In 2018, the Academy of Medical Sciences published its first international policy report evaluating the growing issue of multimorbidity as a global health challenge.Ongoing
Multimorbidity: a priority for global health research
Throughout the world, as life expectancy increases, the population incidence of non-communicable diseases is also increasing. Further, communicable diseases continue to affect millions of people every year. Together, all of these factors mean that multimorbidity has become, and will increasingly be, an international health challenge.
However, currently there is no commonly used framework for defining or more widely understanding multimorbidity. Further, most health related research is currently focused on the prevention and management of disorders in isolation. Consequently, it is difficult to compile a coherent body of research in this area or develop evidence-based strategies for use in healthcare systems.
In order to address the international challenge of multimorbidity, we must understand the problem better. The Academy is therefore delighted to have published a policy report which explores multimorbidity in an international context.
The full report and an associated ‘Overview and key messages’ document can be downloaded from the right-hand side of this page.
The report summarises the available evidence on multimorbidity and highlights key evidence gaps. In doing so, the report calls for a standardised definition and reporting system for multimorbidity, and recommends a series of research priorities to better understand:
- The trends and patterns of multimorbidity across the globe.
- The burden caused by common clusters of conditions.
- The determinants of the most common clusters of conditions.
- How best to prevent the development of multimorbidity.
- How to maximise benefits and limit risks of treatment for patients with multimorbidity.
- How to organise healthcare systems to better manage patients with multimorbidity.
More information and some thoughts on the findings of the report can be found here.
The report was informed by an expert international working group, a call for written evidence, and by two international workshops to explore the issue with researchers and research funders from a range of countries.
For additional information about the working group members and project activities please see the tabs at the top of this page.
Following the publication of this policy report, the Academy organised a two-day workshop together with the Medical Research Council (MRC, now part of UK Research and Innovation (UKRI)), the National Institute for Health Research (NIHR), and Wellcome. Held on 20 and 21 June, this workshop provided a platform from which to further explore how best to enable multimorbidity research in the UK and across low-and middle-income countries.
We are delighted that the outcomes of this workshop have been fed into the development of a joint funding call by the MRC and NIHR, which aims to increase our understanding of disease clustering in the UK context. More information can be found at the following site: https://mrc.ukri.org/funding/browse/multimorbidity/multimorbidity-in-the-uk-population-understanding-disease-clustering/
More information about the workshop, including an agenda and copies of the presentations, can be found on our dedicated page by clicking here.
We would welcome your comments on the report and happily address any questions not answered on this page (please contact firstname.lastname@example.org).
This page provides information about the working group members and observers.
- Professor Stephen MacMahon FMedSci, Principal Director, The George Institute for Global Health
Professor Stephen MacMahon is Principal Director and co-founder of The George Institute for Global Health. He also holds positions as Professor of Medicine and James Martin Fellow at the University of Oxford and Professor of Cardiovascular Medicine at the University of New South Wales. The George Institute is a research and development organisation with 650 staff located at centres in Australia, China, India and the UK. Its primary goal is the improvement of healthcare provided in major emerging economies, and its focus is on the management of those chronic conditions responsible for most premature deaths. Stephen is also the founder of George Health Enterprises Limited, a wholly-owned subsidiary of The George Institute devoted to building social enterprises that deliver products and services designed to reduce the global burden of disease. Stephen has published more than 300 scientific papers and delivered more than 200 invited lectures. For his work in the field of cardiovascular disease, he has received numerous awards, fellowships and honours from various governments, universities and learned societies. For his research achievements in cardiovascular medicine, Stephen has been elected a Fellow of the Australian Academy of Science, the British Academy of Medical Sciences and the Australian Academy of Health and Medical Sciences. He was made an Officer of the Order of Australia in the 2017 Queen’s Birthday Honours list.
