A Theory of Multimorbidity

  • Jose Luis Turabian Specialist in Family and Community Medicine, Health Center Santa Maria de Benquerencia. Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain.
Keywords: Multimorbidity, Chronic Disease/epidemiology, Comorbidity, Humans, Complexity, Systems Theory.


Multimorbidity is the presence of two or more long-term health problems. It often involves the superposition of mental, cardiovascular, diabetes, cancer, and respiratory diseases. It is evident that the accumulation of health problems in a person implies more complexity and difficulties regarding their health care. However, it has not been drawn with sufficient clarity, the path that leads to the accumulation of diseases and if that situation can occasionally be an advantage, rather than a disadvantage, and in what situations It can be intervened to avoid and prevent added risks and more health problems. These multumorbility paths would be 1. Causality, associations, and links; 2. Coincidences, series, synchronicities;3. Chance and rearrangement situations; 4. Due to our own interventions to solve other previous problems;5. The very presence of multimorbidity gives rise to added psychosocial problems; 6. "Two diseases is better than one";7. “Multi-problem families”; 8. Co-development; And 9. Rhizome. It is necessary to study the evolutionary perspective and ancestral environments in which humans developed, as well as the paths that lead to the accumulation of diseases and comorbidity and multimorbidity, to see how certain combinations of diseases increase the risk and whether certain diseases could offer protective advantages to the patient. Ockham's maxim must be remembered: It must be looked for simplicity. Perhaps, what we call multimorbidity is not so multiple, and where we believe that 2 or 3 or more diseases are added, we should only see 1 new condition. But, how is it possible to organize almost unlimited data that can be collected from multimorbidity and its accumulation and relationship mechanisms?: finding the system that defines the problem.