Conceptual Framework

The concept of ‘syndemicity’ (Singer, 2003) helps to build a framework that will enable us to understand and address the mutually reinforcing cycle of GV and poor MH amongst migrants in precarious situations. Syndemic theory suggests that a constellation of health problems accrue across the lifespan and each condition can amplify the negative impact of one or more other health problems. In applied health research, ‘syndemics’ has been used to investigate interactions among co-morbid health conditions especially under conditions of “structural and political adversity” (Willen et al., 2017) described as ‘precarious situations’ in our research programme. While the concept has been widely applied, this has largely been in the context of HIV, substance abuse and MH problems such as depression; and limited to a conceptual level, rarely informing interventions/ actions. Applied to our enquiry, this approach can yield useful insights into the effects of social determinants on health and identifying opportunities for upstream interventions.

Contextualising such a framework to the contexts and populations of interest to GEMMS, and understand the drivers of GV and poor MH in migrants in precarious situations, we expand on the dimensions of precarity that work together to produce interrelated states of insecurity, disempowerment, exclusion, locking migrants in a continuing cycle of precarity and ill-health”. (Kapilashrami & John, forthcoming):

• Work-based, concerned with the nature and disempowering conditions of work and capturing the variations in types of work that migrants engage in. Here, we recognise that much of these falls outside of what is seen as “formal” labour which produces additional stressors and layers of precarity.
• Social position-based, pertaining to exclusion resulting from the intersecting inequalities experienced by migrants. This will allow capturing influence of gender and other factors that shape MH and GV risks.
• Status-based, derived from vulnerabilities arising from the mobile and transient nature of their lives and patterns of migration. This will explore the nature of the mobility and transience, long distance from across geographical borders and distances, to shorter internal movements and in duration.
• Governance-based, the variation and extent to which people are legally ‘recognised’ in their contexts, which has direct bearing on their access to services and support.

These dimensions will be further explored in WP1 and 2.1 and expanded in relation to understand the GV-MH cycle.

This work will be framed by a rights oriented public health approach developed by Kapilashrami (2021) to apply to domestic violence and abuse (DVA) (2021). The approach extends Bronfenbrenner’s Social Ecological Model (1979) in order to examine the population-wide determinants of these burdens and highlight the ways that primary, secondary and tertiary responses can tackle these challenges at a population level. Drawing on this, we highlight the multiple intersecting levels at which these challenges come to the fore in migrants in precarious situations, including at the individual, social and institutional levels. This framing embeds an intersectional lens to highlight how determinants like class, caste, religion, ethnicity/ indigeneity, gender and sexual orientation (John & Kapilashrami 2020; Kapilashrami & John, forthcoming; Misago, 2017; Camminga, 2019; de Gruchy & Vearey, 2020; Palmary) converge to produce individual experience.

Adopting an intersectionality lens will generate more comprehensive understandings of what drivers of the syndemic cycle of GV and poor MH in migrants and highlight inequalities in the distribution of these factors among the populations, informing more directed policy and programmatic responses (Kapilashrami & Hankivsky 2018). We will explore how these intersectional determinants are associated with the syndemicity of GV and poor MH experienced by migrants in SA, Zimbabwe, India and Cambodia. This will inform the development of a ‘typology of precarity’ that will allow us to describe forms of precarity associated with increased GV & MH risks (WP2).

There are three iterative workstreams around which the work of GEMMS centres.