Literature Collection

Health disparities in the United States are not produced by single risk factors but by interacting social and biological conditions that cluster within structurally marginalized communities. Poverty, violence, and poor physical and mental health form a reinforcing system of disadvantage that traditional healthcare models-organized around isolated diseases-are poorly equipped to address. This perspective examines these dynamics through a syndemic framework, which conceptualizes co-occurring conditions as mutually interacting epidemics intensified by social inequality. Drawing on interdisciplinary evidence from public health, medicine, and social science, we describe how poverty-related stressors such as housing instability, food insecurity, and barriers to healthcare intersect with exposure to interpersonal and structural violence to amplify risks for depression, posttraumatic stress disorder, chronic disease, and premature mortality. These interactions produce compounded health burdens that are disproportionately experienced by marginalized populations. Despite increasing attention to social determinants of health, current healthcare responses remain fragmented. Health systems frequently identify risks through screening for social needs or trauma exposure but lack the institutional infrastructure, reimbursement mechanisms, and cross-sector partnerships required to address them effectively. We argue that advancing health equity requires moving beyond additive models of care coordination toward syndemic-informed healthcare systems that intervene simultaneously on clustered conditions and their shared upstream drivers. We outline key priorities for practice, policy, and research, including linking screening to actionable care pathways, strengthening partnerships between healthcare and social service systems, and expanding workforce training to include structural and syndemic competency.

Integrating exercise prescriptions with medication management represents a novel approach for enhancing health and function, optimising medication effectiveness, and reducing adverse drug reactions and polypharmacy in older adults (ie, those aged ≥60 years). This Personal View highlights the need for a comprehensive assessment of lifestyle, diagnoses, geriatric syndromes, and medications with an emphasis on fully incorporating exercise treatment into geriatric care. Exercise is an alternative to less effective or unsafe medications for many conditions, including depression, anxiety, insomnia, osteoarthritis, and dementia. Exercise is an important adjunct to pharmacotherapy for many common chronic conditions such as coronary artery disease, heart failure, diabetes, osteoporosis, cancer, and chronic obstructive pulmonary disease. Adding exercise to drug management can mitigate adverse drug reactions, enhance medication compliance, and reduce the adverse effects of sedentary behaviour and ageing processes on chronic disease expression. Targeted exercise programmes have also been shown to ameliorate drug-induced side-effects, including anorexia, falls, sarcopenia, osteoporosis, and orthostatic hypotension, and to overcome constraints such as reduced aerobic fitness, balance impairment, and muscle atrophy due to some medications. Health-care professionals require additional training and support to ensure that exercise assumes a key, central role in older adults with multimorbidity and polypharmacy, as supported by the current literature. This Personal View describes practical approaches to incorporating exercise into clinical practice as a step towards an integrated geriatric care model, with the ultimate aim of increasing health span and minimising disability.

This Grantmakers in Health Bulletin article, authored by NYSHealth Senior Program Director Jacqueline Martinez Garcel and NYSHealth Chief Program Learning Officer Kelly Hunt, examines the lack of integrated care for people with co-occurring mental health and substance use disorders and how NYSHealth has supported efforts to transform the systems of care for New Yorkers coping with both conditions.Care for people with co-occurring conditions remains terribly fragmented. Three separate systems exist - health, mental health, and substance use services - to care for each individual problem, each one with its own set of norms, culture, regulations, reimbursement process, and accountability. These siloed systems of care have led to a revolving door for people seeking help. To help transform the systems of care, NYSHealth established the Center for Excellence in Integrated Care (the Center), the first-of-its-kind in New York State. As of the end of 2012, the Center has worked with more than 600 mental health and substance use outpatient sites to help them fully integrate services for patients with co-occurring disorders. The article looks at the approach and impact of integrating care across the two systems, the outcomes to date, and how this can be a model for care management teams.

People have infinite needs, including illness prevention, wellness, self-care, practical support, and quality of life. This article describes community-based, informal care programs that help people identify their needs, set goals, and organize networks of care to address their needs holistically in a way that can also significantly reduce healthcare costs. Approaches can be customized for primary care, home and community, hospice, and other care sectors to facilitate low-cost, high impact adoption. We provide a blueprint for programs that integrate informal and formal care across social, physical, and mental health domains as a key part of healthcare system transformation.