But this is not the whole health story. Even before fentanyl, the premature death rate for residents
. The problems represent a “syndemic” — co-occurring crises of poverty, substance use, drug toxicity, and mental and physical illness. Inadequate housing provides a foundation made of sand. Vancouver’s short-term approach to treating complex issues must change. This is an opportunity for the city to lean into this challenge, and take action on inequities. Incomplete understanding of the origins of the problem, and the systemic failures of responses result in ongoing harm.
Multiple well-meaning efforts to reduce harm followed. Typical were interventions focused piece-by-piece on individual components of the “syndemic.” Continued efforts of this type are likely to be no more successful than any others attempted over the past decades. Admittedly, no simple example of successful intervention for a problem of this complexity captures all that is required.