits of Solution Focused Brief Therapy (SFBT) in the treatment of depression with these outpatients who were living with type 2 diabetes, as evidenced by decreased or stabilized scores on the nine question psychometric screening instrument, the Patient Health Questionnaire-9 © (PHQ-9 ©). Further results indicated that applied syndemic theory was very useful and a "goodness of fit" in addressing the research questions and the intersections of race, gender and class.

In Rethinking Diabetes, Emily Mendenhall investigates how global and local factors transform how diabetes is perceived, experienced, and embodied from place to place. Mendenhall argues that the link between sugar and diabetes overshadows the ways in which underlying biological processes linking hunger, oppression, trauma, unbridled stress, and chronic mental distress produce diabetes. The life history narratives in the book show how deeply embedded these factors are in the ways diabetes is experienced and (re)produced among poor communities around the world. Rethinking Diabetes focuses on the stories of women living with diabetes near or below the poverty line in urban settings in the United States, India, South Africa, and Kenya. Mendenhall shows how women's experiences of living with diabetes cannot be dissociated from their social responsibilities of caregiving, demanding family roles, expectations, and gendered experiences of violence that often displace their ability to care for themselves first. These case studies reveal the ways in which a global story of diabetes overlooks the unique social, political, and cultural factors that produce syndemic diabetes differently across contexts. From the case studies, Rethinking Diabetes clearly provides some important parallels for scholars to consider: significant social and economic inequalities, health systems that are a mix of public and private (with substandard provisions for low-income patients), and rising diabetes incidence and prevalence. At the same time, Mendenhall asks us to unpack how social, cultural, and epidemiological factors shape people's experiences and why we need to take these differences seriously when we think about what drives diabetes and how it affects the lives of the poor.

Central to this volume, and critical to its unique creative significance and contribution, is the conceptual unification of syndemics and stigma. Syndemics theory is increasingly recognized in social science and medicine as a crucial framework for examining and addressing pathways of interaction between biological and social aspects of chronic and acute suffering in populations. While much research to date addresses known syndemics such as those involving HIV, diabetes, and mental illness, this book explores new directions just beginning to emerge in syndemics research – revealing what syndemics theory can illuminate about, for example the health consequences of socially pathologized pregnancy or infertility, when stigmatization of reproductive options or experiences affect women’s health. In other chapters, newly identified syndemics affecting incarcerated or detained individuals are highlighted, demonstrating the physical, psychological, structural, and political-economic effects of stigmatizing legal frameworks on human health, through a syndemic lens. Elsewhere in the volume, scholars examine the stigma of poverty and how it affects both nutritional and oral health. The common thread across all chapters is linkages of social stigmatization, structural conditions, and how these societal forces drive biological and disease interactions affecting human health, in areas not previously explored through these lenses.

In Rethinking Diabetes, Emily Mendenhall investigates how global and local factors transform how diabetes is perceived, experienced, and embodied from place to place. Mendenhall argues that the link between sugar and diabetes overshadows the ways in which underlying biological processes linking hunger, oppression, trauma, unbridled stress, and chronic mental distress produce diabetes. The life history narratives in the book show how deeply embedded these factors are in the ways diabetes is experienced and (re)produced among poor communities around the world. Rethinking Diabetes focuses on the stories of women living with diabetes near or below the poverty line in urban settings in the United States, India, South Africa, and Kenya. Mendenhall shows how women's experiences of living with diabetes cannot be dissociated from their social responsibilities of caregiving, demanding family roles, expectations, and gendered experiences of violence that often displace their ability to care for themselves first. These case studies reveal the ways in which a global story of diabetes overlooks the unique social, political, and cultural factors that produce syndemic diabetes differently across contexts. From the case studies, Rethinking Diabetes clearly provides some important parallels for scholars to consider: significant social and economic inequalities, health systems that are a mix of public and private (with substandard provisions for low-income patients), and rising diabetes incidence and prevalence. At the same time, Mendenhall asks us to unpack how social, cultural, and epidemiological factors shape people's experiences and why we need to take these differences seriously when we think about what drives diabetes and how it affects the lives of the poor.

This book focuses on syndemics in the Global South and uses COVID‐19 as a window to understand clusters of disparities and disease comorbidities. The pandemic has exposed and multiplied structural inequalities and certain subpopulations were more exposed to COVID‐19 as well as experienced greater morbidity and mortality. The effects of the pandemic differ between countries but have had an especially major impact, although in varying ways, in the Global South. The contributions in this volume explore the differential impacts of COVID‐19 at individual, community, national, or regional levels, considering how structural violence is institutionalized in a way that creates vulnerable situations and disproportionate suffering. The book will be of interest to anthropologists and sociologists as well as to those working in global and public health.