Stigma Syndemics: New Directions in Biosocial Health

243 Pages·2017·6.569 MB·English

by  Lerman, Shir, Ostrach, Bayla, Singer, Merrill

Stigma Syndemics

Stigma Syndemics
New Directions in Biosocial Health
Edited by Bayla Ostrach, Shir Lerman,
and Merrill Singer
LEXINGTONBOOKS
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LibraryofCongressCataloging-in-PublicationData
Names:Lerman,Shir,editor.|Ostrach,Bayla,editor.|Singer,Merrill,editor.
Title:Stigmasyndemics:newdirectionsinbiosocialhealth/editedbyShirLerman,BaylaOstrach,
andMerrillSinger.
Description:Lanham:LexingtonBooks,[2017]|Includesbibliographicalreferencesandindex.
Identifiers:LCCN2017029247(print)|LCCN2017027715(ebook)|ISBN9781498552158(Elec-
tronic)|ISBN9781498552141(cloth:alk.paper)
Subjects:|MESH:SocioeconomicFactors|SocialStigma|HealthStatusDisparities|Vulnerable
Populations
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Contents
Introduction vii
MerrillSinger,BaylaOstrach,andShirLerman
1 AbortionComplicationSyndemics:StructuralStigma,
PathologizedPregnancies,andHealthConsequencesof
ConstrainedCare 1
BaylaOstrachandRoulaAbiSamra
2 TheSyndemicofEndometriosis,Stress,andStigma 35
VéroniqueA.S.Griffith
3 PathologizedPregnanciesandDeleteriousHealthOutcomes:
IatrogenicEffectsofTeenPregnancyStigma 61
CourtneyL.EversonandBaylaOstrach
4 TheMultipleStigmasofthePDISyndemic:Poverty,“Racial”/
EthnicDiscrimination,Incarceration,andReproductiveand
FamilialRisk 95
PamelaI.Erickson
5 SicknessintheDetentionSystem:SyndemicsofMental
Distress,Malnutrition,andImmigrationStigmaintheUnited
States 119
MeganA.Carney
6 StigmaSyndemicamongPeoplewithIntellectualDisability
WhoHaveBeenIncarcerated 141
FernandaClaudio,KatevanDooren,JesseT.Young,andNick
Lennox
v
vi Contents
7 ExploringtheRoleofStigmainMalnutrition-Related
Syndemics:LessonsfromGuatemala 169
ElaineM.Bennett
8 “ToothlessMaw-mawcan’teatnomore”:StigmaandSynergies
ofDentalDisease,Diabetes,andPsychosocialStressamong
Low-IncomeRuralAppalachians 193
SarahRaskin
Conclusion 217
BaylaOstrach,MerrillSinger,andShirLerman
Index 219
AbouttheContributors 225
Introduction
Merrill Singer, Bayla Ostrach, and Shir Lerman
Social stigmatization,disproportionatelyaffectingthosealready atincreased
risk for various health problems and with less access to needed resources,
damages health through multiple pathways of interaction with biological
conditions and structural environments. Given its conception of disease as
the product of multiple, yet identifiable, entwined biosocial processes, syn-
demics provides a useful approach for assessing the role(s) of stigma in
health, and thus has been a focus of research and applied interventions in
anthropology,publichealth,andbeyond.
The overarching conceptual framework of the syndemic approach re-
ceived early attention from the Centers for Disease Control, which at one
time maintained a Syndemics Prevention Network (Milstein 2002) to inform
epidemiological research, and the influence of syndemics perspectives con-
tinues to grow. In 2017, The Lancet devoted a special issue to syndemics
(Singer et al. 2017; Mendenhall 2017; Mendenhall et al. 2017; Tsai et al.
2017;HartandHorton2017).Researchersinpublichealthsectorsandclini-
cians from many specialties including oral health, chronic illness manage-
ment, infectious disease prevention, and mental and sexual/reproductive
health fields use syndemics approaches. Here we address many of these
topics, paying attention to stigma as the key structural factor driving linked
biologicalandsocialprocessesthatthreatenhealth.
As skillfully and richly demonstrated by the contributors in our compan-
ion volume, Foundations of BioSocial Health: Stigma and Illness Interac-
tions (Lexington Books), syndemics research goes beyond simple co-mor-
bidity or co-occurrence to describe complex overlapping and intersecting
healthriskfactorsandinteractionsthatilluminatethemulti-facetednatureof
many illnesses and health conditions. Syndemics are consequential interac-
tionsbetweenoverlappingorsequentialdiseasesorbiologicalconditionsina
vii
viii MerrillSinger,BaylaOstrach,andShirLerman
population, highly influenced by social conditions that cluster diseases,
heightenvulnerability,andincreasetheoverallhealthburdenforindividuals
andgroups.
The preceding, related volume explored the foundations of syndemics
research and the role of stigma in established syndemics. In this volume,
contributors examine stigma as it drives syndemic interactions in areas that
constitute new and emerging directions for syndemics research. We interro-
gatestigmaasthestructuralfactorthatintersectsandinteractswithincarcer-
ation or detention; with pregnancyandother biosociallypathologizedrepro-
ductive states; and with malnutrition and oral health—highly visible/detect-
able,andthereforepotentiallystigmatizable,aspectsofbodilyhealth.
Anemerging bodyof syndemics research(e.g.,Emard2016; Operario et
al.2014;Martín2013),withthesetwobooksservingasthemostcomprehen-
sivecontributionstodate,identifiessocialstigmatizationofdiseasesorindi-
vidualswhosufferfromthemaskeytopromotingsyndemicinteractionsand
overall suffering. Syndemic interactions, in which stigma is a primary driv-
ing structural or socialfactor, affect diseaseinteractions throughthestigma-
tized identities of the sufferers, the stigmatization of illnesses or health con-
ditions, or both. Explorations of stigma-driven syndemics demonstrate both
the nature and significance of disease-disease interactions that occur in con-
texts of stigmatization, further complicating recognition, treatment, and pre-
vention.Specifically,identificationofthesesyndemicsillustrateshowstigma
comes to be translated from a social condition into a damaging force in
physical and/or mental health. The impact of social stigma on the patholog-
ization of physical conditions continues to capture new academic, clinical,
andappliedattention,asshownbytheauthorsofeachchapterincludedhere.
As the term “syndemic” describes various disease-disease interactions
caused,exacerbated,orintensifiedbyadversesocialconditionsandenviron-
ments(Singer2009;OstrachandSinger2012);inthisbookanditspreceding
volume, the social context of interest is structurally enforced stigmatization.
All contributors, a combination of experts and emerging scholars in their
respectiveinterdisciplinaryfields,addresstheroleofstigmainproducingan
arrayofnewlyidentifiedorexpandedsyndemicsorsyndemicmodels.
The contributors to Stigma Syndemics: New Directions in BioSocial
Healthexplorebiologicalandstructuralpathwaysofsyndemicinteractionin
three overarching areas where the framework contributes to understanding
interconnectedcausesofsuffering,andinterrelatedopportunitiesforpreven-
tion, intervention, and change. Broadly, all of the contributions to this vol-
ume expand upon and contribute to the literature on carceral/detention syn-
demics; reproductive syndemics—including the proposal here of two novel
pregnancy-related syndemics in which social stigma pathologizes otherwise
healthy pregnancies, and oral health and malnutrition syndemics. In each of
these categories, researchers from diverse disciplines, such as medical and