The (failed) promise of multimorbidity: chronicity, biomedical categories, and public health
dc.contributor.author | Lynch, R | |
dc.contributor.author | Hanckel, B | |
dc.contributor.author | Green, J | |
dc.date.accessioned | 2022-07-26T09:35:26Z | |
dc.date.issued | 2021-12-30 | |
dc.date.updated | 2022-07-26T09:08:05Z | |
dc.description.abstract | Multimorbidity has become an increasingly prominent lens through which public health focuses on the ‘burden’ of ill health in ageing populations, with the promise of a more upstream and holistic approach. We use a situational analysis (drawing on documentary analysis and interviews with service providers, policy actors and people living with multiple conditions) in south London, UK, to explore what this lens brings into focus, and what it obscures. Local initiatives mobilised the concept of multimorbidity in initiatives for integrating health care systems and for commissioning for prevention as well as care. However, as the latest of a series of historical attempts to address system fragmentation, these initiatives generated more complexity, and a system orientated to constant transformation, rather than repair or restoration. Service providers and patients continued to struggle to navigate the system. Dominant policy and practice narratives framed patient self-management as the primary route for addressing individualised risk factors on a trajectory to multimorbidity, whereas the narratives of those living with multiple conditions were more oriented to a relational model of health. The findings suggest possibilities and limitations for leveraging the concept of multimorbidity for public health. In this field, the promise arose from its potential to make spaces for a focus on populations, not patients with discrete diseases. Realising this promise, however, was limited by the inherent tensions of biomedical nosologies, which separate discrete diseases within individual bodies, and from epidemiological approaches that reify the socio-material contexts of failing health as risks for individuals. | en_GB |
dc.description.sponsorship | Guy’s and St Thomas’ Charity | en_GB |
dc.description.sponsorship | Wellcome Trust | en_GB |
dc.format.extent | 1-12 | |
dc.identifier.citation | Published online 30 December 2021 | en_GB |
dc.identifier.doi | https://doi.org/10.1080/09581596.2021.2017854 | |
dc.identifier.grantnumber | EIC180901 | en_GB |
dc.identifier.grantnumber | 203109/Z/16/Z | en_GB |
dc.identifier.uri | http://hdl.handle.net/10871/130384 | |
dc.identifier | ORCID: 0000-0002-2315-5326 (Green, Judith) | |
dc.language.iso | en | en_GB |
dc.publisher | Taylor & Francis Group | en_GB |
dc.rights | © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. | en_GB |
dc.subject | Multimorbidity | en_GB |
dc.subject | chronicity | en_GB |
dc.subject | situational analysis | en_GB |
dc.subject | public health | en_GB |
dc.title | The (failed) promise of multimorbidity: chronicity, biomedical categories, and public health | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2022-07-26T09:35:26Z | |
dc.identifier.issn | 0958-1596 | |
dc.description | This is the final version. Available on open access from Taylor & Francis Group via the DOI in this record | en_GB |
dc.identifier.eissn | 1469-3682 | |
dc.identifier.journal | Critical Public Health | en_GB |
dc.relation.ispartof | Critical Public Health | |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0/ | en_GB |
dcterms.dateAccepted | 2021-12-08 | |
rioxxterms.version | VoR | en_GB |
rioxxterms.licenseref.startdate | 2021-12-30 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2022-07-26T09:33:14Z | |
refterms.versionFCD | VoR | |
refterms.dateFOA | 2022-07-26T09:35:29Z | |
refterms.panel | C | en_GB |
refterms.dateFirstOnline | 2021-12-30 |
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Except where otherwise noted, this item's licence is described as © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.