- Professor Peter Calverley FMedSci, Professor of Respiratory Medicine, University of Liverpool
Peter Calverley is Professor of Respiratory Medicine within the Institute of Ageing and Chronic Disease at the University of Liverpool. He was an Honorary Consultant Physician at Aintree University Hospital, Liverpool until 2015 when he retired clinically. His major research interests have been in applied respiratory physiology, sleep and breathing disorders and chronic obstructive pulmonary disease (COPD) and he has published extensively in these areas. He authored the first textbook devoted to COPD and chaired the Department of Health group which developed the national COPD strategy. He chaired the National Institute for Health Research (NIHR) Clinical Research Network Respiratory Specialty Group for five years and served on the Department of Health Respiratory Programme Board. He is a past President of the British Thoracic Society and is currently an Associate Editor of the American Journal of Respiratory and Critical Care Medicine.
- Professor Nishi Chaturvedi, Professor of Clinical Epidemiology and Vice Dean for Research, Faculty of Population Health Sciences, University College London
Nishi Chaturvedi is Professor of Clinical Epidemiology in the Institute of Cardiovascular Science at University College London (UCL). She qualified in Medicine at the University of London in 1985 and has subsequently specialised in clinical epidemiology, obtaining first an MSc and subsequently an MD in epidemiology. Professor Chaturvedi began her epidemiological career at UCL, moving to Imperial College as a professor in 2000, and then returning to UCL in 2013. Professor Chaturvedi leads one of the largest tri-ethnic older age cohorts (SABRE, Southall And Brent REvisited), and was appointed to lead the oldest national UK birth cohort (National Survey of Health and Development) in 2017. Her work highlights the marked ethnic contrasts in risks of cardiometabolic disease. This was used to inform lower obesity thresholds for diabetes screening in the UK. Previously, she led the largest cohort of type 1 diabetes (the EURODIAB cohort), which informed two trials of interventions to reduce the burden of diabetes complications, the EUCLID trial and the DIRECT programme, all of which were published in The Lancet. She has also worked on the aetiology of and interventions for cardiometabolic disease in low- to middle-income countries such as the Caribbean, Egypt and Pakistan. Her current key interest is the exploitation of detailed, non-invasive precision phenotyping to understand disease aetiology and mechanisms for the identification of novel interventions. Additional current roles include Vice Dean for Research for the Faculty of Population Health Sciences, Associate Editor of Diabetologia and Chair of the British Heart Foundation Fellowships Committee.
- Professor Zhengming Chen, Professor of Epidemiology and Director of China Programmes, University of Oxford
Zhengming Chen qualified in medicine at Shanghai Medical University in 1983 (now Fudan University), and gained his DPhil in epidemiology at the University of Oxford in 1993. He is now Professor of Epidemiology at the University of Oxford. His research focuses on the environmental and genetic causes of chronic conditions, evidence-based medicine and evaluation of widely practicable treatments for chronic conditions. Over the past 20 years, he has initiated and led several large randomised trials in heart disease, stroke, and cancer and has been the lead principal investigator for the Kadoorie Biobank, which involves over 512,000 adults recruited from ten diverse areas of China during 2004–08 with extensive data collection by questionnaire and physical measurements, and with long-term storage of biological samples and linkages to any episodes of hospitalisation.
- Dr Lynne Corner, Director of VOICE based at the National Innovation Centre for Ageing at Newcastle University; Director of Engagement at the Newcastle University Institute for Ageing
VOICE is an international organisation established in 2007 to harness the immense experience, ideas and insights of the public, especially older people, to develop evidence based products and services that are needed to support healthy ageing, working with researchers and businesses, and to respond to the challenges and opportunities arising from demographic change. She works closely with the NIHR Innovation Observatory on the Horizon Scanning and public insights programme, and co leads the NIHR James Lind Alliance Priority Setting Partnership on older people living with multiple conditions. Lynne has a special interest in dementia, and through the Dementia Innovation Hub at Newcastle University works with families living with dementia to develop training and support to help people live well with dementia.
