'It's not discrete, it's not going to be easy': A qualitative analysis of the practical application of syndemic theory in healthcare.

Over the past decade, multiple federal, state and local government mission statements have employed syndemic theory in proposed policies and practices. We interviewed 20 key informants from academia, non-governmental organisations and local government public health officials on range of topics relating to how syndemic theory is shaping healthcare policy and practice. Informants highlighted the role of syndemic theory in providing person-centred services. They also provided examples of HIV-related care services and organisational change that have been influenced or shaped by syndemic theory. However, informants also indicated that they are just beginning to understand how to employ syndemics and noted that there are many barriers to putting syndemic theory into practice. In particular, they described how governance structures and funding are siloed and therefore at odds with the holistic and integrated framework that is core to syndemic theory. Nevertheless, they felt the central messages of syndemic theory are well supported among colleagues and remained committed to finding ways to put syndemic theory in practice. We argue that that governmental and non-governmental institutions and departments will need to substantially invest in braided funding streams and associated healthcare administrative structures.