tive to collaborate across professional boundaries and to develop effective health-promotion and risk-modifica-patients will be deprived of the creative energy unleashed tion strategies. Because a syndemic orientation has not through collaboration. ²⁹ Such a focus will also fuel inef- been a model in this area of healthcare and professional ficiency. ²⁹ A syndemic orientation provides a clearer pic- boundaries still are fairly engrained, it is not yet known ture of what forces cause chronic conditions to cluster how powerful interventions can be if they are focused on together. ²⁹ Because medical and dental providers are disrupting forces that unite these chronic disease states. ²⁹ finally looking at disease relationships the same way, a syndemic perspective provides a catalyst for collabora- The challenge of controlling diabetes can best be ad-tion. ²⁹ A syndemic orientation also promotes effective col- dressed by adopting a syndemic orientation and imple-laboration at a scale that better matches the complexity menting a transdisciplinary approach combating diabe-of multi-factorial chronic disease states. ²⁹ As Donahue tes. The term transdisciplinary is used to describe the im-and Wu’s²⁷ model suggests, there are multiple opportu- portance of going across and beyond professional bound-nities for intervention by disrupting the forces that link aries looking at these interrelated inflammatory events as these conditions, and no single profession can tackle the a whole instead of discreet disease entities. cluster of the interrelated chronic conditions.

Prerequisites for Transdisciplinary Intervention

Some may question a syndemic approach, but their objec- Before an intervention can occur, practitioners must de-tions must be weighed against the known limitations of cide whether they are willing to become involved in com-maintaining the status quo. ²⁹ Specifically, preoccupation bating diabetes. In the concluding statements made by the with a single disease, like diabetes or periodontal disease, ADA in Standards of Medical Care in Diabetes (2006), the rather than focusing on multiple forces that bind chronic authors wrote, “Evidence suggests that individual initia-inflammatory conditions together will handicap attempts tives work best when provided as components of a multi-

Figure 1 — Syndemic relationships of the interrelated cluster of chronic inflammatory disease states

The blue nodes represent diseases or conditions, and the ties represent forces (environmental and acquired risk factors) that cause the diseases or conditions and bind them together. Healthcare providers have been trained to focus mainly on the nodes, i.e., obesity, diabetes, hypertension, periodontal disease. These forces (ties) are as much of a problem as the diseases themselves, and the prevalence of chronic diseases may persist unless the connecting forces are addressed. To affect change, intervention strategies that disrupt these ties must be developed and implemented.