- Professor Melanie Davies CBE, Professor of Diabetes Medicine, University of Leicester
Melanie Davies is Professor of Diabetes Medicine at the University of Leicester, and an Honorary Consultant Diabetologist at the University Hospitals of Leicester NHS Trust. She is also an NIHR Senior Investigator Emeritus and Director of the NIHR Leicester Biomedical Research Centre. Professor Davies’ research interests include the causes, screening, prevention, self-management and treatment of type 2 diabetes mellitus. Professor Davies has published over 500 original articles in national and international peer-reviewed journals, such as The Lancet, The New England Journal of Medicine and the BMJ, and has over £60m of peer-review grant funding.
- Professor Majid Ezzati FMedSci, Chair in Global Environmental Health, Imperial College London
Majid Ezzati is Chair in Global Environmental Health at Imperial College London. He is also the Director of the Wellcome Trust-Imperial Centre for Global Health Research, and the Director of the WHO Collaborating Centre on NCD Surveillance and Epidemiology. He leads an interdisciplinary research programme in global health and the environment.. He led the World Health Organization’s Comparative Risk Assessment Study, a multi-institution study that developed and applied a framework for consistent and comparable analysis of risk factors, which formed the scientific core of the World Health Report 2002: Reducing Risks, Promoting Healthy Life. Majid leads the NCD Risk Factor Collaboration (www.ncdrisc.org), a worldwide scientific collaboration to strengthen the evidence on the exposure to and health effects of NCD risk factors.
- Professor Bruce Guthrie, Professor of Primary Care Medicine and Head of Population Health Sciences Division, University of Dundee
Bruce Guthrie is a general practitioner and Professor of Primary Care Medicine at the University of Dundee where he leads the Quality, Safety and Informatics Research Group, which conducts applied research to translate basic and clinical research into effective and reliable clinical practice. He was previously an MRC Health Services Research Training Fellow in Edinburgh and a Harkness Fellow in Health Care Policy at the University of California, San Francisco. His research interests focus on the definition, measurement and improvement of quality and safety. His current work primarily examines multimorbidity and prescribing safety, including developing and testing complex interventions in both fields. As well as conducting research, he practices clinically in a former mining village in Scotland, and is a member of a number of NHS advisory bodies, recently chairing the guideline development group for the NICE guideline Multimorbidity: clinical assessment and management.
- Professor Kara Hanson, Professor of Health System Economics and Associate Dean for Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine
Professor Hanson’s research focuses on the economics of health system financing and organisation in LMICs. Her recent research has focused on the potential for strategic purchasing in the context of pathways to universal health coverage. She has also worked extensively on the role of the private sector in health systems, and co-edited the recent The Lancet series on the private sector in health. She has also researched the economics of delivering MCH and malaria interventions in a range of sub-Saharan African settings. She is co-Research Director of RESYST (Resilient and Responsive Health Systems), a health policy and systems research consortium including partners from seven countries in Africa and Asia. She has published extensively in health economics and health policy journals and has advised the WHO and UNICEF on health financing issues.
- Professor Vivekanand Jha, Executive Director, The George Institute for Global Health, India; James Martin Fellow, The George Institute for Global Health, University of Oxford.
Vivek Jha is a physician with a specialisation in the area of kidney diseases and is currently the President-Elect of the International Society of Nephrology. Professor Jha is recognised as a global expert on kidney disease, and focuses on emerging public health threats globally and in India. He currently leads research projects operating in more than 20 countries. He is particularly interested in using multi-disciplinary approaches and innovations to address the major challenge posed to humanity by non-communicable diseases. He is a member of Task Forces and Scientific Advisory Committees of the Department of Science and Technology of the Government of India, is an advisor to the World Health Organisation (WHO), and has developed guidelines for management of patients with kidney disease.
