The (failed) promise of multimorbidity: chronicity, biomedical categories, and public health

Multimorbidity has become an increasingly prominent lens through which public health focuses on the ‘burden’ of ill in ageing populations, with promise a more upstream and holistic approach. We use situational analysis (drawing documentary interviews service providers, policy actors people living multiple conditions) south London, UK, to explore what this brings into focus, it obscures. Local initiatives mobilised concept multimorbidity for integrating care systems commissioning prevention as well care. However, latest series historical attempts address system fragmentation, these generated complexity, orientated constant transformation, rather than repair or restoration. Service providers patients continued struggle navigate system. Dominant practice narratives framed patient self-management primary route addressing individualised risk factors trajectory multimorbidity, whereas those conditions were oriented relational model health. The findings suggest possibilities limitations leveraging In field, arose from its potential make spaces focus not discrete diseases. Realising promise, however, was limited by inherent tensions biomedical nosologies, separate diseases within individual bodies, epidemiological approaches that reify socio-material contexts failing risks individuals.