Understanding Syndemics in the Context of Māori Health
Syndemics refer to the synergistic interaction of two or more diseases or health conditions that amplify each other's effects, leading to worse health outcomes than the sum of their individual impacts. This concept, first popularized in public health research, highlights how biological, social, and environmental factors converge to create concentrated burdens on vulnerable populations. In Aotearoa New Zealand, syndemics are particularly relevant to Māori health, where longstanding disparities in infectious diseases and long-term conditions create cycles of poor health exacerbated by structural inequities like poverty and overcrowded housing.
Recent data from the Global Burden of Disease Study underscores the scale of this issue. Māori experience double the age-standardised rate of years of life lost compared to non-Māori, at 15,660 per 100,000 versus 7,860 per 100,000. Non-communicable diseases account for 78% of Māori premature deaths, with cardiovascular diseases at 22% and cancers at 29%. Ischaemic heart disease tops the list for Māori men, while lung cancer leads for women. These figures reveal not isolated ailments but overlapping epidemics that demand a syndemic lens.
The SYMBIOTIC Programme: Pioneering Research at University of Otago
At the forefront of this exploration is the SYMBIOTIC programme, a five-year, $5 million initiative funded by New Zealand's Health Research Council and led by Professor Michael Baker from the University of Otago's Department of Public Health in Wellington. Launched recently at Kōkiri Marae, the programme deliberately targets preventable health issues that disproportionately burden Māori whānau through seven interconnected projects.
SYMBIOTIC investigates the bidirectional links between infectious diseases—such as strep A infections leading to rheumatic fever—and long-term conditions like diabetes and heart disease. By integrating syndemics into a whānau ora framework, it emphasizes holistic family-centred care, drawing on Māori knowledge systems to address root causes. Co-led by public health researcher Cheryl Davies of Ngāti Raukawa, Ngāti Mutunga ki Te Wharekauri, and Ngāti Pikiao, the team collaborates with Māori health providers like Takari Mai Te Ata Whānau Ora Collective and Te Awakairangi Health Network.
Rheumatic Fever: A Classic Syndemic Example in Māori Communities
Rheumatic fever exemplifies syndemics in Māori health. Triggered by group A Streptococcus (strep A) throat or skin infections, it leads to acute rheumatic fever and potentially rheumatic heart disease—a lifelong condition damaging heart valves. Crowded housing, a key social determinant, heightens strep A exposure, interfering with immune responses and causing inflammation.
Māori and Pacific children face stark inequities: 90% of cases occur in these groups, with Pacific children 80 times and Māori 36 times more likely than others to develop the disease. Recent reports show rates returning to pre-pandemic levels after a Covid-19 dip, with ongoing disparities in deprived areas. SYMBIOTIC builds on prior Otago research, quantifying how infections drive long-term cardiac burdens and testing whānau-level prevention like improved housing and antibiotic stewardship.
Intersections of Infections and Chronic Conditions: Diabetes and Beyond
Diabetes, prevalent among Māori at twice the non-Māori rate, interacts dangerously with infections. Acute gastroenteritis or antibiotic overuse in childhood may elevate risks for type 1 diabetes, inflammatory bowel disease, and ADHD—pathways SYMBIOTIC is mapping using New Zealand's linked health data like the Integrated Data Infrastructure.
Similarly, Helicobacter pylori (H. pylori) infections, common in Māori, cause chronic gastritis and stomach cancer, New Zealand's fastest-rising cancer. The programme proposes national screening to eradicate it, potentially slashing cancer burdens. During Covid-19, Māori with underlying diabetes or heart disease faced 2-3 times higher hospitalization and mortality risks, illustrating how long-term conditions heighten infection vulnerability.
Professor Baker notes, "We've missed opportunities by studying infections and long-term conditions separately." This siloed approach ignores how poverty amplifies both, creating vicious cycles.
Social Determinants: Housing, Poverty, and Health Inequities
Social factors underpin Māori syndemics. Overcrowded homes foster strep A spread, while poverty limits GP access and nutrition, worsening diabetes control. Māori live seven years less on average, with disparities in mental health, self-harm (leading YLL for ages 15-44), and multimorbidity.
SYMBIOTIC's whānau ora integration addresses this holistically: reducing discrimination effects, aligning primary care, and prioritizing based on hospitalization, mortality, and cost data. Cheryl Davies emphasizes trusted relationships: "Working alongside communities as providers builds those bonds, sharing expertise for better decisions."
Learn more about the SYMBIOTIC programme at University of Otago.Quantifying the Burden: Data-Driven Insights from GBD and Beyond
The Global Burden of Disease 2021 Māori estimates reveal 123,685 years of life lost prematurely, driven by clustered conditions. Cardiovascular diseases claim 22%, often intertwined with infections like rheumatic fever. SYMBIOTIC uses predictive modeling to estimate multimorbidity benefits, such as flu vaccination reducing hospitalization in diabetics.
- Cancer: 29% YLL, H. pylori-linked stomach cases rising.
- Self-harm: Top for young Māori, compounded by chronic illness stress.
- Infections: 2-3x Māori hospitalization rates, fueling LTC progression.
These interactions demand integrated metrics beyond siloed DALYs (disability-adjusted life years).
Community-Led Solutions: Whānau Ora and Prevention Strategies
Whānau ora shifts focus from individuals to families, incorporating housing fixes, vaccination, screening, and cultural safety. SYMBIOTIC co-designs with marae like Kōkiri, interviewing whānau on Covid experiences to identify gaps.
Actionable insights include antibiotic stewardship to curb overuse-linked conditions and H. pylori elimination campaigns. Partners like Massey University's Jeroen Douwes probe childhood exposures, while policymakers gain evidence for equity-focused funding.
Policy Implications and Calls for Systemic Change
SYMBIOTIC evidence could reshape New Zealand's health strategy, prioritizing syndemics in Te Aka Whai Ora (Māori Health Authority) plans. Ending rheumatic fever requires housing investments; diabetes syndemics demand integrated care models.
Beyond Māori, findings apply globally, informing Pacific health where similar burdens persist. Baker stresses: "Inequalities in infections mirror social divides—unacceptable today."
Explore Māori YLL data from GBD Study.Future Outlook: Research Careers and Innovations in Māori Health
Ongoing SYMBIOTIC work promises breakthroughs, like H. pylori prevalence studies informing national programmes. University of Otago's role highlights higher education's pivot to equity-driven research, training next-gen epidemiologists in syndemics.
For academics eyeing Māori health, opportunities abound in public health, data analysis, and community-engaged research. This field demands interdisciplinary skills blending epidemiology, Māori studies, and policy.
Pathways Forward: Actionable Insights for Stakeholders
Stakeholders—from GPs to iwi—can act now: promote whānau-centred care, advocate housing reforms, and support screening. Research like SYMBIOTIC equips them with data for change, potentially halving inequities.
Aotearoa's unique datasets and indigenous partnerships position it as a syndemics leader, fostering healthier Māori futures.
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