- Professor Vikram Patel FMedSci, Pershing Square Professor of Global Health and Wellcome Trust Principal Research Fellow, Harvard Medical School; Joint Director of the Centre for Chronic Conditions and Injuries at the Public Health Foundation of India
Vikram Patel is the Pershing Square Professor of Global Health at Harvard Medical School. He is an Adjunct Professor and Joint Director of the Centre for Chronic Conditions and Injuries at the Public Health Foundation of India; Honorary Professor at the London School of Hygiene & Tropical Medicine (where he co-founded the Centre for Global Mental Health in 2008); and a co-founder of Sangath, an Indian NGO which won the MacArthur Foundation’s International Prize for Creative and Effective Institutions in 2008 and the WHO Public Health Champion of India award in 2016. He is a Fellow of the UK’s Academy of Medical Sciences and has served on several WHO expert and Government of India committees. His work on the burden of mental disorders, their association with poverty and social disadvantage, and the use of community resources for the delivery of interventions for their prevention and treatment has been recognised by: the Chalmers Medal (Royal Society of Tropical Medicine and Hygiene, UK); the Sarnat Medal (US National Academy of Medicine); an Honorary Doctorate from Georgetown University; the Pardes Humanitarian Prize (Brain & Behavior Research Foundation); an Honorary OBE from the UK Government; and the Posey Leadership Award (Austin College). He also works in the areas of child development and adolescent health. He was listed in TIME Magazine’s 100 most influential persons of the year in 2015.
- Professor Martin Prince, Professor of Epidemiological Psychiatry and Assistant Principal (Global Health), King’s College London
Martin Prince directs King’s Global Health Institute and is the Director of the NIHR Global Health Research Unit on Health System Strengthening in Sub-Saharan African Countries at King’s College London. His epidemiological research has been oriented to the salience of mental and neurological disorders to health and social policy in low and middle income countries, with a focus on older adults and dementia. His current work focuses on healthcare delivery in resource-poor settings, and system and practice innovations to improve coverage, processes and outcomes of care.
- Professor Arnie Purushotham, Professor of Breast Cancer, King’s College London and Director of King’s Health Partners Comprehensive Cancer Centre; Consultant Surgeon, Guy’s & St Thomas’ NHS Foundation Trust; Senior Clinical Advisor, Cancer Research UK; Senior Clinical Advisor, Tata Trusts Cancer Program, India
Professor Arnie Purushotham has been a consultant surgeon and clinical academic for 22 years having worked in Glasgow, Cambridge, London and Mumbai. As a scientific researcher for the last 25 years, Professor Purushotham’s goal has been to drive high-quality clinical and translational research that directly impacts on cancer patients. Key areas of research are patterns of metastatic spread, pathophysiology of lymphoedema, sentinel lymph node biopsy, novel optical intra-operative imaging, window-of-opportunity targeted therapy trials, cancer and evolutionary biology, cancer outcomes and cancer policy.
- Professor Alan Silman FMedSci, Professor of Musculoskeletal Health, University of Oxford
Professor Alan Silman is an epidemiologist and a rheumatologist. He was Director of the UK’s Arthritis Research Epidemiology Unit at the University of Manchester between 1988 and 2006 and has published over 500 articles in the broad field of arthritis and musculoskeletal diseases. His research interests covered pharmacoepidemiology, genetics and disease outcome; research that spanned several musculoskeletal disorders. He then became Arthritis Research UK’s (ARUK) first Medical Director, a post he held from 2007 until the end of 2014. At ARUK he was responsible for the strategic direction of the charity’s research activities as well as leading on both healthcare professional and patient education initiatives. Currently he is Professor of Musculoskeletal Health at the University of Oxford. Amongst his other roles, he chairs appeal panels for NICE, advises the Medicines & Healthcare products Regulatory Agency (MHRA) on drug safety and is one of the editors of the leading international postgraduate textbook, Rheumatology (6th Edn. Elsevier 2014).
- Professor Stephen Tollman, Director, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, South Africa
Steve Tollman directs the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) and the Health and Population Division in the School of Public Health, University of the Witwatersrand. Internationally, he is guest professor in the Centre for Global Health Research, Umeå University, Sweden, and Principal Scientist of the INDEPTH Network (International Network for the Demographic Evaluation of Populations and Their Health). Steve was founding Board Chair of INDEPTH and is principal investigator for multicentre research for the INDEPTH Programme on Adult Health and Aging. Currently he serves on a panel of the National Academies of Science, USA, addressing the continuing epidemiological transition in sub-Saharan Africa. Major research interests focus on adult health and ageing, non-communicable diseases and chronic care.
