19 May 2023
Response authors:
All from the MELD-B1 research collaboration:
Dr Simon Fraser – an Associate Professor of Public Health at the University of Southampton
Prof Nisreen Alwan – a Professor of Public Health at the University of Southampton
Mrs Rebecca Wilkinson – a Consultant in Public Health at Southampton City Council and part-time researcher at the University of Southampton
About the MELD-B research collaboration:
Funded by the NIHR Artificial Intelligence (AI) for Multiple Long-Term Conditions call, MELD-B uses AI-enhanced and epidemiological analysis of birth cohort data and electronic health records to quantify the burden of multimorbidity and identify life course time points and targets for the prevention of early-onset, burdensome multiple long-term conditions.
Executive summary:
Our submission to the Welsh Parliament Health and Social Care Committee’s inquiry into supporting people with chronic conditions particularly covers the following broad areas - Multiple conditions (The ability of NHS and social care providers to respond to individuals with multimorbidity) and Prevention and lifestyle (Action to improve prevention and early intervention).
We provide evidence and recommendations in relation to the prevention of burdensome multiple long-term conditions among people of working age. This issue is of great importance because early onset multiple long-term conditions are common, increasing and significantly impact people’s quality of life and ability to work. In turn this impacts the economy, placing enormous pressure on health and care systems and impacting unequally across society.
We recommend that the Committee focus its attention on finding public health approaches to prevent burdensome multiple long-term conditions The MELD-B study aims to increase understanding of the most effective ways to do this and, therefore, can support the Committee’s future work in this area.
Response:
1. Context
1.1 The unprecedented challenge of increasing costs of health and social care, plus the acute pressures on our care system2, will be exacerbated as the prevalence of multiple long-term conditions increases.
Currently, one in four of us are living with two or more long-term health conditions like diabetes, heart disease, depression, or dementia,3 and the numbers are rising. People with multiple long-term conditions are more likely to have a poorer quality of life and a higher risk of dying than those in the general population.4 Even more concerning is the health inequality of this issue; for instance, having multiple long-term conditions happens 10-15 years earlier in people living in the most deprived areas, compared to those in the least deprived.5
1.2 Although associated with older age, most people living with multiple long-term conditions are under 656, significantly impacting their ability to work, quality of life and, therefore, the economy. Additionally, irrespective of people’s age, multiple conditions drive increased health and social care costs including hospital and primary care. A review of studies found that having four or more conditions increases the odds of unplanned, potentially preventable, hospitalisations, by up to 14.7
2. What do we already know?
2.1 The prevalence of multiple long-term conditions is forecast to increase dramatically over the coming years; for example, the proportion with 4+ diseases will almost double by 2035,8 calling for urgent preventive action earlier in the life course.
2.2 We know that wider societal determinants, such as family circumstances, education, housing, neighbourhood and work, influence physical and mental health through multiple mechanistic pathways across the life course to affect the risk of developing long-term conditions.9 Despite this, there has been little evidence around the influence of early life determinants on the combinations of long-term conditions, with much of the research on multiple long-term conditions adopting a disease-based focus for treatment and/or management in later stages. Evidence is also lacking on the prevention of burdensome combinations of conditions - those which are more likely to prevent people from doing what they need or want to do in life. This represents a significant public health and societal challenge.
2.3 The importance of environmental, social and economic factors means that effective prevention is likely to require population-based strategies.10 Many public health interventions focusing on wider determinants are highly cost-effective,11 averaging a fivefold return on investment.12
3. What the Committee should focus on
3.1 We recommend that the Committee focus its attention on finding public health approaches to prevent burdensome multiple long-term conditions. This should involve the following aspects:
3.1.1 Focusing on the concept of preventing burden which involves understanding what burdensomeness and complexity mean to people living with multiple long-term conditions
3.1.2 Investing in early life, public health interventions to prevent or delay the onset of burdensome multiple long-term conditions
3.1.3 Taking a population-level approach to prevention by developing policies on the wider determinants of health (such as education, employment, housing and social support) in addition to more individual-based health promotion campaigns
3.1.4 Selecting evidence-based interventions that will reduce the population disparities in the early onset of multiple long-term conditions using innovative methodologies
4. How can MELD-B research support the Committee?
4.1 Evidence for the recommended focus requires a whole life course approach. Our study, MELD-B, takes this life course approach by using AI to handle the complex analyses required to learn and infer across the different types of datasets that capture early life determinants and health outcomes later in life.
4.2 Additionally, the MELD-B study offers the opportunity to model targeted public health interventions and prevention scenarios. We can, therefore, support the Committee’s understanding of the most effective ways to prevent burdensome multiple long-term conditions through our emerging findings and would be happy to work with the Committee on scenario testing.
