This month's newsletter is written by guest author Sydney Pryor. Sydney is currently a second year PhD student in the Department of Health Policy and Management at The George Washington University Milken Institute School of Public Health where she is also a Graduate Fellow for the Sumner M. Redstone Global Center for Prevention and Wellness. 

A syndemic is defined as having three key features: 1) a cluster of multiple diseases or epidemics that occur within a population at the same time and place; 2) biological, social, and/or psychological interactions between the diseases that significantly worsen the health of the people experiencing the clustered diseases; and 3) system-wide social forces that foster the disease clustering with a disproportionate impact on marginalized populations.
 
In January of 2020, we discussed the report on the “Global Syndemic of Obesity, Undernutrition, and Climate Change” published by the Lancet Commission on Obesity. The report described the underlying societal drivers and consequences of the syndemic, and comprehensive recommendations to address obesity within the context of the syndemic. Since we recognized the global syndemic, a second overlapping syndemic has arisen: the syndemic of COVID-19, obesity, and food insecurity. In this month’s newsletter, we explore the ways in which these three epidemics interact and how the syndemic perpetuates existing disparities among marginalized populations.
 
As discussed in last month’s newsletter, obesity is associated with increased risk of severe COVID-19 illness and death among both children and adults. The pandemic has also contributed to an increase in the prevalence of obesity in youth and adults. In both cases, the consequences of COVID-19 infection, hospitalization, and death have occurred more frequently in American Indian/Alaska Native, Black, and Hispanic adults compared to white adults. Additionally, disruptions to the food system and increased inactivity increased the prevalence of obesity in adults and youth, which in turn widened existing racial disparities in obesity prevalence.
 
COVID-19 has also exacerbated the existing problem of food insecurity in the United States. The prevalence of food insecurity increased among U.S. adults from 1999 to 2016, with greater increases for Black and Hispanic adults compared to their white counterparts. Although directly comparable data are not currently available, a nationally representative survey indicates that food insecurity among families was even higher in 2020 compared to adults in 2016, with especially high rates among Black or Hispanic families. Factors that have contributed to the increase in food insecurity during the pandemic include poverty, unemployment and lost wages, instability of the food supply, and lack of access to or enrollment in federal assistance programs. The pandemic has also contributed to an increase in the consumption of ultra-processed foods, especially among individuals and families who are unemployed and/or food insecure. Consumption of ultra-processed foods is associated with weight gain, obesity, and type 2 diabetes mellitus in adults and increases in BMI trajectories in children. These conditions contribute to the severity of COVID-19 illness. Surveys have also shown declines in physical activity in response to the pandemic, which contribute to weight gain and increased severity of COVID-19 illness.
 
The pandemic has disrupted every step of the food supply chain, resulting in negative financial and health effects on the essential workers who comprise the nation’s food and agriculture systems. The various sectors of the U.S. food system make up over 10% of U.S. employment. The food processing sector, which includes meat-packing plants, has higher proportions of Black and Hispanic individuals compared to the U.S. workforce as a whole. Numerous instances of major COVID-19 outbreaks have occurred in meat-packing plants and among farmworker employees, due to the lack of protective equipment and workers coming to work while ill because they cannot afford to jeopardize their employment. Thus, the pandemic has disproportionately impacted the historically underpaid and marginalized food supply chain workers. The inadequate protections and the resulting high rates of infection among food system workers led to processing plant closures and bottlenecks in the supply chain.

The complex nature of the syndemic requires complex solutions that address its issues from multiple angles. “Triple duty” solutions can decrease and prevent food insecurity, reduce obesity, and minimize the impact of COVID-19 infection and severe illness. Strategies include:

• Addressing food insecurity:
  • Increasing the federal minimum wage
  • Expanding social safety net programs, including SNAP and refundable tax credits
  • Increasing the diversity of vendors that accept SNAP to enable greater access to unprocessed and local foods
• Improving conditions for the essential workforce:
  • Increase protections for essential workers including personal protective equipment and occupational safety measures, health insurance, hazard pay, paid sick leave, and equitable wages
  • Increase union membership, which could increase pressure for employers to provide worker protections and health care benefits

Sydney Pryor, MPH
GW Milken Institute School of Public Health PhD Candidate, Health Policy
Sumner M. Redstone Global Center for Prevention and Wellness Graduate Fellow
Yale School of Public Health '20 
Virginia Tech '17
sydneypryor@gwu.edu