- Professor Jadwiga Wedzicha FMedSci, Professor of Respiratory Medicine, Imperial College London
Wisia Wedzicha is Professor of Respiratory Medicine at the National Heart and Lung Institute, Imperial College London. She qualified at Somerville College, University of Oxford and St Bartholomew’s Hospital Medical College, Queen Mary University of London. She was elected as a Fellow of the Academy of Medical Sciences in 2013 and is an NIHR Senior Investigator. Professor Wedzicha has a major interest in the causes, mechanisms, impact and prevention of COPD exacerbations, and in the role of bacterial and viral infection in COPD exacerbations. She directs an active research group specialising in COPD exacerbations, and has published extensively on this topic. She chaired the Department of Health Home Oxygen Clinical User Group, and was a member of the guideline development group for the revision of the NICE COPD guideline. She was also a member of the Programme Board for the COPD National Clinical Strategy. Professor Wedzicha was Editor-in-Chief of Thorax from 2002 to 2010, and is a member of the BioMed Central advisory board. She is currently Editor-in-Chief for the American Journal of Respiratory and Critical Care Medicine. In addition, she is on the editorial boards of a number of international journals. She was The Lancet Ombudsman until 2014, Publications Director for the European Respiratory Society (ERS) and has also previously been ERS Guidelines Director.
- Professor Christopher Dye FRS FMedSci, Director of Strategy, World Health Organisation (WHO) / Dr Somnath Chatterji, Team Leader for Surveys, Measurement and Analysis, Department of of Information, Evidence and Research, World Health Organisation (WHO)
- Dr Mary De Silva, Head of Population, Environment and Health, Wellcome / Dr Branwen Hennig, Senior Portfolio Lead in Population, Environment and Health, Wellcome
- Dr Desmond Walsh, Head of Population and Systems Medicine Board, Medical Research Council (MRC) / Dr Neha Issar-Brown, Programme Manager, Population Health and Clinical Trials, Medical Research Council (MRC)
- Professor Christopher Whitty CB FMedSci, Chief Scientific Advisor, Department of Health and Social Care
In October 2015, the Academy hosted a roundtable event on 'Multiple morbidities as a global health challenge'. The event provided an opportunity to bring a cross-disciplinary group of experts together in order to explore the profile and impact of multiple morbidities in low resources settings, and the role that research and evidence can play in tackling this global health challenge.
The discussions held during this event helped direct the development and remit of this wider Working Group project.
A report of the meeting can be downloaded from the right hand side of this page.
This project, and its final report, will be informed through various mechanisms including desk-based research and expert input from the project's working group. The projects remit also calls for contributions from outside of the Academy, and this will be gathered in a number of ways, including through responses to an open call for written evidence, oral evidence sessions, and workshops.
More information about these activities will be provided below when they occur. In the meantime, should you have any questions please contact the Secretariat.
Call for written evidence
A call for written evidence was launched in September 2016 to coincide with the formal launch of the project. The questions outlined in the call for evidence have been developed in order to gather information on the definition(s) of multimorbidity, better understand the current knowledge base on multimorbidity as an international health challenge, and to gather opinions about future priorities and opportunities.
The call is now closed (close: Wednesday 30 November 2016), however we are happy to accept late submissions. If you would still like to respond, please contact Dr Rachel Brown. The call for evidence questions are available to download from the right hand side of this page as a Word document.
To date, 22 responses have been received to our call for written evidence. A summary of the information provided, and each individual submission in full, can be accessed by clicking on the ‘Evidence' tab above.
At the second meeting, held on 20 January 2017, the working group members heard oral evidence from:
- Professor Susan Smith, author of the Cochrane review on 'Improving outcomes for people with multiple chronic conditions', and
- Dr Lynne Corner and Professor Stuart Parker, co-leads on the James Lind Alliance Priority Setting Partnership on Health with Multiple Conditions in Old Age at Newcastle University.
Following a brief introductory presentation by the witnesses, working group members engaged in wider discussion and questioned the witnesses for further details of their work on multimorbidity. A summary of the oral evidence sessions, and associated discussions, can also be found on the ‘Evidence' tab above.
