Exploring syndemic vulnerability across generations: A case study of a former fishing village in the Netherlands

Social Science & Medicine, vol. 295, pp. 113122

Abstract

This qualitative case study uses a life-course approach to explore syndemic vulnerability in a former fishing village in the Netherlands. Building on four years of fieldwork in a low-income neighborhood, we explored salient themes between and across families and generations. Elderly community members (>65 years) were interviewed to map village history and explore how contextual factors have affected family life, health, and wellbeing since the 1940s. We systematically traced and compared processes leading to or from syndemic vulnerability by studying seven families across three generations. Adults with at least one of clustering diseases, their parents (when possible), and their children participated in semi-structured life-course interviews. A complex interaction of endemic social conditions, sociocultural normative processes, learned health behaviors, and disheartening life events shaped families' predispositions for a syndemic of psychological distress, cardiometabolic conditions, and musculoskeletal pain. Educational attainment, continued social support, and aspirational capabilities emerged as themes related to decreasing syndemic vulnerability. This study demonstrates that syndemic vulnerability is potentially intergenerational and reveals the need for culturally sensitive and family-focused syndemic interventions. Future longitudinal research should focus on unravelling the pathogenesis of the clustering of psychological distress, cardiometabolic conditions, and musculoskeletal pain among young people.

Authors 3

1. M. Nienke Slagboom corresponding Aachen Public Health & Primary care

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Public Health and Primary Care, Leiden University Medical Centre, the Netherlands. Electronic address: m.n.slagboom@lumc.nl

   Public Health and Primary Care, Leiden University Medical Centre, the Netherlands

2. Mathilde R. Crone Aachen Public Health & Primary care

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Public Health and Primary Care, Leiden University Medical Centre, the Netherlands

3. Ria Reis Aachen Public Health & Primary care

   Leiden University · University of Amsterdam · University of Cape Town · Leiden University Medical Center · Amsterdam Institute for Global Health and Development

   Affiliation as printed

   Public Health and Primary Care, Leiden University Medical Centre, the Netherlands; Amsterdam Institute for Global Health and Development, University of Amsterdam, the Netherlands; The Children's Institute, School of Child and Adolescent Health, University of Cape Town, South Africa

   Amsterdam Institute for Global Health and Development, University of Amsterdam, the Netherlands

   Public Health and Primary Care, Leiden University Medical Centre, the Netherlands

   The Children's Institute, School of Child and Adolescent Health, University of Cape Town, South Africa