The emergence of multimorbidity as a matter of concern: a critical review

Abstract

Multimorbidity is considered one of the greatest emerging challenges for contemporary health care systems. However, the meaning of the term ‘multimorbidity’ is not straightforward. Despite many attempts to clarify the definition and its measurement, the concept remains elusive. Still, academic interest in the study of multimorbidity has grown exponentially in the past ten years. In this paper, we trace the emergence of multimorbidity as a ‘matter of concern’ within health care research, exploring what has been called ‘the multimorbidity epidemic’ in the context of changing disease categories. We analyse how multimorbidity as a concept lays bare some major unresolved challenges within contemporary care services and summons up traditional primary care ideals of holistic, person-centred care. However, we argue that the current focus on the measurement and the identification of disease clusters falls short in contributing to better care for people who live with multiple long-term conditions now. Instead, we propose a novel understanding of ‘multimorbidity’ as an experience that manifests through people’s navigations of care infrastructures. To study this experience of multimorbidity, we discuss the potential of social science approaches that focus on ‘living well’ with illness.

Making morbidity multiple: History, legacies, and possibilities for global health

“…Our intention was not to synthesise all that has been published about multimorbidity, but rather to understand how multimorbidity is crystallising as a concept and field of study in the context of global health. As such, rather than adopting a structured framework designed to capture the entire domain of multimorbidity, we followed the approach of similar reviews on multimorbidity 10 and other health issues 11 , 13 that utilised a more open-ended, exploratory approach to the identification and synthesis of literature. This allowed us to trace how multimorbidity is being constructed as an object of science, policy, and care across a variety of bodies of literature in a way that is not facilitated by more structured literature review approaches.…”

“…21 It is notable against this backdrop that a recent review of narratives and responses to multimorbidity has shown that its apparent rise may be as much an artefact of the expansion of disease and risk categories within biomedicine as much as any ‘true’ rise in disease burdens. 10 This not only leads to habitual overdiagnosis and ‘polypharmacy’, presenting challenges for patients and providers at the clinical level. 10 , 23 The new configurations of risk and responsibility enabled by these categories also makes disease classification pivotal to the extension of modern political power at the population level.…”

“… 10 This not only leads to habitual overdiagnosis and ‘polypharmacy’, presenting challenges for patients and providers at the clinical level. 10 , 23 The new configurations of risk and responsibility enabled by these categories also makes disease classification pivotal to the extension of modern political power at the population level. Referred to as ‘biopolitics’, this entails the naming and defining of people and populations as entities for management by the state.…”

“…They consider multimorbidity not as a compound disease category, but as an “experience that manifests through the discrepancy between medical policy and life-as-lived, brought to the fore by people’s attempts to bridge fissured care systems”. 10 Accordingly, they carefully draw out the benefits of a social navigation approach that centres social research in documenting the lived experience of contending with multimorbidity in practice. 10 Based on our analysis of the sub-Saharan African context, we would emphasise that such a wide-angle lens on multimorbidity has the potential to shine light not only on the suffering of patients and the challenges they face navigating vertical, northern-driven health systems.…”

“… 10 Accordingly, they carefully draw out the benefits of a social navigation approach that centres social research in documenting the lived experience of contending with multimorbidity in practice. 10 Based on our analysis of the sub-Saharan African context, we would emphasise that such a wide-angle lens on multimorbidity has the potential to shine light not only on the suffering of patients and the challenges they face navigating vertical, northern-driven health systems. It also reveals the tensions, challenges, and epistemic injustices such programming creates across the field of global health, from patients, to providers, to scientists, to health planners and policymakers.…”