'Addressing the global challenge of multimorbidity: Lessons from South Africa' workshop
On 2 - 3 November 2016, the Academy of Medical Sciences, in partnership with the Academy of Sciences South Africa, is convening a policy workshop on multimorbidity in Johannesburg, South Africa.
This policy workshop, Co-Chaired by Professor Karen Hofman and Professor Stephen MacMahon FMedSci, considered the burden of multimorbidity in South Africa and the UK, and asked how we can achieve a more coherent and consistent approach to defining, researching, and addressing multimorbidity.
Both a proceedings and synopsis report of the workshop are now available to download from our dedicated policy page. This page also includes an animation which highlights some of the key messages to have emerged from the workshop.
'Addressing the global challenge of multimorbidity: Lessons from the BRICS countries' workshop
On 27 - 28 March 2017, the Academy of Medical Sciences is hosting a policy workshop, Chaired by Professor Stephen MacMahon FMedSci, to consider the burden of multimorbidity in the BRICS (Brazil, Russia, India, China and South Africa) countries and the UK.
For more information about this workshop, please visit our dedicated policy page.
This page details all of the evidence received to date which will inform the report of the Academy’s ‘Addressing the global challenge of multimorbidity’ policy project. For more information about ongoing activities which will also inform the project, please click on the ‘Project activities’ tab above.
To read sumamries of the evidence, or each submission in full, please click on the relevant link as provided below. Should you have any questions, please contact Dr Rachel Brown.
Written responses to the Academy’s call for evidence
- Summary of all written evidence responses
- Dr Madhavi Bajekal, Senior Research Fellow, Department of Applied Health Research, UCL. Submitted on behalf of the UCL Multimorbidity Research Team.
- Professor Martin Dawes, Head of Department of Family Practice, University of British Colombia
- Dr Nafeesa Dhalwani, Lecture in Epidemiology, Diabetes Research Centre, University of Leicester
- Professor Dame Anna Dominiczak DBE FRSE FMedSci, Regius Professor of Medicine. Submitted on behalf of the University of Glasgow’s College of Medical, Veterinary and Life Sciences
- Professor Martin Fortin, Applied Research Chair in Health Services and Policy Research on Chronic Diseases in Primary Care
- Professor Jane Gunn, Chair of Primary Care Research, University of Melbourne
- Professor Umesh Kadam, Professor of Clinical Epidemiology and Health Services Research, Keele University
- Professor Stewart Mercer, Professor of Primary Care Research, University of Glasgow
- Kathryn Nicholson, Department of Epidemiology and Biostatistics, Western University, Ontario, Canada. Submitted on behalf of a team of researchers from across Australia, Belgium and Canada
- Professor Katherine Payne, Professor of Health Economics, University of Manchester. Submitted on behalf of a research team based at the University of Manchester
- Professor Mahfuzar Rahman, Head of Health, Nutrition and Environment Research Unit, BRAC, Bangladesh
- Professor Rajesh Sagar, Professor of Psychiatry, All India Institute of Medical Sciences
- Professor Christopher Salisbury, Professor of Primary Health Care, University of Bristol
- Professor Marjan van den Akker, Associate Professor, Maastrict University
- Professor Graham Watt FMedSci, Norie Miller Professor of General Practice, University of Glasglow
- The National Institute for Health and Care Excellence (NICE)
- Royal College of General Practitioners
- The Stroke Association. Additional documents can be accessed here, here, and here
- The British Pharmacological Society
- The AGE group, Institute of Neuroscience, Newcastle University
- The Scottish School of Primary Care (SSPC)
- The Society for Academic Primary Care (SAPC)
Oral evidence sessions
- Professor Susan Smith, author of a Cochrane review on ‘Improving outcomes for people with multiple chronic conditions’.
- Dr Lynne Corner and Professor Stuart Parker, leads on the James Lind Alliance Priority Setting Partnership on Health with Multiple Conditions in Old Age at Newcastle University.
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