Abstract for: Understanding Syndemic Problems: Lessons from Four Communities on Health Disparities and Structural Inequities

Syndemic problems emerge when multiple epidemics interact within a system of systems. These problems are often worsened by social and structural factors. A system-level approach that examines how sectors interact while integrating diverse, community-based perspectives is needed to ensure interventions address not only immediate health crises but also the underlying inequities. We conducted group model building workshops and key informant interviews with local stakeholders in Baltimore City, MD; Jersey City, NJ; Shelby County, TN, and Lee County, IA. The collected data were initially thematically analyzed to develop four distinct CLDs, each capturing different facets of the system. We then synthesized these CLDs into one holistic diagram to capture the complex interactions shaping syndemic conditions across communities within a system-of-systems framework. The synthesized, holistic CLD helps community partners recognize critical cross-sector interactions. A variable that may be considered exogenous in one community could become endogenous when presented in a system-of-systems framework. The synthesized CLD, however, necessarily excludes specific decision levers relevant to individual communities. Having both the holistic CLD and the community-specific CLD will help communities develop comprehensive strategies while communicating locally relevant policy levers.