Multiplying and Dividing - The University of Auckland

Table 2Selected social determinants of health as defined by the Winnipeg Regional HealthAuthority in the Point Douglas and Downtown CAs with respect to the WHR.Point Douglas Social determinant of health DowntownLow Median household income LowestHigh Mobility of residents HighHigh Rate of unemployment HighBelow Average Level of social support Below AverageLow Average level of education LowHighPercentage of recent immigrants toWinnipegHighestClustering of Afflictions – Is there a link? Syndemic Synthesis and FutureResearchIt is undeniable that the Downtown and Point Douglas community areas of Winnipegrepresent a disproportionately high frequency of both biological afflictions and poor socialconditions with respect to the rest of the Winnipeg Health Region. Both CAs have a highfrequency of multiple health conditions, low levels of income, employment, education, socialsupport, and owned housing. Also, racism and discrimination may be present. While it isundeniable that there are forces at work in these CAs that suggest that these conditions maybe operating synergistically, the question that needs to be asked is: are these afflictions, bothbiological and social, linked together in a clear way such that they affect each otherdetrimentally? To answer this question, there are several lines of inquiry that need to beexplored. It would be useful to examine co-infection rates to determine if diseases areoperating synergistically within individuals, not just in the population as a whole. Forexample, in the work of Singer et al (2006), individuals in the study were afflicted withmultiple sexually transmitted diseases. This is the core of the syndemic, as these diseasesoperated synergistically in the community along with cultural logic systems that enabled themto flourish. Additionally in the case of Winnipeg, a closer examination is necessary todetermine if connections exist between the social and biological condition of inhabitants ofthese CAs, or if this clustering of biological and social afflictions is a random event.If tuberculosis proves to be part of a syndemic in Winnipeg, it would be vital for future healthinitiatives to determine which social conditions most enable poor biological health in order todetermine appropriate methods of bettering the social conditions that most effect physical andmental health. For example, it may be shown that increasing the number of job opportunitiesor permanent housing in the area would impact health positively. This follows fromFreudenberg et al (2006) and others who noted that, during the New York City syndemics,tuberculosis increased in relation to overcrowding in homeless shelters, prisons and lowincomehousing due to low employment and a general lack of jobs in the area. Therefore, itmay become part of the jurisdiction of the WRHA to work with the business sector to increaseemployment opportunities for residents of downtown Winnipeg. Also, Rhodes and colleaguesnote that borders and areas of economic growth constitute social locations of heightened HIVrisk, partly due to the social disruption created during periods of transition (Rhodes et al2005:1029). It follows that vulnerability to other diseases, such as tuberculosis, may alsoincrease during periods of uncertainty and transition, such as migration to a new country orgeneral mobility, both of which are highest in these CAs. Singer and colleagues’ (2006) ideasabout cultural attitudes toward condom use and the STD syndemic in Connecticut raisequestions of the cultural logic systems of individuals in the Point Douglas and Downtown51