Dixon Justin, Mendenhall Emily, Bosire Edna N, Limbani Felix, Ferrand Rashida A, Chandler Clare I R
The Health Research Unit Zimbabwe (THRU ZIM), Biomedical Research and Training Institute, Harare, Zimbabwe.
Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
J Multimorb Comorb. 2023 Mar 27;13:26335565231164973. doi: 10.1177/26335565231164973. eCollection 2023 Jan-Dec.
Multimorbidity has been framed as a pressing global health challenge that exposes the limits of systems organised around single diseases. This article seeks to expand and strengthen current thinking around multimorbidity by analysing its construction within the field of global health. We suggest that the significance of multimorbidity lies not only in challenging divisions between disease categories but also in what it reveals about the culture and history of transnational biomedicine. Drawing on social research from sub-Saharan Africa to ground our arguments, we begin by describing the historical processes through which morbidity was made divisible in biomedicine and how the single disease became integral not only to disease control but to the extension of biopolitical power. Multimorbidity, we observe, is hoped to challenge single disease approaches but is assembled from the same problematic, historically-loaded categories that it exposes as breaking down. Next, we highlight the consequences of such classificatory legacies in everyday lives and suggest why frameworks and interventions to integrate care have tended to have limited traction in practice. Finally, we argue that efforts to align priorities and disciplines around a standardised biomedical definition of multimorbidity risks retracing the same steps. We call for transdisciplinary work across the field of global health around a more holistic, reflexive understanding of multimorbidity that foregrounds the culture and history of translocated biomedicine, the intractability of single disease thinking, and its often-adverse consequences in local worlds. We outline key domains within the architecture of global health where transformation is needed, including care delivery, medical training, the organisation of knowledge and expertise, global governance, and financing.
多重疾病被视为一项紧迫的全球健康挑战，它揭示了围绕单一疾病构建的医疗体系的局限性。本文旨在通过分析多重疾病在全球健康领域的构建方式，来拓展和强化当前对多重疾病的认识。我们认为，多重疾病的重要性不仅在于它挑战了疾病类别之间的划分，还在于它揭示了跨国生物医学的文化和历史。我们以撒哈拉以南非洲的社会研究为论据基础，首先描述了在生物医学中发病率如何变得可划分的历史进程，以及单一疾病如何不仅成为疾病控制的核心，还成为生物政治权力扩张的核心。我们观察到，多重疾病虽有望挑战单一疾病治疗方法，但它却是由那些它所揭示的、存在问题且负载历史的类别所构成。接下来，我们强调了这种分类遗产在日常生活中的后果，并指出为何整合照护的框架和干预措施在实践中往往效果有限。最后，我们认为围绕多重疾病的标准化生物医学定义来协调优先事项和学科的努力，有可能重蹈覆辙。我们呼吁在全球健康领域开展跨学科工作，以更全面、反思性地理解多重疾病，突出跨国生物医学的文化和历史、单一疾病思维的顽固性及其在当地环境中常常产生的不良后果。我们概述了全球健康架构中需要变革的关键领域，包括照护提供、医学培训、知识和专业技能的组织、全球治理以及融资。
