Multimorbidity, chronic disease, and community health science

The central thesis of Sturmberg et al in “Multimorbidity” as a Manifestation of Network Disturbances is that multimorbidity and its symptoms are the end product of complex physiological processes—most notably stress activation and mitochondrial energetics. The authors present evidence for conceptualizing the way we think about disease and how the health care system might respond to managing disease in the light of this evidence. According to their reconceptualization, disease processes and outcomes can only be understood—and managed —when the human organism is taken as a whole and not as a collection of distinct organ systems to be treated individually. Accordingly, multimorbidity is a complex adaptive systems response to biobehavioral and socio‐environmental (respectively, internal and external stimuli) networks, and successfully managing multimorbidity requires a care delivery response that can address the underlying disease processes, resulting from physiological dysregulation. Thus, care delivery must respond to biobehavioral and socio‐environmental factors by combining personalized biotechnology interventions with community‐embedded interventions that address care needs in the context of the patients' illness experience. This thoughtful treatise and the evidence in support of its major propositions are timely, topical, accurate, important, and needed. In the following commentary I will briefly address the reasons why I feel the reconceptualization is needed in light of the growing worldwide prevalence of chronic disease. I will then describe community health science and translational science as necessary approaches that can go beyond traditional biomedical research approaches for investigating chronic disease, the social determinants of heath, and disease prevention. Finally, I will offer closing thoughts relevant to systems thinking and the human organism.