Multimorbidity, chronic disease, and community health science

Multimorbidity—A manifestation of network disturbances? How to investigate? How to treat?

“…We move next to the commentary by DeHaven . DeHaven concurs with the overall thesis presented by Sturmberg et al and is clear that the need to improve our understanding of disease processes to be able to intervene more effectively in their management has never been greater, due, perhaps in no small measure, to what DeHaven sees as Society's overreliance on the health care system for preventing and managing chronic disease.…”

“…We move next to the commentary by DeHaven. 5 DeHaven concurs with the overall thesis presented by Sturmberg et al 1 and is clear that the need to improve our understanding of disease processes to be able to intervene more effectively in their management has never been greater, due, perhaps in no small measure, to what DeHaven 5 sees as Society's overreliance on the health care system for preventing and managing chronic disease. As he points out, existing health systems are ill equipped to respond to these requirements, not least because they have traditionally been designed to focus on individual organ system dysfunction and treatment, with the overall aim of resolving existing symptoms, with little historical emphasis on genetics, lifestyle, nutrition, exercise, the environment, and socioeconomic status as interacting determinants of predisposition and disease.…”

“…DeHaven believes that persistent chronic disease prevalence can be addressed through community health science and he proceeds to discuss his rationale of how this approach is an alternative yet complementary approach to the more familiar perspectives of biomedical researchers. For DeHaver, the approach he presents has the advantage that it conducts research in the “real‐world” setting where comorbidity and multimorbidity have become extremely common and where patients with multiple medical conditions are ineligible for entry into “conventional” clinical research trials. The ongoing focus of medical systems and research methodologies in the West continue, as DeHaver says, to be conceptualised with a reductionist philosophy and approach, which sees only the parts and not the whole.…”

“…For DeHaver, the approach he presents has the advantage that it conducts research in the “real‐world” setting where comorbidity and multimorbidity have become extremely common and where patients with multiple medical conditions are ineligible for entry into “conventional” clinical research trials. The ongoing focus of medical systems and research methodologies in the West continue, as DeHaver says, to be conceptualised with a reductionist philosophy and approach, which sees only the parts and not the whole. Yet all the evidence points to the fact that unless we urgently address the multiple causal factors of the multimorbid state, and develop the clinical methods with which to address them, we can reliably predict that the current problems we are experiencing will exacerbate and continue to spiral upwards in their severity.…”

Designing health care: A community health science solution for reducing health disparities by integrating social determinants and the effects of place

“…In the United States, chronic illnesses have become a way of life for multiple generations—they are the number one cause of death and disability (accounting for more than 70% of deaths), 60% of American adults have at least one chronic disease, and 40% have multiple chronic conditions (75% among those aged 65 and older) . Although multiple factors contribute to the growth in chronic disease prevalence, a major factor has been overreliance on health‐care systems for promoting health and preventing disease . Large health‐care systems are ill equipped for this role since they are designed to detect, treat, and manage disease, not to promote health or address the underlying causes of disease .…”