Taking multimorbidity out of the ‘too difficult’ box

In this joint blog as we launch our multimorbidity resource hub, The Academy of Medical Sciences, the Medical Research Council, the Department of Health and Social Care and the Wellcome Trust lay out the current reality of living with multiple long term conditions and outline what needs to be done to tackle this global problem. 

From left to right:

Sir Jeremy Farrar OBE FRS FMedSci, Director of the Wellcome Trust

Professor Dame Anne Johnson DBE FMedSci, Vice-President - International, Academy of Medical Sciences

Professor Chris Whitty CB FMedSci, Chief Scientific Adviser for the Department of Health and Social Care

Professor Fiona Watt FRS FMedSci, Executive Chair of the Medical Research Council

Moira is 54 years old and has just been diagnosed with type 2 diabetes. She already had asthma, high blood pressure and high cholesterol, so takes several different medications every day. She’s worried about her heart health and would like to get fitter, but has a hard time staying motivated as she has suffered with anxiety and depression for many years and more recently started to develop signs of arthritis.

Moira, as a patient, is complex, but not untypical. When she sees her doctor Moira will be treated according to a number of different clinical pathways and guidelines, often each focused on just one of her conditions. For too long now providing the scientific basis to support care and treatment for people affected by multiple long-term conditions, or multimorbidity, has been viewed as too complex to tackle, with scientific and clinical groups often organised around single diseases.

This is a mindset that we need to change.

Moira is a fictional example, but the reality is that increasingly people across the globe are living with multimorbidity. Perhaps surprisingly, the majority of people living with multimorbidity in the UK are under the age of 65[i].

Multimorbidity is associated with a reduction in quality of life, increased use of health services and reduced life expectancy. This presents major challenges for patients, carers and the health and social care system, but we are confident that research can help. Better care for people with multimorbidity can be achieved with scientific research. Our emerging ability to exploit large-scale datasets of linked biological, medical and socio-economic data to explore causes and solutions provides the opportunity to rise to the challenge.

In 2018, the Academy of Medical Sciences published an international policy report evaluating the growing issue of multimorbidity as a global health challenge. The report summarises the existing evidence around multimorbidity in the UK and globally, particularly in low- and middle-income countries.

The key message from the Academy’s report is that while there are barriers to commissioning and executing high quality research on multimorbidity, they are not insurmountable if we come together to address them in a coordinated fashion.

There have been examples of good work in the area such as the NIHR funded University of Bristol 3D study. However, to date we have not seen the necessary change in either understanding the root causes of why some diseases cluster together or the way we need to transform health and social care to treat patients with multiple long-term conditions holistically. Much of the problem is that we currently treat multimorbidity as if it were an assortment of disconnected diseases, rather than as predictable clusters of diseases upon which clinical services and research should focus.

We need to move away from thinking about multimorbidity as being too big, or too compliated to address effectively.

This requires organisational and cultural changes for researchers, policy makers, healthcare professionals, and patients. By funding strong multi-disciplinary research to identify and map disease clusters and the mechanisms that underpin them; drawing on existing and newly constructed datasets in novel ways using innovative research methods; understanding what matters from a patient perspective; and delivering and implementing the results of health services research, we can deliver the paradigm shift required.

The Academy’s report and other initiatives, such as the Richmond Group of Charities Taskforce on Multiple Conditions, have provided the catalyst to bring together research funders and charities to jointly identify and tackle the barriers to funding multimorbidity research.

The Academy's multimorbidity hub, which we are launching today, is both evidence of this and a way to support further progress. We are confident that this virtual platform will help build a community where those interested in supporting or conducting multimorbidity research can find out about current projects and opportunities and identify partners to collaborate with towards shared goals.

There are already exciting opportunities emerging from funders working together. A recent MRC and NIHR joint funding call has supported several excellent projects that will provide new and important insight into our understanding of multimorbidity mechanisms, clustering and trajectories in the UK. The response to the call was fantastic and we hope to see those who were not successful applying for future opportunities in this area.

We are also pleased to pre-announce an MRC-led call for seed-funding applications in global multimorbidity. This scheme will support proposals that test innovative ideas, foster interdisciplinary collaboration, build capacity, and lay the groundwork for future large-scale activity aimed at understanding and tackling multimorbidity in low and middle income countries. The call will be formally announced within the next few weeks via the MRC webpages. Although led by the MRC, this call stems directly from the efforts of the wider group of funders and demonstrates our continued commitment to multimorbidity research.

Multimorbidity is recognised as an important priority across all our organisations and we all take a special interest in it.

Working together will be vital in removing the barriers to supporting the high-quality research needed to tackle this health, economic and societal problem globally.

We are already beginning to see a new willingness among the research community to come together in multi-disciplinary collaborations to examine priority research questions. We welcome this and look forward to seeing how research can contribute to changing the health and care system, in the UK and globally, to improve our understanding of multimorbidity and most importantly, the lives of people like Moira.

[i] Richmond Group of Charities: Taskforce for Multiple Conditions, Multimorbidity: Understanding the Challenge. Available online here 

From left to right:

Sir Jeremy James Farrar OBE FRS FMedSci, Director of the Wellcome Trust

Professor Dame Anne Johnson DBE FMedSci, Vice-President - International, Academy of Medical Sciences

Professor Chris Whitty CB FMedSci, Chief Scientific Adviser for the Department of Health and Social Care

Professor Fiona Watt FRS FMedSci, Executive Chair of the Medical Research Council

On 19 April 2018, the Academy of Medical Sciences published its first international policy report evaluating the growing issue of multimorbidity as a global health challenge. The project was led by an expert working group, chaired by Professor Stephen MacMahon FMedSci, made up of a broad range of experts including representatives from India, China, and South Africa.