Hygeia’s Constellation: Navigating Health Futures in a Dynamic and Democratic World

Effective public health work is rooted in traditions of concerned, humane, directed science. However, the field has changed significantly since its formalization in the mid-19th century, and even today, innovators are reshaping its underlying orientations. This study examines the origins and implications of one such innovation, the recent introduction of the term syndemic, along with related shifts in thinking and action that occur when operating from a syndemic orientation. Distinguishing between a single epidemic and the phenomenon of syndemics expands, in very particular ways, the conceptual, methodological, and moral dimensions of public health work. This perspective is a reminder that epidemiologic principles have been applied largely to the first tier of a highly complicated health system. It also alerts us to the inevitability of boundary judgments, the need to actively critique those judgments, and the possibilities that exist for orienting the entire health protection enterprise in new directions.

Because public health workers aspire to assure safer, healthier conditions—which are politically contested and constantly in flux—the concepts, methods, and moral principles that shape health policy must themselves resemble the features of dynamic, democratic systems. Hence, a second purpose of this study is to explore what an explicitly dynamic and democratic view of public health work might entail. Examples provided here illustrate how innovators are learning to better acknowledge the interdependency of people in places; map the dynamics that govern patterns of health, vulnerability, and affliction; anticipate a range of plausible health futures; and work democratically with other citizens to build the public strength needed for navigating change and expanding people’s freedoms. This inquiry joins conversations from three spheres of scholarship: public health, systems thinking and modeling, and social navigation. All of these inform our collective efforts to navigate health futures through the processes of setting direction, understanding change, and governing movement.

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