Time to break the chains: advancing bio-social understanding of multimorbidity

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The current COVID-19 pandemic highlights in a dramatic way the essential link between human biology and its physical and social environment. The pandemic has thrown multimorbidity into the spotlight as underlying chronic conditions seem to be critical markers of vulnerability and intensive care needs. This project sets out to explore and explain how multimorbidity, the presence of two or more chronic conditions in a person, is a result of bio-social trajectories over the life course, by visiting some of the best researchers in the field and learning new skills; analyzing bio-social linkages on my PhD data; publishing for academic and non-academic target groups; organizing an inter-disciplinary conference at University of Liverpool and a public engagement event with discussions and a short film screening. My PhD research showed that the burden of multimorbidity in the English ageing population is associated with socio-economic, psycho-social and lifestyle circumstances. Developing multimorbidity is not the result of either biological ageing or a consequence of unhealthy lifestyle choices. In general, ageing individuals from better-off backgrounds are healthier than their peers who are worse-off.The first aim of the proposed project is enriching the current debate on multimorbidity with social science perspectives by organising the conference What's the point of Multimorbidity? Biosocial and critical understanding of the concept in July 2021 at UoL. By bringing together medical scientists and clinicians, social scientists, policy makers, patients and members of the public, I want to raise awareness of the social determinants of and inequalities in multimorbidity, and discuss ways forward. This will raise the profile of multimorbidity research and enhance the impact of my past and current research findings. Using a visual approach to communicate the topic, an animated film about ageing lives with multimorbidity will be produced and presented to the community. To effectively engage the public and to formalize regional focus on social aspects of multimorbidity, I will collaborate with the North West Coast Applied Research Collaboration. This network will be translated into my further career plans and funding application to Welcome Trust in January 2021. The second aim of the project is to better predict an early risk of developing multiple health conditions, as this contribution to knowledge can help prevent or delay the accumulation of multimorbidity in later life. Biological markers, often based on physical capacity or blood concentrations of certain molecules, could provide an early and more advanced insight into the onset of multiple chronic conditions. This analysis would extend my PhD life course model of multimorbidity by integrating biomarkers collected in the English Longitudinal Study of Ageing, using advanced features of Structural Equation Modelling. If society wishes to prevent the development of multimorbidity, we need to improve our knowledge of the chains of risk leading from the childhood circumstances to the actual manifestation of multimorbidity. Detecting early signs, measured directly in our bodies as biomarkers, could help identify a window of opportunity to break the chains of risk before multimorbidity develops. These issues have not been explored yet and they present an exciting extension of my PhD.